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Volume X |
Number 1 |
March 1997 |
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SUMMARIES
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DEEP BURNS OF THE KNEE: JOINT CAPSULE RECONSTRUCTION WITH DERMIS GRAFT
(M. Masellis - Italy)
Cases are presented of serious 111 degree deep burns in the knee area, with carbonization of skin tissues, the rotular apparatus, and muscle and articular tissues, with ample exposure of the femoral and tibial condyles. In the light of experience acquired both clinically and experimentally, the authors reconstructed the joint capsule with autologous dermis graft. This method, by permitting fairly good and rapid articular stability, allows early mobilization and therefore a favourable modulation of the periarticular scar tissue, with good recovery of joint movement.
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BURN CAMPAIGNS IN BELGIUM FOR CHILDREN UNDER THE AGE OF FIVE YEARS
(A. Hendrickx, W Boeckx - Belgium)
Of Belgium's population of about 10,000,000, some 120,000 (1.2%) are the victims of burn injury every year. Ten thousand (0. 1 %) need to be hospitalized, in either a general hospital or a burns centre. Approximately 800 of these patients are treated in one of the six specialized burn units in Belgium. Annually about 150 patients die owing to the consequences of their burns. Since the early 1980s, the number of burn cases has not substantially changed. By the year 2000 we expect an important increase in burn prevention measures (e.g. smoke detectors) as well as a growing awareness among the target-public (e.g. through media campaigns), as a result of which, hopefully, there will be a drop in the number of burn injuries. Studies show that in Belgium 70% of all burn-related accidents occur in the home and that pre-school children (23 yr) form an extremely vulnerable group. There is a need for general awareness of the dangers involved, with education of the public underlining the importance of parental supervision: for example, keeping children out of the kitchen would prevent a significant number of accidents. It is important to organize ongoing information campaigns, as those who have recently become parents may not be aware of the dangers facing their children. Safety training is an absolute necessity and accordingly there are several organizations and centres in Belgium that specialize in burn prevention. This paper also describes a number of practical precautions and a video campaign.
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CHEMICAL BURNS - EPIDEMIOLOGY
(E. Vaglenova - Bulgaria)
This survey considers the 5-year period 1991-1995, during which the total number of burn patients admitted to our clinic was 1548. Forty-nine (3.2%) presented chemical burns (38 male/11 female; mean age, 41.4 yr; age range, 14 to 80 yr). The commonest cause of chemical burns was some form of acid. The home was the most frequent site of chemical burn incidents (73.5% of all such cases), the main reasons being criminal acts or negligence. Burn extent ranged from I to 95% TBSA, with a predominance of injuries in less than 10% TBSA. Thirty-six patients (73.5%) presented deep partial-thickness and full-thickness skin loss. The head, face, and neck were affected in 31.8% of the patients, the lower limbs in 30.8%, the upper limbs in 19.6%, and the trunk in 17.8%. Patient mortality in this series was 4. 1 %.
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LES BRULURES ELECTRIQUES - ETUDE RETROSPECTIVE ET ANALYTIQUE A PROPOS DE 588 CAS SUR LINE DECENNIE 1984-1993
(S. Joucdar, H. Kismoune, F. Boudemia, D. Bacha - Algerie)
Les brûlures constituent certement la plus habituelle des conséquences des accidents électriques. Il est difficile de connaître leur fréquence pour l'ensemble des accidents électriques, mails on estime que les brûlures sont observées dans plus de 80% des cas. Les différents aspects physiologiques de l'électricité et de ses conséquences sont passés en revue à propos d'une étude rétrospective et analytique concernant 588 cas sur la décennie 1984-1993. Du point de vue étiologique, ce sont surtout les accidents du travail qui dominent. Si ce sont les non professionnels de l'électricité qui fournissent le gros des malades, les professionnels de l'électricité ne sont pas indemnes, et la négligence, la méconnaissance de l'électricité, l'imprudence et les défauts de sécurité se retrouvent isolés ou associés. Au niveau des accidents domestiques, on retrouve surtout l'absence des nonnes de sécurité. L'enfant paie un lourd tribut à l'électricité. Les lésions sont souvent graves et profondes avec un taux de mortalité de 13,2%. Le taux de morbidité est impressionnant: plus de 60% des patients présentent des séquelles invalidantes témoignant de l'ampleur des dégâts. La thérapeutique est décevante, les interventions chirurgicales longues et itératives, aboutissant malheuresement à des amputations. Le meilleur traitement reste la prévention par l'instauration de mesures de sécurité draconiennes avec des campagnes d'information et une législation ferme et sévère.
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THE ROLE OF AZTREONAM IN THE CONTROL OF GRAM-NEGATIVE BURN WOUND INFECTION
(A.H.Kamel, E.A. El Megeed - Egypt)
This study was conducted on 68 patients with mixed second- and third-degree burns and/or raw areas admitted to the Burn Unit of Assiut University Hospital and the Assiut Burn Centre (Egypt). The purpose was to study the effect of topically applied Aztreonarn alone and in conjunction with its systemic administration in the control of gram-negative burn wound infection. The results were compared with those of a control group of 57 patients with gram-negative infection who received a classic method of dressing. Assessment was performed on clinical and bacteriological bases. It is concluded that the use of Aztreonam, as a topical dressing is very helpful in the control of gram-negative mixed second- and third-degree degree burn wound infection, particularly if due to Pseudomonas, and that in the presence of high fever over 38.5 'C it is advisable to administer Aztreonarn also systemically.
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USE OF A BIOLOGICAL FILM AS A CULTURED EPIDERMAL AUTOGRAFT SUPPORT IN THE TREATMENT OF BURNS: PRELIMINARY REPORT OF A NEW TECHNIQUE
(P.Y. Gueugniaud, A. Fabreguette, L. Oddou, P.Petit, C. Colombel, 0. Damour - France)
The long-term outcome of the most critically burned patients is now in part linked to the successful use of cultured human epidermal sheets. This technique however presents certain disadvantages: a long delay before the sheets are available, the fragility and difficult handling of the grafts, and the variability of the graft take rate, which is often poor, particularly in some difficult areas (e.g. joints, back, neck), where the gauze used to transfer the epidermal sheet impedes adherence of the sheet to the prepared wound. The aim of this preliminary study is to assess a biological film for supporting keratinocyte growth and transferring cultured epithelium to the wound without gauze transfer. The film consists of 72% collagen, 20% chitosan and 8% glycosaminoglycans. The technique was used in three patients following the surgical methods routinely used in our Centre, i.e. either "combined" graft with conventional large mesh amograft covered with autologous cultured sheets, or cultured epidermal autografts covering remaining allodermis after early homograft. The culture time was shortened by several days because perfect confluence of epidermal cells to achieve a multilayered epidermis was no longer necessary: cultured grafts were available 14-16 days post-biopsy. The in vitro manipulation before grafting allowed a saving of several hours by eliminating transfer on to a gauze. The areas thus covered were the shoulder, flank, trunk, and forearm (range, 600 to 960 CM2). Clinically, the seeded biological film was easy to handle and more adhesive to irregular wounds than any classical dry or vaseline gauze. When the dressing was removed for graft verification, the film disintegrated spontaneously, without detrimental effects to initial take. The success rate ranged from 85 to 98% after the first grafting procedure. In conclusion, the film seems to be useful as it accelerates keratinocyte cutture. It permits good co-ordination between the biological and the medical teams, and it therefore appears to be a valid technical alternative to conventional cultured epidermis, especially in mobile zones.
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HISTOLOGICAL AND IMMUNOHISTOCHEMICAL EVALUATION OF HUMAN CULTURED EPIDERMAL CELLS
(E. Garcia Fernandez, J.M. Bejar, M. Maruri, M.D. Garcia Masdevall, C. Camarero, F.J.Gabilondo - Spain)
The cutaneous coverage of large and deep skin defects secondary to burn wounds or certain diseases is a complex surgical problem. Normal human keratinocytes can be serially cultured in vitro, and in appropriate culture conditions give rise to a stratified squamous epithelium. Although no stratum corneurn is developed in vitro, these cultures enable us to study early events in the development, proliferation, and differentiation of human keratinocytes. For a better understanding of these findings, a study was made of cell viability and the histological (morphological analysis) and immunohistochemical picture in epidermal sheets, tested at different culture times, as compared with normal human skin from foctuses, newborns, and adults. It was observed that cultures a few days old are similar to foetus and newbom skins as regards immunohistochemical expressivity (but not the number of cell layers). Adult skin is more similar to secondary cultures as regards its superficial differentiation, slight positivity to involucrin, and larger number of cell layers, although the cultures never present such a high number of cell layers as adult skin.
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A PRELIMINARY STUDY OF BIFIDOBACTERIA FEEDING ON THE PREVENTION OF BACTERIAL TRANSLOCATION IN SEVERELY BURNED RATS
(J. Chen, Y. Zhang, G. Xiao, A.(N.) LI - Peoples - Republic of China)
Disruption of the ecological balance of the normal indigenous microflora is one of the major pathogenic factors responsible for bacterial translocation. This study was conducted to evaluate the role of Bifidobacteria feeding in the prevention of bacterial translocation in severely burned rats. Antibiotics and Bifidobacteria were orally administered to rats which had sustained 30% T13SA scalding on the back, maintaining the intestinal biological barrier. The rats were randomly divided into a Bifidobacteria feeding group, a burn group, and a normal group. In the first two groups, the bacterial contents in the caecum, the incidence of bacterial translocation, caecal secretory immunoglobulin A (slgA), and endotoxin level in the vena cava were monitored respectively 24, 48, 72 and 96 hours post-burn. The results showed that the content of bacterial flora in the caecum changed considerably, i.e. the number of anaerobes decreased, while that of Enterobacteria and Candida increased significantly 24 hours post-burn, which suggests that the ecological balance of the normal indigenous microflora was disrupted in the post-burn period. In the burn group, caecal sIgA decreased significantly, but the bacterial translocation rate and the plasma toxin level increased. In contrast, the plasma endotoxin level and the bacterial translocation rate in the Bifidobacteria feeding group decreased, whereas caecal sIgA content increased and caecal content changed slightly. These results suggest that Bifidobacteria could in some measure prevent the translocation of both endotoxin and bacteria from the gut lumen to the internal organs.
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MICROGRAFTING - REVIVAL OF AN OLD TECHNIQUE
(R.P. Hermans, R. Kreis - Netherlands)
The technique of micrografting was largely abandoned when the mesh-graft technique was developed. The old technique does however still present some advantages, and it is recommended in extensively burned patients with little possibilities for autograft. The technique is described and its advantages listed. Associated use of the sandwich technique further improves the micrograft technique.
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RISQUE CHIMIQUE EN MILIEU SOUTERRAIN
(B. Viala - France)
L'Auteur considère tous les aspects du risque chimique en milieu souterrain - tunnel routier ou ferroviaire, métro ou galerie marchande. Certaines contraintes de ce milieu sont identiques, comme l'accessibilité, la visibilité, l'acoustique, et le problème psychologique. Les risques potentiels sont l'incendie et l'attentat par gaz toxique. Après avoir discuté les paramètres à prendre en compte dans une stratégi * e particulière pour affronter ces situations de risque, l'Auteur indique les modalités du sauvetage des victimes en soulignant l'importance de la mise en oeuvre d'un plan de secours spécifique préétabli.
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