Volume XII

Number 2

June 1999

FIRE DISASTER AND BURN DISASTER: PLANNING AND MANAGEMENT
Masellis M., Ferrara M.M., Gunn S.W.A. - Italy
Disaster planning and response require ever more scientific elaboration. All phases of the rescue processneed an efficient managerial system, from prediction and prevention to preparedness, immediate medical response, assistance, and rehabilitation. Definitions are given of the various types of disaster. A thermal agent disaster is "a disaster causing severe losses in liuman lives and material goods as a result of massive heat production." Bum disaster can be defined as "the overall effect of the massive action of a known thermal agent on living beings. It is characterized by a high number of fatalities and of seriously burned patients with a high potential rate of mortality and disability." Any health management plan in the event of a burn disaster must include: a) rapid evaluation of the extent of the disaster; b) specific and rapid health assistance response on site; c) assessment of the capacity of local specialized structures to receive burn victims; d) selective evacuation of the injured away from the disaster zone. Disaster plans, like those for any other types of rescue operation, will be no more than empty words unless they are tested in training programmes, made intelligible to the general public, supported by adequate resources, and updated as necessary. The acquisition of emergency capability by ordinary people is a sign of civil and cultural progress, but the most important factor of all is disaster preparedness.

EPIDEMIOLOGICAL SURVEY OF CHILDREN'S BURNS IN BULGARIA AND A BURN PREVENTION PROGRAMME
Hadjiiski 0., Dyakov R., Atanassov N. - Bulgaria
A burn prevention programme was developed following an epidemiological study of 2161 children conducted at the Centre for burns and Plastic Surgery in Sofia, Bulgaria, over the 7-year period 1986-1993. The results of the study have determined the main points for the development of a prevention programme directed at kindergarten and primary school children. The main points are burn accident prevention behaviour, burn accident behaviour, and the awareness of the necessity of safe behaviour. The long-term goal of the project is to reduce the number of burned children through burn awareness and prevention. The programme has been published in two separate books: "Protect from burns - nine easy lessons for pre-schoolers" and "Protect ourselves from burns - thirteen lessons for children in primary school". The programme has been approved by the National Fire Department and the Bulgarian Red Cross. The Ministry of Education, Science, and New Technologies has approved the books as authorized texts for use in primary schools.

AETIOLOGIES AND OUTCOMES OF BURNS IN INFANTS UNDER ONE YEAR OLD
Arslan E., Dalay C., Cinaroglu E, Aksoy M.K., Acarturk S. - Turkey
Between January 1993 and December 1997, 711 burn victims were hospitalized in the Burns Care Unit of Balcali Hospital in Adana, Turkey, of whom 39 (5.48%) were under 12 months old. Of these 39 infants (mean aged 9 ± 0.5 months ± S EM), 26 were male and 13 female. Burn extent ranged between 5 and 9 1 % T BSA. The main aetiological factors were hot water and mi lk scalds, fl ame, and electricity. There were 11 deaths overall (28.20%). The mortality rate was 37.5% among infants aged 0-6 months and 25.801 among infants aged 7-12 months. The mean burn extents, in these two age groups, were respectively 22.87% and 20.25%. The mortality rate was 58.33% in burns > 25 % and 85.71% in burns > 30 %. The results indicate that burns in infants are serious traumas and have higher mortality rates than in other age groups. As infant burns are preventable, education of the parents is a basic requirement.

GRAM-NEGATIVE BACTERIAL SURVEILLANCE IN BURN PATIENTS
Arslan E., Dalay C., Yavuz M., Gocenler L., Acarturk S. - Turkey
A retrospective study of gram-negative bacterial surveillance from the wound swab cultures of burn patients treated in a major burn unit in Adana, Turkey, was performed. Over a 17-month period, 232 swab cultures from 114 patients were evaluated and 176 gram-negative micro-organisms were isolated. Pseudomonas aeruginosa was the organism most frequently isolated (53.97%). Imipenern-cilastatin was the most active antibiotic to P. aeruginosa (44%) and to all species (58%). The results showed a very serious antibiotic resistance of micro-organisms isolated from burn wounds. Surgical excision in order to remove infected and necrotic tissues from the body is thus confirmed as a routine basic procedure for the management of burn wounds, and antibiotics should be regarded as supportive agents.

ACUTE COLONIC PSEUDO-OBSTRUCTION (OGILVIE'S SYNDROME) - A RARE COMPLICATION OF SEVERE THERMAL INJURY. REPORT ON TWO CASES
Tsoutsos D., Tsakou E.G., Lykoudis E., Stamatopoulos C., Tatoulis R, Ioannovich J. - Greece
Two cases of acute colonic pseudo-obstruction (Ogilvie's syndrome) in patients with extensive burns arc presented. Tile clinical symptoms, diagnostic approach, and therapeutic measures are analysed and discussed in relation to their impact on burn patient survival and outcome.

TRAITEMENT URGENT ET INTERMEDIAIRE DES LESIONS PROVOQUEES PAR LE COURANT ELECTRIQUE DE HAUT VOLTAGE
Colic M., Jovanovic M., Beokovic M. - Yougoslavie
En cas de lésions électriques, une chaleur extrême se génère par la résistance tissulaire lors du passage du courant électrique à travers ces tissus. Un itinéraire imprévisible à travers le corps et les différentes réactions de certains tissus rendent cette lésion spécifique par rapport aux autres types de lésions thermiques. Comme une forme unique et destructive du trauma thermique, le trauma électrique représente une combinaison de brûlure cutanée et de dysfonction des tissus profonds, dont la profondeur et l'étendue sont imprévisibles. La, lésion provoquée par le courant électrique a pour conséquence une perte rapide et presque immédiate du liquide corporel dans la région de destruction tissulaire, ainsi qu'une libération de myoglobine dans la circulation depuis les cellules musculaires lésées, de petites quantités d'hémoglobine résultant de la destruction des érythrocytes et d'autres substances intracellulaires provoquant les acidoses métaboliques graves. L'aspect le plus important de la réanimation initiale des patients lésés par le courant électrique est la compensation du liquide perdu. La baisse du pH sanguin dans les lésions électriques est beaucoup plus importante que dans les lésions proprement thermiques, c'est-à-dire dans les brûlures, et elle est le résultat d'une grande quantité de produils acides de destruction issus du tissu dévascularisé et dévitalisé.

MODULATION BY ASPIRIN OF PLATELET FUNCTION IN BURN PATIENTS: CLINICAL AND LABORATORY ASSESSMENT
Kamel A.H., Ahmed Y.A.A., Thabet N.M., El-Haish M.K. - Egypt
A study was carried out on twenty burn patients in order to study the effect of aspirin on burn wound healing and platelet function. The patients were equally divided into two groups, a classic group and a group that received aspirin. The use of aspirin in an antithrombotic dose (150 mg/day) starting from the first day post-burn was found to enhance burn wound healing, without any complications.

USE OF MEPITEL ON GRAFTED AREAS IN BURN PATIENTS
Deveci M., Sengezer M., Kopal C. - Turkey
Autografting is the best procedure for replacing skin defect due to deep dermal burn. Currently, textile dressings are frequently preferred for grafts. This dressing material does not however fix the graft sufficiently well and may damage the graft, also causing maceration and pain in the graft area during dressing changes. In this study, a silicone-coated polyamide dressing material was used for graft dressing and its effects on graft take rate were investigated. Silicone-coated polyamide (Mepitel/SCA Molnlycke) is an elastic transparent, non-adherent, porous material. Mepitel's porous structure permits wound exudate to pass directly into absorbent dressings. Mepitel adheres to dry skin but not to moist wounds. In this study, conducted between May 1997 and May 1998, eighteen patients (mean age, 23 yr; mean total body surface area burned, 12%) were treated at the GUlhane Military Medical Academy Burn Centre in Turkey. All the patients had Mepitel dressings applied over their grafts. Suction compresses were changed on post-operative day 4 without Mepitel being removed. The compresses were changed until post-operative day 8-12, but not Mepitel. The grafts were easy to observe because of Mepitel's transparence, and exudate was evacuated by its porous structure. Graft take was above 90% in all cases. Minimal graft loss was observed in patients receiving Mepitel as a graft dressing. In conclusion, Mepitel was found to be effective for graft take and facilitated the observation of haernatorna and serorna.

EXPANDED SUPRACLAVICULAR ARTERY ISLAND FLAP FOR POST-BURN NECK RECONSTRUCTION
Abdel-Razek E.M. - Egypt
Burn scar contractures involving the anterior neck represent a surgical problem for the plastic and reconstructive surgeon. To improve functional and cosmetic results we used a new technique by means of which we obtained a large amount of skin with the same functional and cosmetic properties as neck skin. This new idea consists of expansion of the supraclavicular area supplied by the supraclavicular artery, followed by transmission of the expanded fasciocutancous flap based on the same artery as an island flap to cover the anterior neck after release and excision of post-burn scars. This technique was used in eleven patients suffering from postburn mentosternal contracture. All the flaps healed primarily with good functional and cosmetic results, and the donor sites closed primarily without any tension.

NEVER TOO LATE? BURNS AND FUNDAMENTALISM
Raveh T., Eldad A. - Isdrael
This article considers how inadequate treatment may aggravate burn wounds. Two case histories are presented. Sometimes surgical treatment is recommended by a patient's physician but opposed by the family's religious adviser. It is recommended in such cases that there should be meetings with the counsellor so that the consequences of purely conservative treatment may be fully appreciated.