Annals of Burns and Fire Disasters - vol. XIII - n° 1 - March 2000

SKIN SUBSTITUTES IN BURNS
A survey is presented of the development of skin substitutes until the present day. The current reality is that skin substitutes are designed to be either temporary or permanent. The uses and formulations of temporary and permanent substitutes now available are reviewed and future directions in skirt substitute research are speculated upon. Current temporary substitutes include porcine xerrograft, synthetic membranes, and allogenic l~,.iiii)~)iai.y,siibstitutes which are described. Current epidermal and dermal substitutes are also presented, as well as composite substances. Future developments point to the creation of temporary dressings containing growth factor secreting allogenic tissues that stimulate native wound healing and to the realization of a permanent composite skin replacement. Progress may also be expected in the field of temporary skin substitutes and improvements in skin banking techniques.

Sheridan R.L., Tompkins R.G.
Burns, 25: 97-103, 1999

CHANGES IN CIRCULATING LEVELS OF INTERLEUKIN 6 IN BURNED PATIENTS
Changes in serum interleukin 6 (IL-6) levels were determined by using serial serum levels in 10 burned patients (burn injury 30-85% TBSA). Five patients recovered and the other five, all septic, died. The results obtained were compared with changes in body temperature and serum TNF-ot and IL-8 determined previously. There was a good correlation between the dynamic changes of circulating levels of the three cytokines TNF-ec, IL-8, and IL-6 in the ten patients. Serum levels of these cytokines were significantly higher in the septic patients. It is concluded that all three cytokines studied may play a significant role in the pathophysiology of sepsis in burned patients.

Yeh F.L., Lin W.L., Shen H.D., Fang R.H.
Bums, 25: 131-6, 1999

CORRELATION BETWEEN FUNGI ISOLATED FROM BURN WOUNDS AND BURN CARE UNITS
A prospective study was made of fungal isolates from burned patients and from burn care units. It was found that the most frequent isolate both in the burn patients and in the burn units was Aspergillus niger. Ulocladium was the commonest isolate in the control group (other areas in the hospital). Aspergillus terreus, Penicillium and Zygomyeetes, all of which were recovered from burn patients, were also found more often in burn care units than in the control group. The findings suggest that there is a potential risk of fungal infection that can be acquired from the immediate surroundings of patients in burn care units. It is therefore recommended that periodical decontamination should be carried out in burn care wards.

Mousa H.A., Al-Bader S.M., Hassan D.A.
Bums, 25: 145-7, 1999

CARE OF BURNS VICTIMS IN EUROPE
A survey is presented of the care of burns victims in European countries. The opinion is expressed that there is a need for a central information point where data and facts relating to all aspects of burn patient care could be collected, creating a central iniormation resource. A European-wide service could thus be called on in the event of a severe fire disaster. Figures are given regarding licspital capacities in all European countries, the number of burn centres, the number of adult/child beds and ventilators, and overall nurnher of admissions. Various disasters (San Juanico, Bashkiri. Los AVaclues, Rarnstein, and others) are referred to, and the lessons learned should be widel) circulated. The international exchange of inforruation is important, as for example by the Arbeitsgemeinschaft flir Verbrefinungsbehandlung, the European Burns Association, and the Mediterranean Club for Burn and Fire Disasters. The Ramstem disaster in particular showed that in certain circumstances (disaster in a well-populated area, pre-existing disaster plans) such disasters can be dealt with efficiently and to the general benefit of all concerned.

Wedler V., Kiffizi W., BUrgi. U., Meyer V.E.
Bums, 25: 152-7, 1999

ACUTE RENAL FAILURE IN SEVERELY BURNED PATIENTS
Acute renal failure (ARF) has been reported to be found as a complication in between 0.5 and 30% of admissions to burn hospitals, depending on the severity of the bums and on the definition of ARF. With a view to analysing possible pathogenic and prognostic factors associated with ARF in burn patients, a retrospective survey was made of the files of 328 patients with burns in over 10% body surface area in a bums centre in Munich over a 4-month period (January-April 1998). The rate of ARF was found to be 14.0%. The patients with ARF were treated by continuous arteriovenous haernofiltration (CAVH) for a mean period of 10.5 days (range 1-47). CAVH had a complication rate of 10%. Most of the complications were associated with the vascular access in the femoral artery. The mortality rate in patients suffering from ARF was 85%, death being due to multiple organ failure in 83% of the cases. Only burned BSA and inhalation injury were significantly correlated with the onset of ARF. The factors of age, burn surface area, day of onset of ARF, and the duration of renal replacement therapy were not significant for comparing survivors with non-survivors and were thus not predictive for survival rate.

Holm C., Hdrbrand E, Henckel von Donnersmarck G., Miffilbauer W.
Bums, 25: 171-8, 1999

SELF-INFLICTED BURN INJURIES
Self-inflicted bums are uncommon in western culture, with a range of 1-9% of total burn admissions reported in different studies. A 9-yr retrospective review of admissions to a bums centre in Pittsburgh, USA, found that 11 out of 1135 burn admissions (0.97%) were due to self-inflicted bums. Of these 11, ten had a previous psychiatric diagnosis (major depression in six cases, schizophrenia in three, and a personality disorder in one case). The eleventh patient was diagnosed during hospitalization as suffering from major depression. Two of the patients were attempting to commit suicide. It is recommended in the light of this review that patients with an abnormal psychological profile (including suicidal orientation) should be adequately monitored and followed by trained mental health professionals. Greater awareness of the potential dangers may help to reduce such self-inflicted injuries in the future.

Erzurum V.Z., Varcelotti J.
J. Burn Care Rehabil., 20: 22-4, 1999

COST REDUCTION STUDIES IN BURN NUTRITION SERVICES: ADJUSTMENTS IN DIETARY TREATMENT OF PATIENTS WITH HYPONATRAEMEA AND HYPO. PHOSPHATAEMIA
This paper describes two simple cost-saving strategies that could be adopted by bums centres. They relate to two projects that were carried out with a view to trimming costs due to two phenomena frequently observed in burn patients: hyponatraemia in children and hypophosphataemia in severely burned adults. The use of adult enteral formulae for paediatric patients reduced the incidence of hyponatraemia and the need for expensive sodium supplements. The prophylactic administration of oral phosphate in the first days of hospitalization was found to lessen the decline in serum phosphate, thus reducing the cost of treating hypophosphataemia in severely burned patients. Both the strategies described were successful in cutting costs in the two categories of patients considered.

Mathews J.J., Aleem R.F., Gamelli R.L.
J..Burn Care Rehabil., 20: 80-4, 1999

IMMUNOHISTOCHEMICAL ANALYSIS OF BURN DEPTH
The techniques normally used for the assessment of burn depth (visual examination; ultrasound and circulatory monitors, including laser Doppler; and thermography) require either very expensive equipment or considerable technological expertise. Clinical judgement may be adequate in very shallow bums and full-thickness bums, but problems of differentiation arise between superficial and deep dermal bums. Employing an in vitro model it has been found that by using cryosections and an immunofluorescent staining method, it is possible to achieve quicker and more clear-cut results than those offered by standard light microscopy techniques. The proposed method helps to define burns that will benefit from early excision and grafting. This experimental model, if further investigated, could become standard practice in routine clinical use.

Ho-Asjoe M., Chronnell C.M., Frame J.D., Leigh I.M., Carver N.J.
Burn Care Rehabil., 20: 207-11, 1999

MORTALITY IN PAEDIATRIC BURNS IN THE PRAGUE BURNS CENTRE (1994-1997)
A survey is presented of the mortality of severely burned children who were hospitalized in the Intensive Care Unit, Prague Bums Centre between 1994 and 1997. Overall 345 children were treated (age range, 3 months-15 yr; bums in 1-88% TBSA, mixed superficial and deep bums). There were no fatalities due to burn shock in the early postbum period. Five children who died after suffering deep bums in more than 50% TBSA presented at necropsy signs of infection-related multiple organ system failure. It is concluded that meticulous clinical care and an interdisciplinary approach are necessary to prevent sepsis and multiple organ failure. This means: stabilization of whole-body haemodynamics with adequate tissue perfusion; support of the gut barrier (early enteral feeding, proper management of burn wounds (early excision + early closure); regular infection control of all possible sources of infection in patients, staff, and ICU equipment.

Kriptier L, Broz L., Kiinigovd R., Bouska 1. Acta Chirurgiae Plasticae, 40: 79-82, 1998

BACTERIOLOGICAL MONITORING IN THE PRAGUE BURNS CENTRE
The Prague Burn Centre regularly monitors microbial flora. The microbiological aspect of the prevention of nosocomial infections in the Centre consists primarily of the surveillance of bacterial flora and its antibiotic resistance. The patients are examined by conventional methods (swab taking in burn sites) and also by the printing method. This permits a semi-quantitative assessment of the colonization of burn areas. An investigation of the bacterial contamination in the external environment of the Department is also carried out, as also colonization in the nursing staff. Sensitivity to antibiotics is examined in all the strains isolated; the knowledge thus gained is important for deciding therapeutic possibilities and for the Centre's antibiotic policy. The typing of bacterial strains makes it possible to determine their epidemiological markers, and consequently to estimate their presence in the Centre. The most frequent isolate has been found to be S. aureus and the prevalence of MRSA is relatively high. With regard to gram-negative rods the strains of P. aeruginosa, K. pneumoniae, and E. cloacae are isolated most frequently isolated. A number of typing methods revealed endemic spread of some strains of rarely isolated species (E. agglomerans, S. marcescens, A. bauniannii, etc.).

Vrankova L, Bendova E., Konigova R., Broz L.
Acta Chirurgiae Plasticae, 40: 105-8, 1998