Annals of Burns and Fire Disasters - vol. XII - n° 2 - June 1999

SELF-INFLICTED BURNS
This article considers two types of self-inflicted burns: those caused by suicide attempts and those caused by self-mutilating behaviour. Such burns represent a small but consistent percentage of admissions to burns centres around the world. The medical records of all patients admitted to the Royal Brisbane Hospital Burns Unit (Australia) and identified as having suffered a self-inflicted burn wound between 1990 and 1995 were reviewed. Patients who covered themselves with a flammable liquid between 1984 and 1995 were also reviewed, in a separate group. Of the 1072 admissions, 44 cases (4. 1 %) were related to deliberately self-inflicted burns. The suicide attempters were nearly all male and the majority (60%) presented a major psychiatric illness. The self-mutilators suffered less serious burns, and none died. The phenomenon of "copycaC suicides is considered: when the media give too much publicity to spectacular suicide attempts, other persons may be tempted to emulate them.

Cameron DR., Pegg S.P., Miller M.
Burns, 23: 519-21, 1997

BURNS OF THE HAND AND UPPER LIMB - A REVIEW
This review paper considers the principles and controversies related to thermal injury in the hand and upper limb. An account is given of accepted principles, and controversial topics are presented impartially. The functional and epidemiological importance of hand burns is described. The article comments on the initial evolution of the burn wound, triage, out-patient and in-patient management, the operative management of the acute burn, and reconstruction. It is concluded that the burn surgeon must organize a multi-disciplinary team that is proficient with the concepts and execution of appropriate treatment protocols. In this way the need for reconstruction can be minimized, and the patient's functional outcome can be improved.

Smith M.A., Munster A.M., Spence R.J.
Burns, 24: 493-505, 1998.

NON-ACCIDENTAL BURNS IN CHILDREN
Child abuse by burning contributes significantly to non-accidental injury. This retrospective review examines 507 consecutive admissions to a burns centre in Australia over a 3-year period, with a view to assessing the characteristics of the burn injury in order to assess which characteristics, if any, might help to distinguish accidental burns from burns due to abuse or neglect. It was found that 86% of admissions could be classified as "accidents". Eight per cent were considered to be due to abuse or neglect, and in 6% of the cases it was found that the family's emotional or social situation was involved. Children injured non-accidentally were found to be more likely to require skin grafting and intensive care unit treatment. They were also more likely to come from one-patient families and to have burns in both hands or both legs. It appears from the statistics presented that many children who suffer non-accidental burns have a history of other types of abuse or neglect.

Andronicus M., Oates R.K., Peat J., Spalding S., Martin H.
Burns, 24: 552-8, 1998.

RECREATIONAL-OUTDOOR BURNS: THE IMPACT AND SEVERITY. A RETROSPECTIVE REVIEW OF 107 PATIENTS
Leisure time activities often involve the use of fire (camping, barbecues, etc.), and fire-related accidents are not rare. This article provides a retrospective review of 107 patients admitted to a burns centre in the USA between 1986 and 1996. It was found that the average burn injury had an extent of 5.7% TBSA (range, 1-47%). The majority of patients were either small children or intoxicated adults. Fifty patients required a total of 92 operations. Severe morbidity included four amputations and two mortalities. The average hospital stay was 14.3 days (range, 1-52 days). It is concluded that campaigns promoting public awareness of this everyday fire hazard should be encouraged.

Phillips B.J., Kassir A., Anderson B., Schiller W.R.
Burns, 24: 559-61, 1998.

EXTRACORPOREAL MEMBRANE OXYGENATION IN THE TREATMENT OF INHALATION INJURIES
Respiratory insufficiency is an important cause of death in children who have suffered smoke inhalation and burns. To combat this condition, conventional ventilation is not always able to maintain adequate tissue oxygenation, to achieve which a possible, though little used, method is extracorporeal membrane oxygenation (ECMO). This method has proved its usefulness in severe neonatal respiratory failure, and has also been used successfully in children and adults. Two cases are presented of children who developed severe breathing problems that did not respond to maximal ventilation. The patients were treated with veno-venous ECMO for 72 h and 144 h respectively, and both made a full recovery.

O'Toole G., Peek J., Jaffe W., Ward D., Henderson H., Firmin
Burns, 24: 562-5, 1998.

IN VITRO ANALYSIS OF BROMINE CHEMICAL BURNS WITH USE OF FULL-THICKNESS HUMAN SKIN
The burns centre where the authors of this article work is situated in the vicinity of a major factory that produces bromine, with the result that the commonest cause of all chemical burns seen at the centre, in Israel, is related to bromine injury. The parameters of bromine injury were studied in vitro with the use of full-thickness human skin (ITS) specimens obtained during various surgical procedures. The damage was considerable in both the epidermis and the dermis. A decreased viability of epidermal cells was also observed. The permeation parameters of bromine via abdominal HS were calculated by quantitating bromine concentration in the donor and receiving compartments. The quantity of bromine permeating bromine was inversely related to the concentration gradient applied. It would appear on the basis of this study that prompt treatment and early medical intervention may be necessary for the successful healing of both mild and severe cases of burning injury.

Eliaz M., Grossman N., Katz S., Zur-Maschiach R., Grunwald M.H., Reuveni H., Rosenberg L., Kost J.
J. Burn Care Rehabil., 19: 18-24, 1998.

A STUDY OF FUNCTIONAL VIABILITY AND METABOLIC DEGENERATION OF HUMAN SKIN STORED AT 4 °C
The purpose of this study was to ascertain whether an in vitro assay could be as reliable as an in vivo assay in determining the viability of human skin stored at 4 'C. A number of allografts from six human donors were stored in RPM1 1640 tissue culture medium at 4 'C. At regular intervals the skin specimens were tested concurrently by two different viability assays: transplantation onto surgically created defects on nude mice, and intracellular enzyme activity, using a 4-hour serniquantitative micromethod system activity. In the first 15 days of storage, human graft survival on the nude mice showed a 100% rate, declining to 50% by storage day 30. The APT ZYM assay (Biomerieux Vitek Inc., Hazelwood, Mo.) showed a comparable progressive decrease in enzyme activity as regards skin storage time. The API ZYM assay is simple and rapid to use, and produces reproducible results. Compared with the biological model it is cost-effective.

Chang P., Rosenquist M.D., Lewis R.W. 11, Kealey G.P.
J. Burn Care Rehabil., 19: 25-8, 1998.

MANAGEMENT OF MASSIVE CALVARIAN EXPOSURE IN YOUNG CHILDREN
Massive exposure in children of the calvaria (i.e. more than 75%) presents very serious problems. Four cases are presented of children with massive exposure of nonviable calvaria (average age, 2.9 yr; age range, 22 months to 5.5 yr). The wounds remained open for an average of 28 months (range, 6 to 45 months). The optimal management is staged debridement of the desiccated outer table with a high-speed drill, paying esI ecial care to avoid air embolisms and dural injury in the area of sutures or the fontanelle. The resulting wounds granulate quickly and car be autografted.

Sheridan R.L., Choucair RT, Donelan M.B.
J. Burn Care Rehabil., 19: 29-32, 1998

THE USE W SHEET AUTOGRAFTS TO COVER EXTENSIVE BURNS IN PATIENTS
The recent goal of burn surgeons has been to cover large surface areas with graft . To evaluate the use of sheet grafts in burns of more than 30% TBS A, the percentage covered with sheet and meshed autograft was n viewed in 105 patients admitted to a burns centre in the USA. The results of the survey are presented. It was found that the extremities and the trunk were more often grafted with mesh graft. Sheet grafts were the only coverage in patients with burns of up to 55%. In even 1arger burns, sheet grafts were employed to cover the face and hands. With its superior cosmetic and functional results, sheet autografting should be considered for important cosmetic and functional areas such as the face and hands, in the presence of massive burns.

Archer S.F., Henke A., Greenhalgh D.G., Warden G.W.
J. Burn Care Rehabil., 19: 33-8, 1998.

BURN AREA CHANGES AFTER SUPERFICIAL BURNS IN CHILDWOOD: CAN THEY BE PREDICTED?
It is difficult to predict pigmentation changes after superficial burn injuries. This article analyses a sample of patients with burn injuries, in an attempt to establish clinical indicators of predictable colour changes in burn wounds. A sample of 50 children, mainly with pigmented skin;, who had sustained partial-thickness burns were included in the study. Chemical and electric burns, as well as those requiring skin graftings, were excluded. The skin colour was graded according to the Fitzpatrick scale. The burn site and some unburned areas of control skin were tested for reflectance and luminance. During the first three years of the study, burn site colour changes were variable, but later there was cumulative hyperpigmentation at the burn site, but only if the melanocyte-bearing deep dermis had not been destroyed. There was a significant correlation between hyperpigmentation and skin colour, as quantified by the Fitzpatrick scale (p < 0.01), and between hyperp gmentation and time after injury (p < 0.05).

de Chalain T.M.B., Tang C., Thomson H.G.
J. Burn Care Rehabil., 19: 39-49, 1998.