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Volume X |
Number 3 |
September 1997 |
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SUMMARIES
| 131 |
THE STRATEGIC MANAGEMENT OF THE HIGH-VOLTAGE ELECTRICAL INJURY
(M.J. Cerepani, L. Leonard, H. Slater, W.I. Goldfarb - USA)
The strategic management of the high-voltage electrical injury can be both challenging and complex. The challenge begins from the time of injury and continues through rehabilitation. The complex aspect of management is the complications that occur due to systemic effects. A 35-year-old male sustained a 65% T13SA partial- and full-thickness electrical burns to the lower extren~ties, posterior trunk, and occipital and parietal skull. He underwent sixteen operations over a period of four months. The operations began with abovethe-knee amputations of the bilateral lower extremities, multiple debridernent of hurried areas with application of cadaver skin graft, splitthickness skin graft and placement of cultured epidermal autograft, multiple debridement of open wound areas on the scalp, and a colostomy. Throughout hospitalization many serious complications occurred. Some were life-threatening and two remain unresolved. The lifethreatening setbacks included a long course of vancomycin to treat MRSA (methycillin-resistant Staphylococcus aureus), persistent diarrhoea, and inability to tolerate solid foods. The frequent surgeries presented a problem for the patient's nutritional status, together with mobility concerns. The unresolved problems remain an issue. A colostomy was performed early in the early stage of hospitalization. It is unclear if it will be reversed. The patient developed calcification of both shoulders, which has made movement extremely difficult. Although these two problems have remained unresolved, the patient and his family consider them to be a minor hurdle that they will conquen The challenge of this complex case of high-voltage electrical injury will be one to remember for a lifetime.
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| 134 |
METABOLIC AND NUTRITIONAL SUPPORT IN BURNS IN THE ELDERLY
(L. Klein, E. Havel, V. Blaha - CZECH REPUBLIC)
The complex and continuous care necessary for burn patients represents an example of the interdisciplinary approach to these patients. There are many specific aspects of this type of trauma, especially in the elderly. In this paper we describe our treatment procedure and experience with metabolic and nutritional support in elderly burn patients. Sixty-two patients over 60 yr of age (average, 72.4 yr) were treated over a five-year period (1991-95). The average burn area was 21% TBSA and the mortality rate was 27.5%. The most important handicaps and "advantages" in the elderly are described. For parenteral nutrition, using "all-in-one" bags, we supply the following: energy 25-30 kcal/kg/day, amino acids 1.2-1.5 g/kg/day, sugar 150-200 g/day, fats 50-100 g/day.
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| 136 |
ALGORITHM FOR ANALYSIS OF PLASMA GLUCOSE IN THE POST-BURN SHOCK. STAGE
(L. Roa, T. Gomez-Cia, J.I. Ortega-Martinez - SPAIN)
Burn injury increases plasma glucose concentration and decreases plasma volume. In this situation, glycaernia is not an accurate reference of the dynamic behaviour of extracellular glucose. We presentan algorithm for the analysis of extracellular glucose behaviour in 36 burn patients duririg the shuck stage: 35 casas resuscitated with a high rate and volume of a colloid-free crystalloid solution and 21 resuscitated with a medium rate and volume of a colloid and crystalloid solution. With our algorithm the dynamic behaviour of extracellular glucose after burn injury - a period with abrupt changes in extracellular volume- can be analysed.
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| 141 |
PROPHYLAXIE ET TRAITEMENT DES ULCERES DE CURLING
(Y. Yonov, P. Petkov, N. Velitchkov - BULGARIE)
L'étude comprend 905 patients avec une surface corporelle brûlée au-dessus de 30%. Des ulcères de Curling sont diagnostiquées chez 77 d'entre eux (8,5%). Les malades sont repartis en trois groupes. Dans le Groupe 1 (années 1979-1984) comptant 52 patients (15%) aucune prévention spéciale n'a été pratiquée. Le Groupe Il (1984-1989) est de 16 patients (5,8%) avec ulcères de Curling auxquels une thérapie avec cimétidine et préparations antiacidiques (Antiacid et Almagel) a été pratiquée. Le Groupe 111 (1989-1994) comprend 9 patients (3,2%) auxquels une prévention avec ranitidine et antiacidiques a été administrée. Dans les trois groupes les patients ont de graves brûlures avec pour la plupart des complications de sepsis et pneumonie et du syndrome de la défaillance pluriorganique comprenant des ulcères de Curling, ces demières étant la cause principale de la mort. Dans les trois groupes la mortalité varie e 78% à 88%.
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| 146 |
INTENSIVE DECOLONIZATION EFFECT ON THE MICROBIOLOGICAL FLORA OF BURN PATIENTS ADMITTED TO A BURN INTENSIVE CARE UNIT
(R. Herruzo-Cabrera, V. Garcia-Torres, J. Garcia-Caballero, M., Fernandez-Arjona, F. Mariscal-Sistiaga, J. Rey-Calero - SPAIN)
Selective intestinal decolonization is one of the most controversial techniques for the reduction of infection in burn intensive care units. In burn patients this technique can be used together with nasal decolonization and intensive skin decolonization. Our objective was to cheek the evolution in time of skin flora in critical burn patients and to establish whether the burn infection was endogenous or not. Two hundred and eight burn patients from our intensive burn unit were included in the study. The colonization of different areas (pharynx, nose, G1, burn zone, and healthy skin) was studied every week. The colonization vs burn infection predictive value was obtained. Staphylococcus aureus (SA) from patients, doctors, and nurses was checked to discover any transmission route of this micro-organism. It was found that in patients with intensive skin decolonization the microbiological normal flora was better preserved. When the normal microbiological flora disappeared, colonization by Pseudomonas aeruginosa (PA) occurred very frequently. Colonization predictive value vs burn infection was low but in weeks 3 and 4 of hospitalization it reached its maximum values (45% in PA). Burn colonization was similar in different parts of the body. SA phagotyping showed that all patients were colonized by a different micro-organism. It was concluded that intensive burn patient decolonization was useful for the preservation of microbiological flora and to prevent colonization and infection from other micro-organisms, mostly endogenously.
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| 152 |
USE OF DIESEL OIL IN THE REMOVAL OF TAR FROM BITUMEN BURNS
(R. Al-Hoqail - SAUDI ARABIA)
Hot tar burns mainly occur in workers in the paving and roofing industries. They present a difficult clinical problem owing to the adherence of material to the underlying skin. In the past, in Lebanon, diesel oil was widely used in the construction business in cases of tar burns, with rapid removal and excellent results. Because of the unavailability of solvents, diesel was applied in a recent case described in this paper. There was no further damage to the underlying burn. A review of the literature revealed that diesel has never been reported as a solvent for tar burns. Further research is recommended.
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| 157 |
BRULURES - COMPRESSION DE LA MAIN ET DU POIGNET
(E. Mahjoub, J. P. Comparin, J.-C. Bichet, J. Latarjet, J.L. Foyatier - FRANCE)
L'association d'une brûlure et d'une compression de l'extrémité du membre supérieur est à l'origine de lésions tissulaires considérables. A partir de l'étude d'une série de dix patients les Auteurs soulignent l'intérêt d'une prise en charge chirurgicale en urgence, l'importance des lésions articulaires et tendineuses, l'échec systématique des greffes de peau mince et le mauvais pronostic de ces lésions. Malgré l'utilisation de lambeaux de couverture et une rééducation précoce adaptée, les séquelles fonctionnelles restent fréquentes, et réduisent le plus souvent les possibilités de reprise du travail.
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| 162 |
DERMOFUNCTIONAL TREATMENT OF HYPERTROPHIC BURN SCARS
(P. De Santis, A. Savoia - ITALY)
A review of the pathology of hypertrophic bums is followed by an analysis of the results of a study of twenty consecutive patients with hypertrophic bum scars. The patients were treated with Synchroline, a cream compound consisting of an association of functional substances capable of stimulating the biosynthesis of the macromolecules responsible for skin pliability and elasticity The criteria for the selection of patients were the presence of deep hypertrophic bum scars, an average burned surface of 20%, and the use of pressure garment therapy. Each patient treated was matched with a control patient selected among patients treated by other physicians working in the same Burn Unit. The patients were matched for age group, scar site, and duration of treatment with hydrating creams and pressure garments. All the patients were followed up monthly and the scar was assessed by a physician in the Burn Unit who was unaware of the patients' group membership. The following scar characteristics were assessed: appearance, consistency, presence of nodules, coloration, and presence of ulcers. One patient underwent two hypertrophic scar biopsies: at the beginning of treatment and after six months. Our results indicate that hypertrophic scars in the Synchroline group were more elastic and pliable at six months than those in the hydrating cream group. The effect of Synchroline as a precursor and stimulator of hyaluronic acid, fibronectin and soluble collagen biosynthesis is discussed.
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| 166 |
LES SEQUELLES DE BRULURES CERVICOFACIALES: CLASSIFICATION ANATOMOCLINIQUE ET CONSEQUENCES THERAPEUTIQUES
(A. Adouani, K. Zitouni, K. Yacou, I. Zairi, M. Mokhtar - TUNISIE)
Les séquelles de brûlures cervicofaciales et du scalp constituent des lésions qui revêtent des caractères particuliers de part leur fréquence, leur siège, leur gravité et le retentissement fonctionnel quelles engendrent. Elles posent un double problème, l'un d*ordre thérapeutique, le second relatif aux répercussions psychosociales en raison des difficultés d'adaptation et d'acceptation dans le milieu socioprofessionnel. L'établissement d'une classification anatomoclinique permet de distinguer les formes mineures, moyennes et majeures. Les procédés thérapeutiques sont orientés en fonction de chacune de ces formes. Nous présentons 65 cas de séquelles de brûlures cervicofaciales colligés dans une période de six ans et analysons les formes anatomocliniques et les conséquences thérapeutiques.
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| 171 |
THE ABBEYSTEAD EXPLOSION DISASTER
(W. Jaffe, R. Lockyer, A. Howcroft - GREAT BRITAIN)
In 1984, 44 people were involved in an underground explosion in which 16 people eventually died. We report on the history of the disaster and the preliminary results of the morbidity as noted after ten years.
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| 174 |
ANATOMICAL STUDY OF THE MEDIAL SEPTOFASCIAL FLAP OF THE LEG - ITS POSSIBLE CLINICAL APPLICATIONS
(Al-Sayed Mandour Ismail - EGYPT)
Most anatomical and injection studies on the septocutaneous vessels of the leg have been performed without separation of the septocutaneous flap as an island-pedicled flap. Using observations on work done in our Unit with the distally based adipofascial flap in the leg and foot, we studied the anatomy of the medial septofascial flaps by an injection study on cadaver after separation of the flaps from the surrounding skin. Seventeen limbs were examined in the study. Our results showed that the subfascial plexus is more important than the suprafascial plexus if the flap is used as an island-based flap on the lower septal vessel. If the adipofascial flap is used as an island flap, the fatty layer does not prove a good surface to carry the split-skin graft until after the formation of granulation tissue from the perforating vessels. However, if this fatty layer is removed (septofascial flap), it can be a good surface to carry a split-skin graft, owing to the good blood supply of the fascia. The distally based septofascial flap without the skin and subcutaneous fat can reach any distance, from the midleg to the great toe, and can be a vehicle to carry a split-skin graft, thus solving many clinical problems in the lower leg and foot, such as chronic ulcers and deep burns. This is the basis of research currently in progress in our unit.
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| 180 |
THE OTHER SIDE OF THE COIN - A DISCUSSION ON BURNS AND FIRES: PREVENTION AND PROTECTION
(I. G. Badran - EGYPT)
This wide-ranging article considers many aspects of burns and fire prevention. Physicians should be not concerned only with the treatment of burn injury - they must also have their say in discussions regarding the incidence of fire accidents and the alleviation of their magnitude. The modem world presents many dangers, while many risk situations continue to exist in developing countries. All these problems are considered, with particular reference to the Author's country, Egypt.
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