of Burns and Fire Disasters - vol. XI - n. 4 - December 1998
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.,
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.
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
Balakrishan C., Emanuel
J.A., Chow I.J.S.
J. Burn Care Rehabil., 18: 245-6, 1997.
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.
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
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.,
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
Tdregim M., Ni5anci M.,
Burns, 23: 496-7, 1997.