Annals of Burns and Fire Disasters - vol. XI - n. 4 - December 1998

INTERNATIONAL ABSTRACTS

POST-BURN OEDEMA AND RELATED CHANGES IN INTERLEUKIN-2, LEUKOCYTES, PLATELET ACTIVATION, ENDOTHELIN-1, AND Cl ESTERASE INHIBITOR
Interleukin (IL-2) promotes multisystem organ oedema, lung neutrophil sequestration, and platelet activation by altering the microyascular barriers and permeability. IL-2, complement, platelet, and vascular endothelial activation were assessed in 60 patients. There was a significantly increased absolute neutrophil count on day 1 and decreased C,Inh, with high IL-2 in the 20-40% group. Endothelin-1 levels were significantly increased in the 20-40% TBSA group on day 5. The absolute neutrophil count was significantly reduced in both groups, while C1Inh increased to nearly normal levels by day 5. Generalized oedema increased with increasing burn wound size in parallel with elevated IL-2 and endothelin-1 levels, reduced C1Inh levels, and leukoeytosis in the first week post-burn. The data indicate that there are dynamic interactions between endothelium, cytokine stimulation, leukoeytosis, complement, and platelet activation in the promotion of microvascular permeability.

Kowal-Vern A., Walenga M.W., Sharp-Pucci M., Hoppensteadt D., Gemelli R.G.
J. Burn Care Rchabil, 18: 99-103, 1997.

BIOMEDICAL ALTERATIONS IN NORMAL SKIN AND HYPERTROPHIC SCAR AFTER THERMAL INJURY
Scar contraction and contracture can significantly limit functional recovery after burn injury, but the mechanisms responsible have not been fully explained. A new device was used to generate surface (shear) waves in normal skin and hypertrophic burn scars. The velocity of propagation was employed to analyse biomechanical changes following burn injury. Shear wave velocity was much higher in sears and slightly higher in injured tissue without obvious scarring, verifying increased skin stiffness. Normal skin anisotropy was exaggerated in scar tissue but was not observed in injured skin adjacent to hypertrophic scars. The results could suggest the reorganization of normal tissue attempts to compensate for scar contraction. The measurement of shear wave velocity documents the changes in skin properties affecting recovery from burn injury. This or alternate technology should increase our understanding of post-burn skin dysfunction and improve our treatment of such patients.

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

A CONSERVATIVE THERMAL INJURY TREATMENT PROTOCOL FOR THE APPROPRIATE JEHOVAH'S WITNESS CANDIDATE
Jehovah's witnesses present a great challenge to the medical profession because of their refusal, on religious grounds, to receive any blood transfusions or blood product transfusions. The physician has the duty to do what is right and good for the patient, but at the same time the physician must respect the individual's choice of refusal. of available treatments. This paper consider the issues raised by thequestion and presents protocol guidelines that take into account the implications of the medical and surgical care of Jehovah's witnesses.

McGill V., Kowal-Vern A., Gamelli R.L.
J. Burn Care Rehabil., 18: 133-8, 1997.

ONCE-DAILY WOUND CLEANSING AND DRESSING CHANGE: EFFICACY AND COST
This study considers the comparative advantages and disadvantages of once- and twice-daily dressing changes in burned children. Paediatric patients usually undergo wound cleansing and dressing twice daily, with associated pain and expense. Fifty burned children were treated with once-daily wound cleansing and dressing change and the results were compared with those obtained in a matched control group treated twice daily. This led to a significant saving of nursing time, together with a decreased need for pain medication, and no change in infectious morbidity, length of hospital stay, or need for surgery. The once-daily regimen aroused enthusiasm among patients, parents and nursing staff.

Sheridan R.L., Petral L., Lydon M., Salvo P.M.
J. Burn Care Rehabil., 18: 139-40, 1997.

DUPUYTREN'S CONTRACTURE AFTER BURNS OF THE UPPER EXTREMITY
Dupuytren's contracture is a disease process involving the palmar fascia. It leads to flexion contracture in one or more fingers. It is a benign condition of unknown cause, but it can have a significant effect on use of the hand. A case is reported that is of interest because the patient had a previous history of burns in the upper extremity, but no particular predisposition to the disease. Burns of the upper extremity should therefore be considered a possible trigger for the onset of Dupuytren's contracture.

Balakrishan C., Emanuel J.A., Chow I.J.S.
J. Burn Care Rehabil., 18: 245-6, 1997.

LONG-TEAM PSYCHOSOCIAL SEQUELAE OF PAEDIATRIC BURNS
Studies of psychosocial sequelae after burns in children have produced conflicting results because of methodological diversities. This paper considers the literature, and reports on a survey conducted in Finland of 91 persons burned during childhood, who were re-assessed by mailed interviews and clinical re-examination. The average extent of their burns was 11.9% TBSA (maximum 50%). The injuries were mainly scalds (90-91%). The median age at the time of admission was 1.9 yr, and only 19 patients (20.9%) remembered the event; 23 patients (25.3%) could recall their hospitalization. Twenty-one patients (23.1 %) had a fear of hot water and fire, and 39 (42.9%) were cautious. The average educational progress was not different from average figures in the general population. Less than 20% of the former patients expressed some difficult in contacts with the other sex. The negative psychosocial sequelae would seem, on the basis of this survey, to be modest after the typical form of paediatric burns, i.e. scalds, sustained in early childhood.

Zeitlin R.E.K.
Burns, 23: 467-72, 1997.

PAEDIATRIC BURNS AND ASSOCIATED RISK FACTORS IN RIO DE JANEIRO, BRAZIL
This study investigates some of the main putative risk factors for burn injuries in children in a case-control study of 94 severely burned children in Rio de Janeiro, Brazil. Ninety-nine children aged 0-11 yr were included in the study. The risk of burns was found to be higher in children who were living in crowded households, were not firstborn, had a pregnant mother, had a mother recently dismissed from employment, or had recently moved house. Burns must be regarded not as fortuitous events but as a signal of underlying causes. Prevention of burn accidents requires individual, family and collective approaches, and if research programmes are to be useful they must appreciate the underlying processes.

Werneck G.L., Reichenheim M.E.
Burns, 23: 478-83, 1997.

THE FATE OF ALLOPLASTIC MATERIALS PLACED UNDER A BURN SCAR: AN EXPERIMENTAL STUDY
The behaviour of three frequently used alloplasts - silicone, porous polyethylene (Medpor), and porous polytetrafluoroethylene carbon (Proplast) - under burn-scarred skin was studied in an animal model. Standard burn wounds were created in rats, and three months later silicone, Medpor, and Proplast alloplasts were placed under the burn scar. The rats were followed for a further three months, during which time the ulceration and/or alloplast exposure rates were evaluated. At the end of the period the specimens were examined histologically for the thickness of the fibrous capsule around the implant, the thickness of overlying tissues, tissue growth, and vascularization of the implants. It was found that ulceration and exposure occurred in two of the 12 Medpor implants, two of the 12 Proplast implants, and none of the 12 silicone implants. Fibrous capsule was significantly thicker around the silicone implants. The Medpor implants showed the most evident tissue ingrowth and vascularization, and Proplast implants showed maximum thickness of the overlying tissue. These results wound indicate that complications with silicone implants may be reduced, compared with other previous implants, when used under burned scar tissues.

Senyuva C., Yticel A., Erdamar S., Cetinkale 0., Seradjmir M., Ozdemir 0.
Burns, 25: 484-9, 1997.

SILVAZINE TM (SILVER SULFADIAZINE AND CHLOR. HEXIDINE) ACTIVITY AGAINST 200 CLINICAL ISOLATES
The results are reported of a study of in vitro sensitivity to SilvazineTM of 200 bacterial isolates from wounds of patients treated in an Australian burns centre. Two hundred non-replicative sequential isolates were collected over a 2-month period comprising 50 Staphylococcus aureus (methicillin-sensitive), 50 StaphylocoCcus aureus (methicillin-resistant), 50 coagulase-negative staphylococci, and 50 Pseudomonas aeruginosa. The method chosen was a pour plate overlay of micro-organisms placed in a Mueller Hinton base containing duplicate wells of 0.1 ml SilvazineTM. Plates were incubated at 35 'C for up to 48 h before examination. All the organisms tested exhibited zones of growth inhibition, the mean diameters of the zones of growth inhibition being similar within the four genera. No bacterial regrowth was observed within the zones of growth inhibition in the course of long-term plate storage. SilvazineTM thus confirmed its efficiency against common burn wound isolates.

George N., Faoagali J., Muller M.
Burns, 23: 493-5, 1997.

BURN SCAR CARCINOMA WITH LONGER LAG PERIOD ARISING IN PREVIOUSLY GRAFTED AREAS

Marjolin's ulcer arises in areas of chronically nonhealing wounds, such as burn scars, stasis or other ulcers, and osteomyelitis. The lesions are frequently overlooked and often inadequately treated. The average time lapse between the original lesion and malignant transformation is reported to be about 35 years. This article describes a case of burn carcinoma in the right foot arising in a previously grafted area after a 55-year tumour-free period. The patient was treated with below-knee amputation and right inguinal lymph node dissection. The probable factors that may induce or facilitate nonmalignant degeneration of burn scars are discussed.

Tdregim M., Ni5anci M., Gfiler M.
Burns, 23: 496-7, 1997.