Annals of Burns and Fire Disasters - vol. X - n. 3 - September 1997

INTERNATIONAL ABSTRACTS

HUMAN KERATINOCYTE ISOLATION AND CELL CULTURE: A SURVEY OF CURRENT PRACTICES IN THE UK
In burn patients, the choice of what keratinocyte culture to use depends on what final product is required. The purpose of this questionnaire was to review current cell-culture practices in the United Kingdom, comparing and contrasting methodologies and success rates. An account is given of the work of a group involving the culture of human keratinocytes in low-calcium, serum-free medium. The survey shows that problems with serum-free culture experienced by the authors of this research were not unique. Further work has led to identification and solution of some of the problems experienced with commercially prepared, lowcalcium, serum-free keratinocyte culture medium. It is recommended that an optimized protocol of keratinocyte culture should be developed for particular manufactured serum-free medium. Hopefully, this would reduce the variation in culture performance such as that that described in the survey.

Daniels J.T., Kearney J.M., Ingham E.
Burns. 22: 35-9, 1996.

THE USE OF CALCIUM ALGINATE DRESSINGS IN DEEP HAND BURNS
The control of haemorrhage during incision and grafting following deep hand burns is a serious surgical problem with major occupational and economic implications. Graft take may be reduced by post-operative haernatoma. Excision may lead to the exposure of important deep structures (e.g. extendor tendons or joints). Satisfactory free skin graft take is thus hindered. This article illustrates the use of calcium alginate dressings, which can be immensely helpful in minimizing the technical problems involved. A detailed case report is presented.

Kneafsey B., O'Shaughnessy M., Condon K.C.
Burns, 22: 40-3, 1996.

AEROMONAS BACTERAEMIA IN BURN PATIENTS
Among burn patients, infection by Aeromonas species is a rare occurrence, with fewer than ten cases reported in the English language literature. Infection is most often associated either with traumatic injuries containinated with water or soil or with imm uno suppression. A review was conducted of the experience of a burn centre with human Aeiomonas infection. The retrospective examination of blood culture results from 8151 patients admitted over the five-year period revealed eight patients with clinically relevant Aeromonas hydrophilia bacteraemia. Although uncommon, Aeromonas must be considered as a possible offending species after failure to respond to the more common pathogens.

Barillo B.J., McManus A.T., Cioffi W.G. Kim S.H., Pruitt B.A., Jr
Burns, 22: 48-52, 1996.

MANAGEMENT STRATEGY IN PURPURA FULMINANS WITH MULTIPLE ORGAN FAILURE IN CHILDREN
Purpura fulminans (PF) refers to the necrosis of soft tissue secondary to diffuse microvascular thrombosis induced by transient protein defi~ ciency associated with meningoeoccal sepsis. PF is unusual, despite for example the approximately 15,000 cases of bacterial meningitis occurring annually in the USA. There is a reported mortality rate of 50% secondary to the multiple organ failure commonly observed with the syndrome, and there is major long-term morbidity in the survivors. This article describes recent experience with three PF patients and provides a management strategy: early incision and closure of deep wounds, aggressive critical care management, and long~term follow-up if there is delayed epiphyseal growth. Children developing multiple organ failure in association with P17 present difficult management problems and will benefit from the surgical and critical care facilities that are available only in burn centres.

Sheridan R.L., Briggs S.E., Remensnyder J.P., Tompkins R.G.
Burns, 22: 53-6, 1996.

UNUSUAL DEVELOPMENT OF GRANULOMAS ON THE HEALING SURFACE OF BURN WOUNDS ASSOCIATED WITH MRSA INFECTIONS
The emergence of methicillin-resistant Staphylococcus aureus (MRSA) is a challenging problem for burn centres involved in the management of extensive thermal injuries. Serious complications may arise as a result of initial colonization of MRSA on the surface of a burn wound, e.g. septicaemia, endocarditis, osteomyelitis, brain abscess, and enterocolitis. This report presents the clinicopathological aspects and management of ten patients in a burn centre in Kuwait who developed rapidly proliferating tumour-like growths on the surface of healing burn wounds, associated with an outbreak of MRSA infection. These growths were unique in their fulminating-type fleshy mass with a consistency varying from soft to firm, the absence of purulent matter or head, and extension up to the fibrous layer covering the musculature. In four cases the growths subsided within 72 h with daily dressing with an injectable solution of vancomycin or teicoplanin; the others required radical excision and immediate cover with split-skin grafts and systemic administration of either of these two antibiotics.

Gang R.J., Bajec J., Krishna K., Sanyal S.C.
Burns, 22: 57-61, 1996.

THE EFFECT OF AN ARGININE-GLYCINE-ASPARTIC ACID PEPTIDE AND HYALURONATE SYNTHETIC MATRIX ON EPITHELIALIZATION ON MESHED SKIN GRAFT INTERSTICES
This study was carried out to determine whether the use of a provisional matrix, composed of an arginine-glycine-aspartic acid (RGD) peptide immobilized on a biodegradable polymer, hyaluronic acid (HA), could accelerate the healing of grafted full-thickness burn wounds. A laboratory model was designed to evaluate the effects of various treatment regimens on the epithelialization of full-thickness wounds covered with meshed skin grafts. Full-thickness wounds were created on athymic mice which were then covered with meshed, human, split-thickness skin. In this full-thickness model it was found that basic fibroblast growth factor caused an overabundant angiogenic response, ablating the epithelialization. It cannot therefore be assumed that this in vivo system measures only isolated epitbelialization. It should instead be considered that the materials tested have substantial effects on the open wound, and this ultimately affects epithelialization.

Cooper M.L., Hansbrough J.F., Polarek JW.
J. Burn Care Rehabil., 17: 108-16, 1996.

CLINICAL EVALUATION OF AN ACELLULAR ALLOGRAFT DERMAL MATRIX IN FULL-THICKNESS BURNS
This multicentre clinical research project considers the capacity of an acellular allograft dermal matrix to function as a permanent dermal transplant in full-thickness and deep partial-thickness burns. The study was conducted in two stages: a pilot phase (24 patients) to establish the optimum protocol and a study phase (43 patients) to assess graft performance. Every patient had both a test site and a mirror-image or contiguous control site. At the test site, the dermal matrix was grafted to the excised wound base and a split-thickness autograft was simultaneously applied over it. The control site was grafted only with a split-thickness autograft. The fourtecn-day take rates of the dermal matrix were statistically equivalent to control autografts. The histology of the dermal matrix exhibited fibroblast infiltration, neovascularization, and neoepithelialization without signs of rejection. Over time, wound assessment showed that thin split-thickness autografts plus allograft dermal matrix were equivalent to thicker split-thickness autografts.

Wainwright D., Madden M., Luterman A_ Hunt L, Monafi) W., Heimbach D., Kagan R., Sittig K., Dimick A., Herndon D.
J. Burn Care Rehabil., 17: 124-36, 1996.

SEQUENTIAL EXCISION AND GRAFTING OF THE BURN INJURIES OF 1507 PATIENTS TREATED BETWEEN 1967 AND '1986: END RESULTS AND THE DETERMINANTS OF DEATH
A more aggressive approach to burn wound management, with complete excision within 72 It post-burn, has suggested the conclusion that total early excision is of major importance in determining the improvement of survival rates. This article summarizes the results of the treatment of 1507 patients with burn injuries treated between 1967 and 1986 with wound management involving standard topical therapy, occlusive dressings, and staged excision and grafting of full-thickness injury or deep dermal injury (not healed within 21 days). A logistic-regression model was used to analyse the data because, except for older patient cohorts, the data did not fit the probit model. The major factors determining death were: percentage of body surface area burned, age, smoke inhalation, and percentage of full-thickness burn (concordance 97%). The findings indicate that aggressive sequential wound excision and grafting produces end results comparable with those obtained with complete early burn wound excision. The early harvest of available donor areas in patients with large burns may be of more importance for survival than complete early wound excision.

Caldwell ET., Jr, Wallace B.H., Cone J.B.
J. Burn Care Rehabil., 17: 137-46,1996.

PERSISTENT PERIPHERAL NERVE PATHOLOGIES IN PATIENTS WITH ELECTRIC BURNS
In Turkey the incidence of electrical burns is relatively common, representing some 20% of all burns treated on an in-patient basis in the series considered in this paper. Twenty-five patients agreed to submit themselves to re-evaluation between two and thirteen years after the electrical injury they had sustained. Altogether 25 patients with electrical burns were considered (male/female ratio, 5.2: 1; age range, 9-65 yr). Abnormal motor nerve conduct findings were detected in twelve of the patients. In nine patients abnormalities were observed in more than one nerve. A positive relation was noted between age and nerve lesions. The most prominent clinical finding was weakness. This study confirms that persistent peripheral nerve pathologies are frequent in electrical burn cases.

Haberal M.A., Gúrer S., Akman N., Basgóze 0.
J. Burn Care Rchabil., 17: 147-9, 1996.

ELBOW ANCHYLOSIS DUE TO POST-BURN HETEROTOPIC OSSIFICATION
Six cases are presented of elbow anchylosis due to post-burn heterotopic anchylosis (HO), with an analysis of the incidence of this complication, the indication and surgical technique, and the results obtained. Two cases were bilateral. The ossification was localized in all cases at the posteriormedial aspect of the elbow. Treatment consisted of resection of the bone mass and transposition of the u1nar nerve. Mobilization was initiated early and rehabilitation continued for at least four months. The results, on the Merle d'Aubign6 and Cahadell scale, were very good in five patients (six elbows; 73.6% in average gain in arch of flexor extension of the elbow) and poor in only one patient (average gain less than 20%).

Holguin P.H., Rico A.A., Garcia J.P., Del Rio J.L.
J. Burn Care Rehabil., 17: 150-4, 1996.