Annals of Burns and Fire Disasters - vol. X - n. 4 - December 1997

INTERNATIONAL ABSTRACTS

SYSTEMIC FACTORS INFLUENCING THE GROWTH OF CULTURED EPITHELIAL AUTOGRAFT
Cultured epithelial autograft (CEA) has been increasingly used all over the world to produce autologous epithelial grafts. A retrospective study of 23 patients who had biopsies taken for CEA autograft showed that in three patients the cells obtained grew slowly or not at all. These patients suffered respectively from metastatic carcinoma, repeated biliary surgery and surgical malnutrition, and chronic narcotic drug and alcohol abuse. The results thus suggest that the keratinocyte cultures of patients with a significant past medical history have a decreased growth rate, particularly if the underlying pathology affects the general physical condition. The general physical condition of the patient is therefore an important factor in choices regarding the clinical use of this technique.

HUMAN SKIN HISTOLOGY AS DEMONSTRATED BY HEROVICE'S STAIN: A GUIDE FOR THE IMPROVEMENT OF DERMAL SUBSTITUTES FOR USE WITH CULTURED KERATINOCYTES?
The success of the use of cultured keratinocytes for burns has been limited by practical problems (e.g., fragility, poor take, and unsatisfactory cosmesis). Dermal equivalents reduce the problems, but there is no general agreement as to the best structure of these substitutes. This study used Herovici's stain to show that in human skin from a variety of anatomical sites the epidermis is not in direct contact with type 1 collagen, but rather with a distinct type Ill collagen layer. It is therefore suggested that dermal equivalents should be constructed that include a layer of type 111 collagen as the interface between the keratinocytes and a type 1 collagen neo-dermis, which in this way would mimic normal skin structure with greater proximity.

THE PULSED TUNABLE DYE LASER AS AN AID IN THE MANAGEMENT OF POST-BURN SCARRING
Permanent erythematous scarring may follow the burn injury and surgery. The scars are difficult to treat and may be disfiguring and very distressing for the patients. In vascular lesions such as port wine stains, telangectasia, spider angioma, and acnea rosacea, pulsed tunable dye laser (PTI)L) is the treatment of choice for vascular lesions of the skin. As this technique destroys abnormal blood vessels in the skin selectively, sparing healthy neighbouring structures, it was felt that the PT13L could be used in the treatment of these persistent red scars, reducing their colour. A case history is described. The final result showed an excellent colour match to the surrounding skin, while the telangectasia of the cheek was fading well. The patient declared that he was very happy with the treatment.

MARKEDLY INCREASED LYMPHATIC REMOVAL OF HYALURONAN FROM SKIN AFTER MAJOR THERMAL INJURY
Hyaluronan (HYA), previously known as hyaluronic acid, is a highmolecular-weight polysaccharide present in the interstitial space throughout the body. After major burn injury HYA increases markedly. This paper investigates the extent to which the lymphatic removal of HYA from the skin is affected following major burns. Experiments performed on sheep showed that the HYA concentration in plasma was 162 ± 12 mg/ml at baseline, while post-injury plasma HYA peaked at two to three times baseline at 4-8 h after the injury. At 24 h post-injury plasma HYA was reduced compared with baseline. It is concluded that after burn injury the lymphatic transport of HYA from the injured area into the systemic circulation increases considerably, resulting in elevated plasma concentrations of this high-molecular-weight connective tissue component.

DOMESTIC CENTRAL HEATING RADIATORS: A CAUSE FOR CONCERN IN ALL AGE GROUPS
The use of central radiators as the main form of domestic heating in developed countries is steadily increasing. This article presents a detailed report of a large series of contact burns and scalds caused by this kind of radiator. Fifty cases are considered of such burns that occurred over a period of nearly four years, treated in a Burns and Plastic Surgery Unit in Wales. There was a male prevalence among the injured, and the average age was 43.4 yr (range, 6 months to, 100 yr). The forearm and hand were predominantly involved. The literature normally suggests that the incidence of contact burns is highest at the extremes of the age spectrum, but this study shows that contact radiator burns are sustained equally by all age groups. The high surface temperature of the radiator is clearly an important factor. Various methods are available for reducing this risk, and the use of low surface temperature radiators is advocated.

A ONE.YEAR PROSPECTIVE STUDY OF BURNS IN AN IRISH PAEDIATRIC BURNS UNIT
The aims of this study were to make a profile of problems related to paediatric burns in Ireland and to consider any region-specific hazards that might be involved. In the one-yw period considered (1992) 336 paediatric burn patients were treated. Sixteen per cent required admission to hospital, and 33% needed prolonged dressings as out-patients. The mortality rate was 1.8% and the morbidity rate 39%, both comparable with other centres. The most remarkable results were: a) the high incidence of sunburn injuries, especially among young infants (reflecting ignorance among the general public of the association between childhood sunburn and the development of skin cancer in later life), and b) the high percentage of accidents occurring in the home (90%), nearly all of which were preventable. Public health education campaigns on this issue could help to reduce the incidence and severity of paediatric burn injuries.

PROGNOSTIC INDICATORS IN THE ELDERLY PATIENT WITH BURNS
This study considers the epidemiology and treatment complications in a large population of elderly victims of burns, in an effort to recognize prognostic indicators that might prove helpful in the prediction of patient outcome. These indicators are significant in the counselling of family members and they may also identify areas of patient treatment that warrant further research and investigation. A retrospective study was conducted of 252 patients aged over 55 yr, and an evaluation was made of demographic information, pre-morbid medical conditions, burn characteristics, clinical management, complications, and survival over a 12-year period. Although burn size did not change in relation to age, older patients (over 75 yr) had a significantly higher mortality rate. Pre-injury health problems were present in over two-thirds of the patients, and when two or more of these were present together there was a higher incidence of complications. The effect of pre-morbid health problems on outcome was most evident in the youngest patients. The lower respiratory tract was the commonest infection site and was related to the highest incidence of sepsis and death. The survey made it possible to identify some predictors of poor outcome in elderly burn patients, and this will prove useful in the treatment of this patient population and facilitate family counselling.

Covington D.S., Wainwright D.J., Parks D.H.
J. Burn Care Rehabil., 17: 222-30, 1996.

ACUTE AND CHRONIC RESPIRATORY COMPLICATIONS OF TOXIC EPIDERMAL NECROLYSIS
Toxic epidermal necrolysis (TEN) was first described in 1956 by Lyell as an acute, generalized, sheet-like loss of epidermis resembling a scald burn. Histological studies have shown that this is a clinical syndrome distinct from staphylococcal scalded skin syndrome (caused by staphylococcal toxin). The plane of separation in TEN is at the epidermaldermal junction, whereas in the scalded skin syndrome it is in the epidermis. The exact cause of TEN is unknown, but is usually related to the ingestion of certain drugs. The disease causes bullous necrosis of the epidermis with partial-thickness loss of skin and mucous membranes. Previous reports have not concentrated on the respiratory complications of the condition. This article considers twelve patients treated over a sixyear period in a burn unit in Toronto (Canada). Five patients required mechanical ventilatory support, and nine showed roentgenographic evidence of respiratory complications. After intensive therapy, there was a 75% survival rate. Nonsurvivors were suffering from severe pre-existing multisystem disease. Four survivors showed evidence of respiratory involvement, three demonstrating a pre-existent reduction in carbon monoxide diffusing capacity of up to 35-40% below normal. On the basis of the results of this survey, it is concluded that TEN, although primarily a dermatological problem, can lead to life-threatening acute respiratory decompensation requiring ventilatory support and also to long-term pulmonary function abnormalities. Patients with TEN thus need close monitoring for pulmonary complications.

McIvor R.A., Zaidi J., Peters W.J., Hyland R.H.
J. Burn Care Rehabil., 17: 237-40, 1996.

DERMASORB# VERSUS JELONET* IN PATIENTS WITH BURNS SKIN GRAFT DONOR SITES
This prospective, randomized, controlled trial compares Jelonet* with a new hydrocolloid dressing, Dermasorb#. Dressings were applied on contiguous donor sites in 21 patients requiring skin grafting for burn wounds. Pain related to the dressing was assessed on days 2, 4, 7 and on two other occasions. Bacteriological swabs were taken and the percentage of epithelialization was recorded during dressing changes. Questionnaires were compiled to assess the perceived performances of the two dressings. It was found that Dermasorb was a less painful dressing than Jelonet, with which wounds healed faster. Dermasorb was preferred by both the investigators and the patients.

(* Jelonet is manufactured by Smith & Nephew); # Dermasorb is manufactured by Convatec.)

Cadier M.A., Clark J.A.
J. Burn Care Rehabil., 17: 246-51, 1996.