Annals of Burns and Fire Disasters - vol. XI - n. 2 - June 1998

INTERNATIONAL ABSTRACTS

THE INDEX OF DEEP BURN INJURY: AN ANALYSIS OF 66 EXTREMITY SITES IN 15 CHILDREN
Severe burns resulting in necrosis of structures deep in the skin and subcutaneous fat constitute a small but difficult category of burn injuries. These burns are often classified generically as "fourth degree", but in fact they vary greatly in extent and severity. The absence of an established grading system has interfered with our chances of learning from the experience of others. The Index of Deep Burn Injury (IDBI) was proposed to fill this gap, and this paper presents initial experience with its use, with regard to a group of locally destructive "fourthdegree" wounds. The IDBI could potentially improve our ability to describe this type of highly destructive wound.

Xhu M., Donelan M., Sheridan R.
Burns, 23: 11-14, 1997.

EARLY INTRAGASTRIC FEEDING OF SERIOUSLY BURNED AND LONG-TERM VENTILATED PATIENTS: A REVIEW OF 55 PATIENTS
This retrospective study had four objectives: to determine the feasibility of an early intragastric feeding protocol, to consider the possibility of providing certain needs via the intragastric route within 72 h post-burn, to consider the influence of the delayed onset of feeding on the ultimate success of the feeding protocol, and to assess the impact, if any, of delayed feeding on morbidity and mortality. The results are described in 55 long-term ventilated patients (mean age, 37.6 yr, mean TBSA 44.2%). The mean duration of ventilation was 24.8 days. The intragastric tube feeding protocol was initiated as soon as possible after admission. It was possible to feed 45 patients (81.8%), satisfying their caloric needs within 72 h, and in these patients the mean interval between burn injury and the commencement of tube feeding was 11.5 h. The mean interval in the other patients was 32.4 h, indicating the failure of early intragastric feeding. Only four of the patients fed enterally within 18 h post-burn did not satisfy their caloric needs. Patients fed successfully presented a significantly decreased mortality. A time interval of over 18 h was unfavourable and had a significant effect on the success rate.

Raff T., Hartmann B., German G.
Burns, 23: 19-25, 1997.

CHARACTERIZATION OF A NEW IN VITRO BURN WOUND MODEL
A variety of animal models have been used to study the healing of burn wounds. However, but the use of animals has its problems, since apart from the ethical considerations there are some major differences in the wound healing process between humans and animals. This study seeks to overcome the problem by presenting a standardized and repeatable in vitro model of the burn wound in human skin. Burn wounds of standardized area and depth were created in human skin from routine breast reduction operations, and incubated in vitro. The re-epithelialization process was followed during the incubation period (14 days) by fixing and staining wounds every other day, after which the viability of the cells in the epidermis and dermis was confirmed by isolation and culture in vitro. It was found that wounds incubated in 10% fetal calf serum healed after 7 days, while wounds incubated in 2% serum showed no signs of re-epithelialization. However, epidermal and dermal cells from wounds incubated in 2% serum were viable after two weeks' incubation. It thus appears that this in vitro model could be very useful in studies on the progressive phases of burn wound healing process due to various pharmacological agents and treatments.

Emanuelsson R, Kratz G.
Burns, 23: 32-6, 1997.

APPLYING WHAT BURN SURVIVORS HAVE TO SAY TO FUTURE THERAPEUTIC INTERVENTIONS
The aim of this paper was to consider whether universal concepts of the post-burn survivor can be detected through a particular type of psychological test, i.e. the sentence completion task. Sixty paediatric burn survivors aged 6-19 yr were submitted to the assessment tool. Questions were asked that covered five major aspects of post-burn life: preoccupation with health, the struggle for internal acceptance, reconstruction of one's life map, changing relationships, and redefinition of the world. These five dimensions of post-burn life are discussed, together with applications for each dimension.

Robert R., Berton M., Moore P., Murphy L., Meyer W., Blakeney P., Hemdon D.
Burns, 23: 50-4, 1997.

IS PROLONGED AND EXCESSIVE COOLING OF A SCALDED WOUND EFFECTIVE?
Rats were used in an experimental study to assess the effectiveness of prolonged and excessive cooling of a burn wound immediately after the lesion. The wound was produced by applying a lint immersed in boiling water. When the lint was applied for 5 sec, followed by immediate soaking in tap water for 1 min, little damage was caused. When the lint was applied for 10 sec, followed by application of ice for 10 min, severe damage was caused. When the lint was applied for 10 sec, without any other treatment, and when the lint was applied for ten see followed by soaking in tap water for 1 min, there was moderate damage. A useful instruction in the event of burn injuries would therefore be: 'When burned, immerse the wound immediately, using tap water. The aim of this manoeuvre is firstly to remove the heat source immediately, and secondly to give mild cooling to the wound. Excessive and prolonged cooling is harmful in some cases.

Sawada Y., Urushidate S., Yotsuyanagi T., Ishita K.
Burns, 23: 55-8, 1997.

HYPERDYNAMIC RESUSCITATION IMPROVES SURVIVAL IN PATIENTS WITH LIFE-THREATENING BURNS
On the basis of the widely observed observation that standard vital signs produce in burn patients, a review was made of three groups of patients. These comprise an index group (resuscitation guided by means of a pulmonary artery catheter), a control group, and a current group resuscitated with hyperdynamic end points defined empirically from surviving patients as guidelines. Over time, the mortality rates and organ failures decreased - the mortality rate of the control group was 48%, of the index group 32%, and of the protocol group 10% (p = 0.003). It is concluded that hyperdynamic resuscitation improves survival and reduces the incidence of organ failure.

Schiller W.R., Curtis Bay R., Garren L.R., Parker L, Sagraves G.
J. Burn Care Rehabil., 18: 10-16, 1997.

INHALED NITRIC OXIDE SELECTIVELY REDUCES PULMONARY HYPERTENSION AFTER OVINE SMOKE INHALATION BUT DOES NOT IMPROVE OXYGENATION
When nitric oxide (NO) is inhaled, it selectively reduces pulmonary hypertension and improves the ventilation-perfusion relationship in patients with lung injury of various origin. Some forms of lung injury do not however react at all to inhaled NO or show only reduced pulmonary arterial pressure (PAP). In order to extend our knowledge of the little-known effects of inhaled NO after smoke inhalation injury its effects were studied in an established model of ovine smoke inhalation injury. Eight chronically, instrumented sheep were subjected to tracheostomy and insufflated with smoke generated from burning cotton cloth. The animals were then connected to a ventilator with oxygen-enriched air, in order to achieve arterial oxygen tensions within the normal range. After 48h, NO was added to the inspired gas in increasing concentrations up to 100 ppm. An analysis was made of systemic and pulmonary haernodynamics and of oxygen transport. The inhaled NO dependently reduced pulmonary hypertension. Concentrations greater than 20 PPM did not further reduce PAP. The right ventricular stroke work index was significantly improved as a result of the reduction in pulmonary vascular resistance. Arterial oxygenation, on the contrary, was not optimized by inhalation of NO, probably due to interstitial oedema formation.

Booke M., Bradford D.W., Hinder R, Nishida K., Biondo N.A., Traber L.D., Traber D.L.
J. Burn Care Rehabil., 18: 27-33, 1997.

SUPERIORITY OF ORAL KETAMINE ASAN ANALGESIC AND SEDATIVE FOR WOUND PROCEDURES IN THE PEDIATRIC PATIENT WITH BURNS
In burned paediatric patients, the management of pain and anxiety includes the problem of finding the right balance between inadequate and excessive medication. Ketamine, with its sedative, analgesic and amnestic properties for children, has been used intravenously with good results. Now that it is available as an elixir, the hypothesis was investigated whether ketamine administered orally could provide effective analgesia and sedation during wound care procedures with a good safety margin. The hypothesis was tested in 19 paediatric patients, who received either ketamine oral suspension or 300 mg acetaminophen with codeine phosphate and diphenhydramine. Ketamine showed a pain reduction with ketamine or more than 400% (p < 0.05), and it improved sedation by 360% (p < 0.05). These results therefore show improved analgesia and sedation with oral ketamine compared with another commonly used narcotic and sedative for the facilitation of wound care procedures on paediatric burn patients. The use of ketamine oral suspension could therefore be more widely adopted.

Humphries Y., Melson M., Gore D.
J. Burn Care Rehabil., 18: 34-6, 1997.

CLINICAL TRIALS OF A BIOSYNTHETIC TEMPORARY SKIN REPLACEMENT, DERMAGRAFT-TRANSITIONAL COVERING, COMPARED WITH CRYOPRESERVED HUMAN CADAVER SKIN FOR TEMPORARY COVERAGE OF EXCISED BURN WOUNDS
A number of problems complicate the use of human cadaver allograft skin (HCAS), and a reliable substitute would be highly desirable. This study assessed the ability of a biosynthetic analogue of human skin, Dermagraft-TC (Advanced Tissue Sciences, Inc.) (DG-TC) for the temporary closure of burn wounds. DG-TC is composed of human neonatal fibroblasts cultured on a synthetic dressing (Biobrane; Don Hickam, Inc.), consisting of nylon mesh fabric covered with a thin layer of silicone rubber membrane, which provides an epidermal barrier. The material is stored frozen, and thawed immediately prior to use. The variants of the DG-TC analogues were tested. It was found that adherence to the wound and subsequent autograft take were excellent and at least as good as with HCAS. There was no evidence of immune rejection of DG-TC, whereas in four patients there was evidence of epidermal sloughing/rejection in the HCAS control sites, leading to limited persistence of the grafts on the wound. This skin analogue is undergoing further clinical trials.

Hansbrough J.F., Mozingo D.W., Kealey G., Davis M., Gidner A., Gentzkow G.D.
J. Burn Care Rehabil., 18: 43-51, 1997.