Annals of Burns and Fire Disasters - vol. XI - n. 3 - September 1998

INTERNATIONAL ABSTRACTS

EFFECTS OF ALLOPURINOL, IBUPROFEN AND CYCLOSPORIN A ON LOCAL MICROCIRCULATORY DISTURBANCES DUE TO BURN INJURIES
The purpose of this experimental study was to consider the biochemical and inflammatory reaction in the site of a burn injury and the surrounding area. With a view to preventing the burn from extending into tissue adjacent to the burn injury, a reduction in progressive microvascular damage was attempted using different drugs in a rat model. lbuprofen, allopurinol and cyclosporin A (CyA) were tested in order to study their affects on progressive ischaernia. It was found that neutrophils and free radical-mediated injury may be involved in the pathogenesis of local response to thermal injury, and that allopurinol and CyA play a role in the prevention of progressive ischaernia, capillary compromise, and oedema.

Cetinkale 0., Demir Xl., Sayman H.B., Ayan E, Onsel C.
Burns, 23: 43-9, 1997.

HETEROTOPIC OSSIFICATION AFTER SEVERE BURNS: A REPORT OF THREE CASES AND REVIEW OF THE LITERATURE
In heterotopic ossification (H0), lamellar bone is laid down in tissues that do not normally ossify. Until recently the condition has been rarely studied. However, with improvements in the survival rates of burn patients, the incidence of HO has increased. The paper describes three patients in a New Zealand Hospital who developed severe HO following major life-threatening burn injury. The aetiology, diagnosis and treatment of the patients is considered. It is particularly important to ensure measures that assist in the reduction of morbidity.

Richards A.M., Klaassen M.F.
Burns, 23: 64-8, 1997.

TIBIALIS ANTERIOR TURNOVER FLAP COVERAGE OF EXPOSED TIBIA IN A SEVERELY BURNED PATIENT
A case report is presented of a longitudinally split tibialis anterior turnover flap reconstruction of an exposed tibia in a burn patient, who had sustained deep partial- and full-thickness burns in 70% TBSA. The left patella and the upper two-thirds of the left tibia were exposed (the man had been trapped in a burning car). No muscle trauma was sustained, and reconstruction was therefore considered possible, using local muscle tissue to provide transposed flap coverage. The technique is described. The advantages offered by this rarely used flap include technical simplicity, reliability, minimal donor site dysfunction, and the possibility of future use of the soleus flap. The tibialis anterior turnover flap could have wide applications in the reconstruction of the severely burned lower extremity.

Chang J., Most D., Hovey L.M., Ymi K.K.
Burns, 23: 69-71, 1997.

ADVANCES IN THE TREATMENT OF BURN PATIENTS

Burn mortality rates have fallen in the last 20 years. This is a result of new therapies that have improved long-term outcome. An improved understanding of burn pathophysiology has led to improvements in fluid resuscitation, infection control, support of the hypermetabolic response to trauma, nutritional support, early closure of the burn wound, and early rehabilitation. These topics are considered in turn.

Rose LK., Herndon D.N.
Burns, 23: S19-26, 1997.

DELIVERY OF MEDICATION BY IONTOPHORESIS TO TREAT POST-BURN HYPERTROPHIC SCARS: INVESTIGATION OF A NEW ELECTRONIC TECHNIQUE
lontophoresis is an advantageous method of transdermal drug delivery, with a permeation rate much higher than that of passive diffusion. Two forms of iontophoresis are used: direct current (DC) and pulsed direct current (PDC). The DC field has high efficiency but exhibits some side-effects; the I'DC field has scarce side-effects but is less efficient. This study presents a new iontopheretic drug device designed to provide maximum efficiency with minimum side-effects. Tests showed that the permeation rate, in both animal and human models, was higher than that of the PDC and DC fields, and that the side-effects were lower than those of the DC field.

Zhao L., Hung L.K., Choy T.T.K.
Burns, 23: 527-9, 1997.

CLINICAL TRIALS OF BIOSYNTHETIC TEMPORARY SKIN REPLACEMENT, DERMOGRAPHED-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, Dermograft-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; Dow 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. Two 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 graft on the wound. This skin analogue is undergoing further clinical trials.

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

POST-BURN OEDEMA AND RELATED CHANGES IN INTERLEUKIN-2, LEUKOCYTES, PLATELET ACTIVATION, ENDOTHELIN-1, AND Cl ESTERASE INHIBITOR
One of the effects of interleukin-2 (IL-2) is the promotion of multisystem organ oedema, lung neutrophil sequestration, and platelet activation as a result of alteration in the microvascular barriers and permeability. Sixty patients were followed up in order to assess IL-2, complement, platelet and vascular endothelial activation. The findings showed that there were dynamic interactions between the endothelium, cytokine stimulation, leukocytosis, complement and platelet activation in the promotion of microvascular permeability. Alternative systemic targets for modification by treatment may therefore be the key to decreasing systemic oedema, and for this reason a more intense definition of the interplay between endothelium, haemostatic factors, and proinflammatory cytokines should be pursued either to determine critical response or to determine the combinations of biological modifiers necessary to counteract the development of systemic oedema.

Kowal-Vem A., Walenga J.M., Sharp-Pucci M., Hoppensteadt D., Gamelli R.L.
J. Burn Care Rehabil., 18: 99-103, 1997.

BIOCHEMICAL ALTERATIONS IN NORMAL SKIN AND HYPERTROPHIC SCAR AFTER THERMAL INJURY
Scar contraction and contracture can significantly limit functional recovery following burn injury. The mechanisms responsible for these problems have not been well described. A new device was used to generate surface (shear) waves in normal skin and hypertrophic burn scar. The speed of propagation was used to examine biomechanical changes after burn injury. Shear wave velocity was considerably higher in scar and slightly higher in injured tissue without evident scarring, verifying increased skin stiffness. In scar tissue normal skin anisotrophy was exaggerated and not seen in uninjured skin adjacent to hypertrophic scar. It would seem,- on the basis of these results, that normal tissue reorganizes in an attempt to compensate for scar contraction. The measurements of shear wave velocity attests a change in skin properties that affect recovery from thermal injury. The new technologies should improve our understanding of post-burn dysfunction and extend our capacity to treat burn patients.

McHugh A.A., Fowlkes B.J., Maevsky A.E., Smith D.J., Rodriguez J.L., Garner W.L.
J. Burn Care Rehabil., 18: 104-8, 1997.

WIDE VARIATION IN SINGLE, DAILY-DOSE AMINOGLYCOSIDE PHARMACOKINETICS IN PATIENTS WITH BURN INJURIES
Recently, as an alternative to traditional aminoglycoside regimens, 5 to 7 mg/kg single, daily-dose aminoglycoside regimens have been advocated. The purpose of such therapy would be to produce an optimal ratio between aminoglycoside peak concentrations (Cmax) and pathogen minimal inhibitory concentration to maximize bacterial killing and produce an aminoglycoside-free period during the 24-h dosing interval. The aim of this study was to calculate the magnitude and variability of aminoglycoside Cmax and the duration of the aminoglycoside-free period after simulated single, daily-dose regimens in patients with burn injuries. Fifty-two patients who Were receiving gentamicin or tobramycin in the burn unit were studied retrospectively to determine the individualized pharmacokinctic parameters and the simulated Cmax and 24-h after the dose through minimum concentrations for 5 and 7 mg/kg single daily-dose aminoglycoside regimens. The findings suggest that many burn patients are not candidates for single daily-dose aminoglycoside therapy because of restrictive creatinine clearance criteria and pronounced variability in the length of the aminoglycoside-free interval. Monitoring is therefore recommended to screen for appropriate candidates.

Hoey L.L., Tschida S.J., Rotschafer J.C., Guay D.R.P., VanceBryan K.
J. Burn Care Rehabil,, 18: 116-24, 1997.

PRIMARY CLOSURE OF FASCIOTOMY INCISIONS WITH A SKIN-STRETCHING DEVICE IN PATIENTS WITH BURN AND TRAUMA
Two case reports are presented in which the use of a skinstretching device assisted in the closure of fasciotomy wounds after severe circumferential burns and traumatic crush injury complicated by frostbite. The closure of fasciotomy wounds often presents clinical problems after successful management of compartment syndromes. Functional and cosmetic results would be improved if primary reapproximation of wounds were more practical, but the procedure is complicated by the excessive tension at the wound edges. The device that is described produced excellent functional and cosmetic wound closure results, and there was no need for additional operative steps.

Caruso D.M., King T.J., Tsujimara R.B., Weiland D.E., Schiller
J. Burn Care Rehabil., 18: 125-32, 1997.