P K Dey, A Galib, A Sardar, M T Islam, H M Z Sharif, F Zaman, N Hannan, M A Rafi
Nosocomial infection is a major challenge for the appropriate management of burns. The present study aimed to investigate incidence, risk factors, and causative organisms of nosocomial infection in burn patients of Khulna, Bangladesh. This cross-sectional study was conducted among patients admitted to the Burn and Plastic Surgery Department of Khulna Medical College Hospital (KMCH) from January to December 2020. Relevant data were collected from the patients' hospital records. Samples of wound swabs and blood were collected and cultured in the microbiology laboratory of KMCH. Logistic regression models were used to determine risk factors for infective complications in burn patients. All statistical analyses were carried out using SPSS version 26.0. A total of 100 burn patients were included. Mean age was 29.2 years with a male-female ratio of 1.3:1. Flame burns were most prevalent among the patients (41%), followed by scald (23%) and electric burns (15%). Almost 40% patients had full thickness burn. The incidence of nosocomial infection was 42% (wound infection 33% and septicemia 9%). Total body surface area of burn >40% (OR 7.56, 95% CI 2.89-19.81), full thickness burn (OR 34.40, 95% CI 3.25-97.14) and prolonged hospital stay (aOR 1.31, 95% CI 1.15-1.51) were significant risk factors for nosocomial infection. Staphylococcus aureus was the most commonly isolated organism (45%), followed by Streptococcus (24%), Pseudomonas aeruginosa (19%) and Escherichia coli (12%). As the epidemiology of nosocomial infection is not the same in different health facilities, a facility-based comprehensive burn management protocol considering the local epidemiology and causative organisms of burn wound infection is crucial for the prevention and management of nosocomial infections in burn patients.
院内感染是烧伤适当治疗面临的一大挑战。本研究旨在调查孟加拉国库尔纳市烧伤患者院内感染的发生率、风险因素和致病菌。这项横断面研究的对象是 2020 年 1 月至 12 月在库尔纳医学院医院(KMCH)烧伤和整形外科住院的患者。研究人员从患者的住院记录中收集了相关数据。采集伤口拭子和血液样本,并在库尔纳医学院医院微生物实验室进行培养。采用逻辑回归模型确定烧伤患者感染并发症的风险因素。所有统计分析均使用 SPSS 26.0 版进行。共纳入 100 名烧伤患者。平均年龄为 29.2 岁,男女比例为 1.3:1。患者中最常见的是火焰烧伤(41%),其次是烫伤(23%)和电烧伤(15%)。近 40% 的患者为全层烧伤。院内感染发生率为 42%(伤口感染 33%,败血症 9%)。烧伤总面积>40%(OR 7.56,95% CI 2.89-19.81)、全厚烧伤(OR 34.40,95% CI 3.25-97.14)和住院时间延长(aOR 1.31,95% CI 1.15-1.51)是导致院内感染的重要风险因素。金黄色葡萄球菌是最常见的分离菌(45%),其次是链球菌(24%)、绿脓杆菌(19%)和大肠杆菌(12%)。由于不同医疗机构的院内感染流行病学不尽相同,因此考虑到当地的流行病学和烧伤伤口感染的致病菌,以医疗机构为基础的烧伤综合管理方案对于预防和管理烧伤患者的院内感染至关重要。
{"title":"Nosocomial Infection Among Burn Patients Admitted to a Tertiary Care Hospital of Bangladesh: A Cross-Sectional Study.","authors":"P K Dey, A Galib, A Sardar, M T Islam, H M Z Sharif, F Zaman, N Hannan, M A Rafi","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Nosocomial infection is a major challenge for the appropriate management of burns. The present study aimed to investigate incidence, risk factors, and causative organisms of nosocomial infection in burn patients of Khulna, Bangladesh. This cross-sectional study was conducted among patients admitted to the Burn and Plastic Surgery Department of Khulna Medical College Hospital (KMCH) from January to December 2020. Relevant data were collected from the patients' hospital records. Samples of wound swabs and blood were collected and cultured in the microbiology laboratory of KMCH. Logistic regression models were used to determine risk factors for infective complications in burn patients. All statistical analyses were carried out using SPSS version 26.0. A total of 100 burn patients were included. Mean age was 29.2 years with a male-female ratio of 1.3:1. Flame burns were most prevalent among the patients (41%), followed by scald (23%) and electric burns (15%). Almost 40% patients had full thickness burn. The incidence of nosocomial infection was 42% (wound infection 33% and septicemia 9%). Total body surface area of burn >40% (OR 7.56, 95% CI 2.89-19.81), full thickness burn (OR 34.40, 95% CI 3.25-97.14) and prolonged hospital stay (aOR 1.31, 95% CI 1.15-1.51) were significant risk factors for nosocomial infection. <i>Staphylococcus aureus</i> was the most commonly isolated organism (45%), followed by <i>Streptococcus</i> (24%), <i>Pseudomonas aeruginosa</i> (19%) and <i>Escherichia coli</i> (12%). As the epidemiology of nosocomial infection is not the same in different health facilities, a facility-based comprehensive burn management protocol considering the local epidemiology and causative organisms of burn wound infection is crucial for the prevention and management of nosocomial infections in burn patients.</p>","PeriodicalId":93873,"journal":{"name":"Annals of burns and fire disasters","volume":"36 3","pages":"202-208"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11041883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study analyzed the structure and determined the factors affecting the cost of treatment of severe burns patients. The results showed that the average total costs for a patient was 3275.9 USD. The daily cost of hospitalization was 113.3 USD, the treatment cost for 1% burn surface area was 109.5 USD with the highest proportion for medication and consumable medical equipment (43.2%), followed by surgery and procedures (30.2%). The treatment costs increased with increasing age, burn extent and deep burn area (p < .05) and were significantly higher in the group of patients with inhalation injury, electrical burns and in non-survivors (p < .01). Multivariate regression analysis found that burn extent, deep burn area and inhalation injury independently influenced the treatment cost of burn patients.
{"title":"Cost Analysis and Influencing Factors Amongst Severe Burn Patients.","authors":"N N Lam, N T Hung, N N Khanh","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This study analyzed the structure and determined the factors affecting the cost of treatment of severe burns patients. The results showed that the average total costs for a patient was 3275.9 USD. The daily cost of hospitalization was 113.3 USD, the treatment cost for 1% burn surface area was 109.5 USD with the highest proportion for medication and consumable medical equipment (43.2%), followed by surgery and procedures (30.2%). The treatment costs increased with increasing age, burn extent and deep burn area (p < .05) and were significantly higher in the group of patients with inhalation injury, electrical burns and in non-survivors (p < .01). Multivariate regression analysis found that burn extent, deep burn area and inhalation injury independently influenced the treatment cost of burn patients.</p>","PeriodicalId":93873,"journal":{"name":"Annals of burns and fire disasters","volume":"36 3","pages":"183-188"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11041904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M R Seswandhana, I D Kurniawan, S L Anwar, H M A Humani, G C Gabriela, I Dachlan, Y W Wirohadidjojo, I Aryandono
Burn injuries are the fourth most common type of trauma worldwide, after traffic injuries, falls and interpersonal violence. Vascular endothelial growth factor (VEGF) is one of the most critical proangiogenic factors. Failure in angiogenesis is often associated with chronic, non-healing wounds. This study aimed to compare the effect of sterile gauze with normal saline (NaCl) 0.9%, intermittent negative pressure wound therapy (NPWT), continuous NPWT, and silver sulfadiazine dressing on increasing VEGF and angiogenesis in deep dermal burn injury. This experimental laboratory study involved six Yorkshire pigs. Twenty burns were made on each pig's flank and dorsum areas, which were divided into four treatment groups: sterile gauze with NaCl 0.9%, intermittent NPWT, continuous NPWT, and silver sulfadiazine dressing. Skin biopsies were done on days 1, 3, 7, 14 and 21 to evaluate VEGF histoscore and mean microvascular density (MVD). We used immunohistochemical staining of VEGF-165 as VEGF's protein marker and hematoxylin-eosin (HE) to count the MVD. There was a significant difference in mean VEGF histoscore on evaluation day 14, in which continuous NPWT had the highest score compared to sterile gauze with NaCl 0.9%, intermittent NPWT, and silver sulfadiazine. The elevated VEGF histoscore could significantly increase the MVD.
{"title":"The Effects of Negative Pressure Wound Therapy on Vegf and Angiogenesis in Deep Dermal Burn Injury: An Experimental Study.","authors":"M R Seswandhana, I D Kurniawan, S L Anwar, H M A Humani, G C Gabriela, I Dachlan, Y W Wirohadidjojo, I Aryandono","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Burn injuries are the fourth most common type of trauma worldwide, after traffic injuries, falls and interpersonal violence. Vascular endothelial growth factor (VEGF) is one of the most critical proangiogenic factors. Failure in angiogenesis is often associated with chronic, non-healing wounds. This study aimed to compare the effect of sterile gauze with normal saline (NaCl) 0.9%, intermittent negative pressure wound therapy (NPWT), continuous NPWT, and silver sulfadiazine dressing on increasing VEGF and angiogenesis in deep dermal burn injury. This experimental laboratory study involved six Yorkshire pigs. Twenty burns were made on each pig's flank and dorsum areas, which were divided into four treatment groups: sterile gauze with NaCl 0.9%, intermittent NPWT, continuous NPWT, and silver sulfadiazine dressing. Skin biopsies were done on days 1, 3, 7, 14 and 21 to evaluate VEGF histoscore and mean microvascular density (MVD). We used immunohistochemical staining of VEGF-165 as VEGF's protein marker and hematoxylin-eosin (HE) to count the MVD. There was a significant difference in mean VEGF histoscore on evaluation day 14, in which continuous NPWT had the highest score compared to sterile gauze with NaCl 0.9%, intermittent NPWT, and silver sulfadiazine. The elevated VEGF histoscore could significantly increase the MVD.</p>","PeriodicalId":93873,"journal":{"name":"Annals of burns and fire disasters","volume":"36 3","pages":"222-228"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11041890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M Rehan, T Iqbal, M Sarwar, M S Khan, M H Tariq, Q Ain, U Waheed
The transfusion of blood and blood components is a life-saving medical procedure, however, it is linked with adverse reactions to transfusions. Information about different types of adverse transfusion reactions (ATRs) will assist in their early identification and subsequent management, as well as in devising strategies to minimize the occurrence of adverse reactions related to blood component transfusion. The current study was therefore executed to analyze the pattern of ATRs in patients with burn injuries at a national burn center. This was a cross-sectional, prospective study involving an analysis of immediate ATRs from January 2020 to June 2021 (18 months). ATRs observed during the study period were documented and analyzed. During the study period, 2,220 units of blood and blood components were transfused to 1,075 burn patients (2.06 transfusions per patient). A total of 27 ATRs were recorded (1.21%). Allergic reactions were the commonest (55.55%) followed by febrile non-haemolytic transfusion reaction (37.03%). The mean volume of blood unit transfused, when the reactions were noted, was approximately 75 ml (range: 15-230 ml). The mean time at which transfusion reactions were noted was 17 min (range: 5-220 minutes). The ATRs were more common in patients with multiple transfusions compared to those receiving a single transfusion. The common adverse reactions were allergic and febrile non-haemolytic transfusion reactions. It is vital to report all transfusion reactions to the attached blood center and hospital transfusion committee (HTC) on standardized reporting forms. Continuous medical education through seminars and sensitization workshops will support consolidating haemovigilance systems.
{"title":"Pattern of Acute Adverse Transfusion Reactions in Patients With Burn Injuries: A Novel Initiative Towards Haemovigilance at the National Burn Centre of Pakistan.","authors":"M Rehan, T Iqbal, M Sarwar, M S Khan, M H Tariq, Q Ain, U Waheed","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The transfusion of blood and blood components is a life-saving medical procedure, however, it is linked with adverse reactions to transfusions. Information about different types of adverse transfusion reactions (ATRs) will assist in their early identification and subsequent management, as well as in devising strategies to minimize the occurrence of adverse reactions related to blood component transfusion. The current study was therefore executed to analyze the pattern of ATRs in patients with burn injuries at a national burn center. This was a cross-sectional, prospective study involving an analysis of immediate ATRs from January 2020 to June 2021 (18 months). ATRs observed during the study period were documented and analyzed. During the study period, 2,220 units of blood and blood components were transfused to 1,075 burn patients (2.06 transfusions per patient). A total of 27 ATRs were recorded (1.21%). Allergic reactions were the commonest (55.55%) followed by febrile non-haemolytic transfusion reaction (37.03%). The mean volume of blood unit transfused, when the reactions were noted, was approximately 75 ml (range: 15-230 ml). The mean time at which transfusion reactions were noted was 17 min (range: 5-220 minutes). The ATRs were more common in patients with multiple transfusions compared to those receiving a single transfusion. The common adverse reactions were allergic and febrile non-haemolytic transfusion reactions. It is vital to report all transfusion reactions to the attached blood center and hospital transfusion committee (HTC) on standardized reporting forms. Continuous medical education through seminars and sensitization workshops will support consolidating haemovigilance systems.</p>","PeriodicalId":93873,"journal":{"name":"Annals of burns and fire disasters","volume":"36 3","pages":"261-265"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11042048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B Ćertić, M Jovanović, M Karamarković, D Vasović, J Isaković-Subotić, M Živković, D Rašić
Here we present a case of a 52-year-old female patient who was admitted to the Clinic in December 2021 due to the presence of right side facial burns which were caused by a cigarette lighter under suspicious conditions. Her past medical history revealed she was diagnosed with bipolar disorder at the age of 20 and was hospitalized multiple times for the treatment of manic episodes. The last psychiatric hospitalization took place in October 2021. She had deep second-degree burns on the right side of the face, head and neck, with a total body surface area involvement of approximately 3%. On hospital day 18, she was found unresponsive, dyspnoic, with no palpable pulse and measurable tension. Electrocardiogram (ECG) monitoring revealed sinus bradycardia followed by cardiac asystole. After the first few minutes of cardiopulmonary resuscitation, heart and lung action was re-established. Due to the presence of ECG changes in the form of ST depression and negative T waves in V2-V6, D1 and aVL, also higher blood level of high sensitivity troponin T, she was urgently transported to the Coronary Unit where she was diagnosed with non-ST-elevation myocardial infarction. On hospital day 27, due to the presence of sub-febrile temperature and non-productive cough, she was tested for COVID-19 infection and transported to the COVID Hospital Batajnica. She was discharged with stable laboratory parameters and normal chest radiography 37 days following initial admission. Considering the great psychological impact related to the COVID-19 pandemic, extensive mental health support and regular monitoring of critical groups is indicated.
我们在此介绍一例 52 岁的女性患者,她于 2021 年 12 月因右侧面部烧伤入院,烧伤是在可疑情况下由打火机造成的。她的既往病史显示,她在 20 岁时被诊断患有双相情感障碍,曾多次住院治疗躁狂发作。最后一次住院治疗是在 2021 年 10 月。她的右侧面部、头部和颈部深度二度烧伤,全身受累面积约为 3%。住院第 18 天,她被发现反应迟钝、呼吸困难、无脉搏和可测量的张力。心电图(ECG)监测显示窦性心动过缓,随后出现心脏骤停。经过几分钟的心肺复苏后,心肺功能得以恢复。由于 V2-V6、D1 和 aVL 出现 ST 段压低和负 T 波的心电图变化,以及高敏肌钙蛋白 T 血液水平升高,她被紧急送往冠状动脉科,并被诊断为非 ST 段抬高型心肌梗死。住院第 27 天,由于出现了亚发热体温和无痰咳嗽,她接受了 COVID-19 感染检测,并被送往 COVID Batajnica 医院。入院 37 天后,她的实验室指标稳定,胸片检查正常,康复出院。考虑到 COVID-19 大流行对心理造成的巨大影响,应为关键群体提供广泛的心理健康支持和定期监测。
{"title":"The Impact of the COVID-19 Pandemic on Self-Inflicted Burn Injuries in Patients With Previously Diagnosed Bipolar Disorder.","authors":"B Ćertić, M Jovanović, M Karamarković, D Vasović, J Isaković-Subotić, M Živković, D Rašić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Here we present a case of a 52-year-old female patient who was admitted to the Clinic in December 2021 due to the presence of right side facial burns which were caused by a cigarette lighter under suspicious conditions. Her past medical history revealed she was diagnosed with bipolar disorder at the age of 20 and was hospitalized multiple times for the treatment of manic episodes. The last psychiatric hospitalization took place in October 2021. She had deep second-degree burns on the right side of the face, head and neck, with a total body surface area involvement of approximately 3%. On hospital day 18, she was found unresponsive, dyspnoic, with no palpable pulse and measurable tension. Electrocardiogram (ECG) monitoring revealed sinus bradycardia followed by cardiac asystole. After the first few minutes of cardiopulmonary resuscitation, heart and lung action was re-established. Due to the presence of ECG changes in the form of ST depression and negative T waves in V2-V6, D1 and aVL, also higher blood level of high sensitivity troponin T, she was urgently transported to the Coronary Unit where she was diagnosed with non-ST-elevation myocardial infarction. On hospital day 27, due to the presence of sub-febrile temperature and non-productive cough, she was tested for COVID-19 infection and transported to the COVID Hospital Batajnica. She was discharged with stable laboratory parameters and normal chest radiography 37 days following initial admission. Considering the great psychological impact related to the COVID-19 pandemic, extensive mental health support and regular monitoring of critical groups is indicated.</p>","PeriodicalId":93873,"journal":{"name":"Annals of burns and fire disasters","volume":"36 3","pages":"214-216"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11041864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J L Lisiecki, M R Buta, S Taylor, M Tait, N Farina, J Levin, J Schulz, N Sangji, J Friedstat, M R Hemmila, S Wang, B Levi, J Goverman
Autografting with split-thickness skin grafts (STSG) remains an essential procedure in burn and reconstructive surgery. The process of harvesting STSG, however, leaves behind a donor site, an exposed area of partial-thickness dermis left to heal by secondary intention. There has yet to be a consensus amongst surgeons regarding optimal management of the donor site. The ideal donor site dressing is one that allows for expeditious healing while minimizing pain and infection. Despite numerous studies demonstrating the superiority of moist wound healing, many surgeons continue to treat STSG donor sites dry, with petroleum-based gauze. In this study, two burn centers performed a retrospective review of burn patients whose STSG donor sites were treated with either Xeroform® or Mepilex® Ag dressings. Infections were documented and in a subgroup analysis of patients, postoperative pain scores were noted and total opiate usage during hospitalization was calculated. Analysis revealed an overall infection rate of 1.2% in the Mepilex® Ag group and 11.4% in the Xeroform® group (p<0.0001). Patients with Xeroform® donor site dressings had increased odds of donor site infection (OR=10.8, p=0.002). In subgroup analysis, there were no significant differences in maximum pain scores between Mepilex® Ag and Xeroform® groups, nor were there differences in opiate usage. STSG donor sites dressed with silver foam dressings have a lower rate of donor site infection relative to those dressed with petroleum-based gauze. Moist donor site dressings such as foam dressings (including Mepilex® Ag) should be the standard of care in STSG donor site wound care.
在烧伤和整形外科手术中,使用劈裂厚皮移植(STSG)进行自体移植仍然是一种重要的手术方法。然而,在采集劈裂厚皮移植片的过程中,会留下一个供皮部位,即暴露在外的部分厚真皮区域,供二次愈合。外科医生对供体部位的最佳处理方法尚未达成共识。理想的供体部位敷料是既能加快愈合,又能将疼痛和感染降至最低。尽管有大量研究表明湿润伤口愈合效果更佳,但许多外科医生仍然使用石油基纱布对 STSG 供体部位进行干性处理。在这项研究中,两家烧伤中心对使用 Xeroform® 或 Mepilex® Ag 敷料治疗 STSG 供体部位的烧伤患者进行了回顾性复查。研究记录了感染情况,并对患者进行了亚组分析,记录了术后疼痛评分,计算了住院期间阿片类药物的总用量。分析结果显示,Mepilex® Ag 组的总体感染率为 1.2%,Xeroform® 组为 11.4%(P® 供体部位敷料增加了供体部位感染的几率(OR=10.8,P=0.002))。在分组分析中,Mepilex® Ag 组和 Xeroform® 组在最大疼痛评分上没有显著差异,在阿片类药物的使用上也没有差异。与使用石油基纱布包扎的供体部位相比,使用泡沫银敷料包扎的 STSG 供体部位感染率较低。泡沫敷料(包括 Mepilex® Ag)等湿润的供体部位敷料应作为 STSG 供体部位伤口护理的标准。
{"title":"Efficacy of Mepliex<sup>®</sup> Ag Versus Xeroform<sup>®</sup> As A Split-Thickness Skin Graft Donor Site Dressing: Bad Habits Die Hard.","authors":"J L Lisiecki, M R Buta, S Taylor, M Tait, N Farina, J Levin, J Schulz, N Sangji, J Friedstat, M R Hemmila, S Wang, B Levi, J Goverman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Autografting with split-thickness skin grafts (STSG) remains an essential procedure in burn and reconstructive surgery. The process of harvesting STSG, however, leaves behind a donor site, an exposed area of partial-thickness dermis left to heal by secondary intention. There has yet to be a consensus amongst surgeons regarding optimal management of the donor site. The ideal donor site dressing is one that allows for expeditious healing while minimizing pain and infection. Despite numerous studies demonstrating the superiority of moist wound healing, many surgeons continue to treat STSG donor sites dry, with petroleum-based gauze. In this study, two burn centers performed a retrospective review of burn patients whose STSG donor sites were treated with either Xeroform<sup>®</sup> or Mepilex<sup>®</sup> Ag dressings. Infections were documented and in a subgroup analysis of patients, postoperative pain scores were noted and total opiate usage during hospitalization was calculated. Analysis revealed an overall infection rate of 1.2% in the Mepilex<sup>®</sup> Ag group and 11.4% in the Xeroform<sup>®</sup> group (p<0.0001). Patients with Xeroform<sup>®</sup> donor site dressings had increased odds of donor site infection (OR=10.8, p=0.002). In subgroup analysis, there were no significant differences in maximum pain scores between Mepilex<sup>®</sup> Ag and Xeroform<sup>®</sup> groups, nor were there differences in opiate usage. STSG donor sites dressed with silver foam dressings have a lower rate of donor site infection relative to those dressed with petroleum-based gauze. Moist donor site dressings such as foam dressings (including Mepilex<sup>®</sup> Ag) should be the standard of care in STSG donor site wound care.</p>","PeriodicalId":93873,"journal":{"name":"Annals of burns and fire disasters","volume":"36 3","pages":"243-250"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11041881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A Almeida, V Alvarenga, P Egipto, A Costa-Ferreira, R Horta, F Martins de Carvalho
Burns in the elderly are a public health concern. This study aimed to analyze etiology, clinical characteristics, and independent risk factors for outcomes of burns in elderly patients. This retrospective study included elderly patients (65 years and over) admitted to a major burn unit between 2006 and 2016. Demographic data, clinical characteristics and outcomes were analyzed. One hundred and thirty patients were included. Most were female (56.2%) and the highest incidence was among those aged 75-84 years. The median burn area was 10.5%. The incidence in winter (50%) was higher (p<0.001) and flame burns predominated (p<0.001). The mortality rate was 32.3%. Independent risk factors for death were older age, larger extent burns, need for escharotomy, and cardiac disease as comorbidity. Amongst the survivors, the median length of stay was 36 days. Development of pressure sores, need for skin grafts, larger extent burns, presence of full-thickness burns, and cardiac disease were shown to be significantly associated with increased length of stay amongst survivors. Preventive measures should target women aged between 75-84 years. Flame burns occurred more frequently in winter. Prognosis is related to age, extent of burns, need for escharotomy at admission, and cardiac disease.
{"title":"Clinical Outcomes Among Elderly People With Burns.","authors":"A Almeida, V Alvarenga, P Egipto, A Costa-Ferreira, R Horta, F Martins de Carvalho","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Burns in the elderly are a public health concern. This study aimed to analyze etiology, clinical characteristics, and independent risk factors for outcomes of burns in elderly patients. This retrospective study included elderly patients (65 years and over) admitted to a major burn unit between 2006 and 2016. Demographic data, clinical characteristics and outcomes were analyzed. One hundred and thirty patients were included. Most were female (56.2%) and the highest incidence was among those aged 75-84 years. The median burn area was 10.5%. The incidence in winter (50%) was higher (p<0.001) and flame burns predominated (p<0.001). The mortality rate was 32.3%. Independent risk factors for death were older age, larger extent burns, need for escharotomy, and cardiac disease as comorbidity. Amongst the survivors, the median length of stay was 36 days. Development of pressure sores, need for skin grafts, larger extent burns, presence of full-thickness burns, and cardiac disease were shown to be significantly associated with increased length of stay amongst survivors. Preventive measures should target women aged between 75-84 years. Flame burns occurred more frequently in winter. Prognosis is related to age, extent of burns, need for escharotomy at admission, and cardiac disease.</p>","PeriodicalId":93873,"journal":{"name":"Annals of burns and fire disasters","volume":"36 3","pages":"191-201"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11042051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S Sljivic, C Zdanski, F Williams, R Nizamani, B King
Flare gun injuries are rare, and patients often present with complex trauma that may require multiple operative interventions. Our objective is to explore a case of a 15-year-old male, who presented with second-degree flame burns to the face, left upper extremity and bilateral hands, as well as third-degree burns to the oropharynx and a tongue laceration after a flare gun was discharged into his mouth. The patient underwent multiple debridements of the oral cavity and oropharynx, and his hospital course was complicated by an intra-oral abscess. He eventually made a full recovery and was discharged. This case not only illustrates the need for early operative intervention, but it also underscores the need for awareness campaigns that highlight the dangers of flare guns and similar devices.
{"title":"A Rare Case of Severe Burn Injury to the Oropharynx Caused by a Flare Gun.","authors":"S Sljivic, C Zdanski, F Williams, R Nizamani, B King","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Flare gun injuries are rare, and patients often present with complex trauma that may require multiple operative interventions. Our objective is to explore a case of a 15-year-old male, who presented with second-degree flame burns to the face, left upper extremity and bilateral hands, as well as third-degree burns to the oropharynx and a tongue laceration after a flare gun was discharged into his mouth. The patient underwent multiple debridements of the oral cavity and oropharynx, and his hospital course was complicated by an intra-oral abscess. He eventually made a full recovery and was discharged. This case not only illustrates the need for early operative intervention, but it also underscores the need for awareness campaigns that highlight the dangers of flare guns and similar devices.</p>","PeriodicalId":93873,"journal":{"name":"Annals of burns and fire disasters","volume":"36 3","pages":"257-260"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11041880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Here we present a case report of a young female patient with severe burn injury inflicting 27% of total body surface area (TBSA) associated with COVID-19 infection. Upon admission, Acinetobacter spp. (sensitive only to Colistin) was isolated from the wound swabs of the right arm, hand and thorax. On the fifth day after admission, a surgical excision was performed and 12% of TBSA was covered with homotransplants. The following day the patient had a sudden drop in oxygen saturation with hypotension (85/45 mmHg). Additionally, agitation, visual and auditory hallucinations were noticed. We found a massive pleural effusion on the left side and pneumonic foci on the right side. On the thirteenth day after admission the final surgical excision and homotransplantation of the skin were performed. In the following days, debridement of all necrotic tissue and covering of all the burned areas with homotransplants were done. Hemodynamic instability of the patient progressed along with the finding on the chest radiography, despite the local finding including adherent homotransplants with no signs of lysis or local infection at the wound beds. Due to low oxygen saturation, the patient was intubated on the fourteenth day after admission. Despite the measures taken, the lethal outcome occurred on the twenty-fifth day after admission to our Clinic. A decision on the right timing for surgical treatment in severely burned COVID-19 patients needs to be investigated in order to enable surgeons to make evidence-based decisions during the pandemic.
{"title":"Challenges in Treating COVID-19 Patients With Severe Burn Injuries.","authors":"B Ćertić, M Jovanović, M Karamarković, M Živković","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Here we present a case report of a young female patient with severe burn injury inflicting 27% of total body surface area (TBSA) associated with COVID-19 infection. Upon admission, <i>Acinetobacter spp</i>. (sensitive only to <i>Colistin</i>) was isolated from the wound swabs of the right arm, hand and thorax. On the fifth day after admission, a surgical excision was performed and 12% of TBSA was covered with homotransplants. The following day the patient had a sudden drop in oxygen saturation with hypotension (85/45 mmHg). Additionally, agitation, visual and auditory hallucinations were noticed. We found a massive pleural effusion on the left side and pneumonic foci on the right side. On the thirteenth day after admission the final surgical excision and homotransplantation of the skin were performed. In the following days, debridement of all necrotic tissue and covering of all the burned areas with homotransplants were done. Hemodynamic instability of the patient progressed along with the finding on the chest radiography, despite the local finding including adherent homotransplants with no signs of lysis or local infection at the wound beds. Due to low oxygen saturation, the patient was intubated on the fourteenth day after admission. Despite the measures taken, the lethal outcome occurred on the twenty-fifth day after admission to our Clinic. A decision on the right timing for surgical treatment in severely burned COVID-19 patients needs to be investigated in order to enable surgeons to make evidence-based decisions during the pandemic.</p>","PeriodicalId":93873,"journal":{"name":"Annals of burns and fire disasters","volume":"36 3","pages":"209-213"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11042047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M Rosadi Seswandhana, A N Prawoto, I T Rachman, S I Wahdini, N Vityadewi, R N Ramli, I Dachlan
We report a case of severe burn injury in a 42-year-old pregnant patient referred to our hospital's burn unit after experiencing a scald burn injury that burned her neck, chest, trunk, abdomen and limbs. The patient had burn wounds distributed on her neck, all four extremities, the chest and abdomen, with a total burn area of 46.5%. The burn wounds were treated with surgical debridement and then covered with silver sulfadiazine and damp gauze. The patient's wounds were treated every three days. The patient delivered a healthy baby full-term through a spontaneous, vaginal delivery. After delivery, the amniotic membrane from the patient was used as an amniotic membrane graft and was planted on the patient's chest, right arm and right thigh. The amniotic membrane in this patient helped to accelerate the preparation of the wound bed for skin grafting. Split-thickness skin grafts were then used on the wounds and the patient was discharged from the hospital one week later. Patients that present with burn injuries during pregnancy require intense monitoring and careful management from a multidisciplinary team. A collaborative effort needs to be made in order to plan the best outcome for the mother and fetus. Precise and early resuscitation is the first step to treating such cases. The administration of fluids should be titered based on the patient's hemodynamic condition and urine output. Wound management can also be optimized using the amniotic membrane as a temporary dressing before skin grafting.
{"title":"Treatment Challenges in a Pregnant Patient With Severe Burn Injury and Wound Care Using Amniotic Membrane: A Case Report.","authors":"M Rosadi Seswandhana, A N Prawoto, I T Rachman, S I Wahdini, N Vityadewi, R N Ramli, I Dachlan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We report a case of severe burn injury in a 42-year-old pregnant patient referred to our hospital's burn unit after experiencing a scald burn injury that burned her neck, chest, trunk, abdomen and limbs. The patient had burn wounds distributed on her neck, all four extremities, the chest and abdomen, with a total burn area of 46.5%. The burn wounds were treated with surgical debridement and then covered with silver sulfadiazine and damp gauze. The patient's wounds were treated every three days. The patient delivered a healthy baby full-term through a spontaneous, vaginal delivery. After delivery, the amniotic membrane from the patient was used as an amniotic membrane graft and was planted on the patient's chest, right arm and right thigh. The amniotic membrane in this patient helped to accelerate the preparation of the wound bed for skin grafting. Split-thickness skin grafts were then used on the wounds and the patient was discharged from the hospital one week later. Patients that present with burn injuries during pregnancy require intense monitoring and careful management from a multidisciplinary team. A collaborative effort needs to be made in order to plan the best outcome for the mother and fetus. Precise and early resuscitation is the first step to treating such cases. The administration of fluids should be titered based on the patient's hemodynamic condition and urine output. Wound management can also be optimized using the amniotic membrane as a temporary dressing before skin grafting.</p>","PeriodicalId":93873,"journal":{"name":"Annals of burns and fire disasters","volume":"36 3","pages":"229-233"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11041888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}