Annals of burns and fire disasters最新文献

Necrotizing fasciitis (NF) is a rare and potentially fatal infection of the soft tissues characterized by widespread fascial necrosis and rapid evolution. Diagnosis is often difficult and relies on a high index of suspicion. The approach to this disease requires a timely diagnosis, early antibiotic therapy, aggressive surgical debridement, and reconstructive procedures. All patients treated by the Plastic Surgery department with the diagnosis of NF between 2006-2019 were identified. A retrospective study was conducted with the treatment of patients' demographic and clinical data. Sixty patients with NF who underwent surgical procedures by Plastic Surgery, such as debridement and reconstruction with grafts and flaps, were identified. Up to a third of patients died from complications directly related to the disease. There was 40% complication rate. The average hospital stay was 34.5 days. Plastic surgeons often collaborate in the management of these patients and must recognize the clinical signs early. Early multidisciplinary collaboration is important. The establishment of supportive measures, antibiotics and early surgical debridements are the key to the treatment of this disease.

Keloid is a benign dermal condition that occurs due to excessive activation of fibroblasts, which leads to an abnormal accumulation of collagen. There are several treatment options, but none have been satisfactory or optimal. Often, combined treatments are used due to its high recurrence rate after surgical excision alone. The aim of this study is to evaluate the efficacy of adjuvant radiotherapy after surgical excision. A retrospective study was performed including patients with keloid scars who underwent surgical excision and adjuvant radiotherapy between May 2016 and March 2020. The data was collected from the radiotherapy and plastic surgery medical charts. There were 13 patients identified. The patient and observer scar assessment scale (POSAS) was performed in all 13 patients. The treatment used was surgical excision of the scar associated with 9 Gy radiotherapy dose within the first 24 hours after the surgery, plus another session after 7 days. 13 patients and 16 keloid scars were evaluated during a mean follow-up period of 13,5 months 95%CI (5,84; 21,16). There was no major adverse event from the treatment used. According to POSAS, the overall satisfaction rate was significantly good (mean of 2,29 on a scale from 1 to 10). Only one recurrence was observed (6.25%). Keloids are difficult to treat due to their high recurrence rate. There is no consent about the best treatment. This study showed that surgical excision combined with adjuvant radiotherapy is an excellent option, even for refractory keloids. The aesthetical result was satisfactory and the recurrence rate was low.

Bloodstream and catheter-related infections frequently occur in patients with burns. Thus, it is important to correctly assess and manage them. This study aimed to investigate the effects of catheter types used in patients with major burns on bloodstream infections and to predict sepsis status and manage its prognosis using a procalcitonin biomarker. The study included 34 patients who were admitted to the burn intensive care unit. These patients were classified into two groups based on whether they used peripheral or central venous catheter. The procalcitonin, thrombocyte and leukocyte levels of the patients were assessed every other day for 4 weeks, starting from the day when they were admitted to the burn center. An intergroup comparison revealed that procalcitonin levels were lower in the peripheral catheter group than in the central venous catheter group after day 10. Furthermore, the procalcitonin levels were significantly lower in the peripheral catheter group than in the central venous catheter group, especially on days 19, 21 and 24 (p <0.05). It is important to consider using peripheral venous catheters instead of central venous catheters in patients with major burns in order to mitigate the risk of catheter-related infections. Monitoring patients based on procalcitonin levels every other day, changing catheters, and administering antibiotic therapy based on changes in procalcitonin levels in patients likely to have elevated procalcitonin levels may reduce unnecessary antibiotic exposure and associated costs to the healthcare system.

After extensive use for head and neck reconstruction, the deltopectoral (DP) flap has been supplanted by alternative methods of reconstruction and relegated to historical references. However, we presented, in a previous article, this very valuable skin flap for postburn head and neck reconstruction. Here, we report three cases of neck reconstruction using a technical variation of the DP flap: the pre-expanded internal mammary artery perforator (IMAP) flap. Technical simplicity and reliability are the main features of this flap. The advantages of the pre-expanded IMAP flap technique lie above all in its prior expansion. The plastic qualities of the skin paddle, autonomy for the distal part of the flap, reduction in donor site morbidity and avoiding the classic secondary division of the DP flap, are the benefits of this technique. It is an excellent indication for postburn neck reconstruction, especially vertical scar contractures.

Burns and burn-related injuries are among the most common causes of morbidity and mortality worldwide. Research has shown that serum albumin levels can predict the burned patient's condition. Considering the limited studies and conflicting results regarding serum albumin levels around the time of skin grafting surgery in burn patients and its effect on the patient's recovery process, conducting a study in this field seems necessary. Thus, this study aimed to determine the relationship between serum albumin level and the severity and total body surface area (TBSA) of burns in patients before and after skin grafting surgery. This cross-sectional and correlational descriptive study evaluated 160 patients hospitalized in the burn department of Imam Khomeini Hospital in Urmia who were candidates for skin graft surgery. Serum albumin levels were measured before and after surgery, and basic information such as age and sex, severity and TBSA were collected and analyzed using SPSS version 22 software. The mean age of the patients was 39.16±12.68, and 57% were men. Fire was the most common cause of burns. The serum albumin level in patients with second-degree burns was significantly higher than in patients with third-degree burns before and after surgery. Also, serum albumin level had a negative and significant correlation with burn severity. Serum albumin level significantly correlates with the severity and TBSA of burns before and after surgery. Thus, serum albumin level can be considered a suitable indicator for predicting the patient's condition and the severity of trauma.

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.