Annals of burns and fire disasters最新文献

The acute management of deep burns to the dorsum of the hand and fingers represents a challenge for the reconstructive surgeon. The exposure of osteo-tendinous structures often requires flap coverage, in a context where loco-regional or free flaps are not always feasible. The aims of reconstruction are to preserve a maximum of digital length, provide supple tissue, obtain protective sensitivity, and achieve a functional hand at 1 year. We report here on a series of 8 deep burns to the dorsum of the hand. Six hands were covered by Colson abdominal flap-graft and two by pedicled inguinal flap. Four out of 6 patients were reviewed in consultation, 1 patient was lost to follow-up, and 1 patient died. Clinical evaluation was performed by a surgeon other than the operator. Functional results are highly variable. Coverage time varies according to lesion depth and patient severity. Flap weaning took place at an average of 30 days. DASH scores ranged from 17.5 to 93/100, with average to poor total active motion (TAM) scores. The aesthetic result was satisfactory, with a Vancouver score of 4.5/13 on average, and an overall patient opinion of 3.75/10 on the POSAS scale. For deep burns to the dorsum of the hand and fingers, local flaps are rarely possible, and loco-regional flaps are not feasible in cases of associated upper limb damage. For medium to large surface areas, pedicled inguinal flaps and pocketing are two reliable techniques. Nevertheless, they require relative immobilization of the upper limb, which leads to stiffness. The question of digital pinning in the intrinsic or straight position remains unresolved, and does not appear to prevent secondary deformities. There is also a learning curve for these two flaps, even though they are reputed to be easy to lift. McGregor's flap or pocketing can be weighed against free flaps. However, the operating time is long, the surgical technique is complex, and vascular damage is common in the burn patient population. Although there have been enormous technical advances since their descriptions, the pedicled inguinal flap and pocketing remain alternatives to be considered in the acute management of deep burns to the dorsum of the hand. In this presentation, we propose a surgical management algorithm to situate these two techniques in the plastic surgeon's therapeutic armament.

Burns are a worldwide major cause of injury. Burns result in damage to the skin and other organs, leading to open wounds, severe emotional and psychological complications, disability, and economic burden. In this article, we report our study of the relationship between patient demographics, burn etiology, and the incidence of burn wound infection. This study was conducted on 110 cases who presented with acute burns at the Burn Unit of the Plastic and Reconstructive Surgery Department at Tanta University Hospital, Egypt, in the period from January 2019 to January 2021. A prospective study was conducted, and the collected data were statistically analyzed regarding the different relationships between patient demographics, burn etiology, and the incidence of burn wound infection. In our study, most indoor burn injuries were scalds, most of which were accidental, while outdoor burns were mostly flame burns. Most burns in the 0-10 years age group were scalds, while in the other age groups, burns were mostly of the flame type. Females had significantly more frequent scald burns. The most important statistically significant prognostic risk factors for burn wound infection are TBSA of burn, depth of burn wound, and length of hospital stay.

The scarcity of data on burn-related injuries in Pakistan prompted this study. The study is specifically aimed at assessing the burn patients who were admitted to a national burn care center (BCC) in Pakistan. This single-center retrospective analysis was conducted for 12 months from January to December 2021. During this time period, 14,069 patients visited BCC with burn injuries of diverse natures while 613 of them were admitted. The patients' information was abstracted from the hospital database. This information included age, sex, diagnosis, burn depth/degree, time of arrival, circumstances of burn injury, TBSA (total burn surface area), complications, outcome, and management plan. This information was shifted to Microsoft Office Excel Worksheet 2015 and then coded into the IBM Statistical Package for the Social Sciences (SPSS) version 24.0. Armonk, NY: IBM Corp. Of 14,069 patients, 613 were admitted to the burn care center, indicating an admission rate of 4.35%. Among these 613 patients, there was a high proportion of males (58.89%) and a mean age of 20.2±12.5 years. Most patients (40.4%) visited within the first hour after being burnt and flame burns were the most common (41.10%). Most patients were burnt due to accidents (97.7%). The mean length of hospital stay was 15.5 days. Flames were the main cause of burns among our cohort of patients. Most patients had a TBSA of >10% and generally had a second-degree burn, mostly in the pediatric population. An urgent appraisal of burn policies and related legislation is needed to halt the burn burden in the country.

The objective of this study was to describe the epidemiology of burn-related injuries in children <15 years in Kosovo, and compare incidence and cause of burns with our previous study conducted over the period 2005-2010 on children with burn injuries of the same age group. This was a retrospective study of pediatric patients (n=277) admitted to the University Clinical Centre of Kosovo between 1 January 2011 and 31 December 2015. We analyzed data on gender, age, cause, location, burn size (TBSA), depth of injury, seasonality, duration of hospitalization and treatment of burn-related injuries, collected from the medical records available in the archives of the University Clinical Centre of Pristina. The patients were categorized into three age groups: infants and toddlers (0-2 years), early childhood (3-6 years) and late childhood (7-15 years). Data were analyzed applying descriptive statistics, Chi-square. P-values less than 0.05 were considered significant. During the study period 2011-2015, in our population, burns in children were predominant in boys, with 166 cases (59.9%), while 111 patients were girls (40.1%). The incidence of extensive burns in childhood remains high, although we have seen a slight decrease compared to the previous 5-year study period.

A review of paediatric burns in our burns facility in the United Kingdom demonstrated variable accuracy of size, and a majority documented as <1% total body surface area (TBSA). Accurate assessment is important for medical records, clinical management and non-accidental injuries. We propose to assess burn size with a coin-based system, where small burns are described by single/multiple sterling coins. Participants were asked about their confidence in evaluating small paediatric burns. Participants were given ten scenarios which included photographs of paediatric patients with small burns. They were asked to assess burn size in their normal manner (TBSA, measurement) and with a coin-based system. The 'burns' were drawn on children based on a given coin size and percentage so that the accuracy of the participant's answer was quantifiable. Participants provided qualitative feedback in a questionnaire on the coin-based system. Thirty nurses and medical staff of varying seniority actively involved in referral/management of paediatric burns took part, creating over 300 responses. In preliminary questions, 66% of participants did not feel confident in estimating paediatric burns and 83% needed to refer to a paediatric burns chart. Accuracy of burn size using TBSA and the coin-based system was 45% and 67%, respectively. The majority (97%) stated estimating size was easier, and 93% found it more accurate. A total of 87% found communication between colleagues easier. Results highlight the improved assessment of small burns in our hospital using a coin-based approach in comparison to TBSA, and could facilitate accurate communication between health care professionals.

Although the burden of traumatic lower limb amputation (TLLA) has been well described when it concerns the adult population, there is an evident scarcity in literature concerning this matter in the pediatric population. Our objective is to review the surgical burden and long-term outcome of lower limb amputation among pediatric trauma victims who have experienced lower extremity amputation as the result of an accident or injury. A PICO format was utilized. The population of interest includes only children and adolescents suffering TTLA. The generation of data to be reviewed was executed using MEDLINE and PUBMED. Altogether, all data that includes trauma in the pediatric population in the timeframe 1949-2019 was revised and yielded 13 observational studies. This systematic review includes statistical comparisons between the group of interest of this review and the adult population. Other comparisons include those between the different sources. Our outcomes include a consistent pattern. This consistency between different studies was opposed by certain contradictions. Disparity between the different reviewed studies was displayed in terms of the distribution of the most cited complications of TLLA among different sources and the frequency of additional surgery. The dichotomy in the results of the reviewed studies highlights a gap in the data relevant to TLLA in the pediatric population. In addition to the discrepancies in the available literature, the significant physio-anatomical differences between the pediatric and the adult populations which are relevant to TLLA highlight a requirement for further studies regarding TTLA in the pediatric age group.

Burns are frequent lesions, often leading to serious functional or even life-threatening sequelae. Their care poses a problem in the countries of the South due to the lack of specialized centres. Through this study, we would like to share our experience. This was a descriptive retrospective study carried out over 36 months on 24 patients treated and followed up in the department for burn sequelae involving a limb. Functional results were classified as excellent, good, fairly good, fair and poor. Aesthetically, they have been categorized into satisfactory, unsatisfactory and poor. We recorded 1480 patients who underwent surgery, 24 of whom were operated on after burns. We noted a female predominance (sex ratio of 1.6) with an average age of 24.2 years (range 16-40). Domestic accidents (n=19) were the main circumstance of occurrence and there was a preponderance of thermal burns by flame (n=21). Twenty people were treated in the first year after burn with excellent, good and fair results in 10, 9 and 4 cases respectively. Burns can cause significant functional sequelae, the management of which requires specialized nursing staff. Training of caregivers oriented towards burn care without forgetting the related means remains a key element to minimizing the occurrence of these sequelae.

The explosion of headphones is a rare incident, not reported in the literature, and is responsible for serious burns involving functional and aesthetic consequences with a major psychological impact. We report here the case of a young boy in order to raise awareness in the population and draw attention to these risks.

Burn injury is one of the most concerning issues in the health industry. Globally, mortality and morbidity rates associated with burn injuries and their sequelae are exceptionally high. This study aims to determine the mortality rate of burn injury patients after the closure of the burn trauma unit at Dr. Hasan Sadikin Hospital, Bandung, Indonesia. This research is a descriptive-analytic study with a cross-sectional approach. The population in this study are burn injury patients treated at Dr. Hasan Sadikin Hospital during April 2021-September 2021. The inclusion criteria for this study were adult (TBSA >20%) and pediatric (TBSA >10%) patients with severe burn injury. The subjects included in this study were 76 patients and were divided into two groups, patients treated in the burn unit (n=27) and in the non-burn unit (n=49). The number of deaths in a non-burn unit (n=24; 48.97%) was higher compared to patients treated in a burn unit (n=6; 22.22%). There is a significant relationship between the type of care unit and the burn injury mortality rate, as indicated by a p value of 0.022 and an odds ratio (OR) of 3.36.

The combination of platelet-rich plasma (PRP) and stromal vascular fraction cells (SVFs) was beneficial in accelerating wound healing. This study aims to assess the effect of this combination in balancing the inflammatory process to accelerate burn healing. Thirty eligible Wistar rats were used in this study to establish a deep dermal degree burn wound model. They were randomly divided into four groups: locally injected with the combination of SVFs and PRP (n=9), vaseline (n=9), placebo (n=9), and healthy Wistar rats group (n=3), as treatment group, positive control group, negative control group and healthy control group, respectively. The burn wound tissue was excised from three separated sacrificed rats (8, 24 and 48 hours) to examine polymorphonuclear (PMN) and lymphocyte counts through the standard hematoxylin-eosin procedure and for cyclooxygenase2 (COX-2) expression through the immunohistochemical procedure. The highest PMN, lymphocyte cell count, and COX 2 expression were found at 8 hours in the local injection with the PRP combination SVF group (28,555±11,237, 8,111±3,218, and 4,666±2,309, respectively, p <0.05 except for COX 2). The regression analysis results showed that local injection of a combination of PRP and SVF could reduce PMN cells by 1.068 times, lymphocytes by 1.786 times, and COX 2 by 1.853 times greater than topical application with vaseline. The combined injection of PRP and SVF effectively heals deep burns by acutely increasing the PMN cell and lymphocyte count, and COX 2 expression. Conversely, the treatment decreased the PMN cell and lymphocyte count but not the COX 2 expression in the sub-acute phase of wound healing.