Annals of Burns and Fire Disasters - vol. XII - n° 3 - September 1999

SUCCESSFUL UTILIZATION OF ECMO TO TREAT AN ADULT BURN PATIENT WITH ARDS
A case is presented of an adult who suffered thermal burns and adult respiratory distress syndrome (ARDS) and was treated with extracorporeal membrane oxygenation (ECMO). This is the first case reported of such a patient who survived. The 26-yr-old man had sustained 12% thermal burns to the face and anterior trunk, as well as inhalation injury which was detected bronchoscopically. As a result of low oxygen saturation the patient required increasing F10, The parameters measured indicated severe ARDS. The patient failed volume control ventilation. Pressure ventilation was attempted but proved inadequate. The patient was thus transferred to a hospital able to provide ECMO treatment, where he received venovenous ECMO. After six week-, the patient was taken off all ventilatory support.

Patton M.L., Simone M.R., Kraut J.D., Anderson H.L. 111, Haig L.R., jr
Burns, 24: 566-8, 1998

DEEP ELECTRICAL BURNS OF THE CALVARIUM: EARLY OR DELAYED RECONSTRUCTION?
This article presents three cases of deep high-energy electrical burns of the calvarium. All the patients suffered massive electrical burns of the soft tissues of the head and underlying skull and they were all successfully treated using specially tailored methods in each individual case. A discussion is made of the surgical aspects involved, i.e. the timing of osteoneCrectomy, reconstruction, and the choice of methods for the covering of the extensively denuded brain.

Norkus T., Klebanovas L, Vikgraitis S., Astrauskas T., GUlunas L, Rinakus R., Zobakas A.
Burns, 26: 569-72, 1998

NEUROLEPTIC MALIGNANT SYNDROME IN A BURN PATIENT
Neuroleptic malignant syndrome (NMS) is an occasionally encountered life-threatening complication of drug therapy, generally developing as a reaction to the administration of certain drugs, e.g. butyrophenones (Haloperidol), phenothiazines, and thioxanthenes. A 39-yr-old male with a 55% total body surface area burn developed the syndrome. On post-burn day 31 his temperature was 108.4 'F (42.2 'C). This high fever was reduced by the use of Dantrolene and Bromocripteme. In view of this kind of case NMS should be included as part of the differential diagnosis of fever in burn patients receiving medication known to cause the syndrome.

Still J., Friedman B., Law E, Deppe S., Epperly N., Orlet H.
Burns, 24: 573-5, 1998

CORRECTION OF POST-BURN CONTRACTURE OF WRIST WITH ILIZAROV METHOD
Post-burn contracture of the hand presents difficult problems as joint deformities are invariably present in severe long-standing cases.
A case is reported of severe post-burn contracture in a man aged 44 yr who had suffered burns at the age of 6 months. He presented a history of recurrent ulceration and a suspected Marjolin ulcer. The deformity was successfully corrected by means of gradual distraction in an llizarov frame. This method appears to be superior to the plaster of Paris cast and more versatile than other forms of external fixation.

Madhuri V., Dhanraj P.
Burns, 24: 577-8, 1998

BURN INJURIES FOLLOWING EXPLOSIONS OF CAR HEATERS
Burns due to the explosion of hot coolant in the heating unit of motor-vehicles are not uncommon and deserve special attention because of the danger not only of the explosion itself but of the possible road accidents they can lead to. Four such cases are described in which the overheating of the unit caused an explosion. Because of the type of accident the body parts most exposed to injury are the lower limbs, genitalia, and buttocks. Three of the four patients healed spontaneously with the topical application of silver sulphadiazine cream.

Fulcurvishi K., Tanaka H., Maruyama J., Takahhashi H., Kitagishi H., Veshima U., Marayuma K., Sakata l.
Burns, 24: 581-3, 1998

LOCAL ANAESTHETICS IMPROVE DERMAL PERFUSION AFTER BURN INJURY
The aim of this study was to evaluate the effects of the topical and systemic administration of amide local anaesthetics on dermal per~ fusion after deep partial-thickness burn injury in rats. It was found that the topical and systemic administration of local anaesthetics prevented dermal ischaemia. The mechanism of the action of the local anaesthetics could be by direct action on the vasculature or indirect by inhibition of several mediators of the inflammatory cascade.

Rinsson A., Brofeldt B.F., Nellgdrd P., Tarnow P., Cassuto J.
J. Burns Care Rehabil., 19: 50-6, 1998

TRAUMATIC URETHRAL FISTULA IN A PATIENT WITH BURNS
Urethrocutaneous fistula is a common complication of peri-urethral abscess but spontaneous healing of the fistula is rare. Urethra fistula has been reported after electric burns to the perineum. Such an unusual case is reported in this article, concerning a 22-yr-old man who sustained 10% flame burns in the upper extremities, lower abdomen, and perineum. A Foley catheter was placed, and marked oedema was observed. On day 5 post-burn, a small laceration was noticed at the right side of the penoscrotal junction. The resulting fistula needed surgical treatment. The oedematous perineum in patients with burn injuries must be carefully managed in order to prevent tearing at the penoscrotal junction.

Balakrishman C., Maralani S., Emanuele J.A.
J. Burn Care Rehabil., 19: 57-8, 1998

TRILAMINAR SKIN COVERAGE COMBINED WITH CULTURED EPITHELIAL AUTOGRAFTS - A NEW TECHNIQUE FOR TREATING THE ELDERLY PATIENT WITH BURN INJURIES
The creation of split-thickness skin graft donor sites in elderly patients with burn injuries may lead to associated morbidity. In view of this danger, an attempt was made to minimize the donor site area and to maximize autografts by means of a new technique using trilaminar harvesting of skin grafts with dermolipectomy closure, and permanent coverage of the autograft layers obtained with cultured epithelial autografts, in an 80-yr-old man with 15% TBSA burns in the lower extremities and buttocks. All twelve meshed split-thickness grafts showed excellent take, and the cultured epithelial autograft take was about 90%. The dermolipectomy sites healed uneventfully. This procedure thus proved useful for the permanent closure of full- and partial-thickness burns in an elderly patient.

Haith L.R., Moss B.E., Kraut J.D., Patton M.L., Germain T.J.
J. Burn Care Rehabil., 19: 59-61, 1998

PILOT STUDY OF A UNIQUE FILM DRESSING FOR THE TREATMENT OF DONOR SITE WOUNDS
This prospective, randomized, controlled pilot study evaluated the clinical benefits of using the VENTEX Wound Dressing System (VWDS) (The Kendall Co.) in the treatment of donor sites. One donor site was managed using VWDS, while the other donor site on the same D.W.
patient was managed by the Authors' standard of care involving the use of Xerofonn gauze (The Kendall Co.). The results are presented. The use of VWDS eliminated donor site pain and accelerated reepithelialization compared with Xeroform gauze. No adverse reactions were associated with the use of VWDS, which was however more complicated to apply and use. No differences were observed the in scar quality of donor sites treated with these dressings.

Himel H.N., Ratliff C.R., Baruch L,D., Rodeheaver G.T.
J. Burn Care Rehab., 19: 62-5, 1998

A PROSPECTIVE ANALYSIS OF SERUM VITAMIN K IN SEVERELY BURNED PAEDIATRIC PATIENTS
Burn patients may exhibit multiple risk factors for the development of vitamin K deficiency. These include malabsorption, limited enteral intake, antibiotic therapy, and multiple surgery. In order to evaluate serum vitamin K values during the first 4 weeks post-burn, a prospective assessment of 48 burned children was carried out at the Shriners Burns Institute, Cincinnati (USA). The findings presented suggest that there is a relationship between coagulopathy and an intact functioning gastrointestinal tract. The relative importance of dietary versus endogenous vitamin K produced by intestinal bacteria still however remains to be clarified.

Jenkins M.E., Gottschlich M.M., Kopcha R., Khoury J., Warden
J. Burn Care Rehabil., 19: 75-81, 1998