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Volume XIII |
Number 1 |
March 2000 |
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SUMMARIES
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MOIST EXPOSED BURN THERAPY: EVALUATION OF THE EPITHELIAL REPAIR PROCESS (AN EXPERIMENTAL MODEL)
(Ioannovich J., Tsati E., Tsoutsos D., Frangia K., Papalois A. - Greece)
The purpose of this experimental study was to evaluate the efficacy of moist exposed burn ointment (MEBO) oil epithelial tissue repair and to assess the debriding effect of partial-thickness burn wounds, compared with other local agents commonly used. Eighty burn wounds on ten Ladrace-Pietrenne youngi pigs were induced by C02 laser and the following parameters were evaluated: alterations of the burn wound area using planimetry; physical examination including necrosis, exudation, oedema, and clinical appearance; pH, transepidermal water loss, and moisture of the wound surface; and histological evaluation of burn depth and epithelial repair. Three different local agents (MEBO, povidone iodine, and silver sulphadiazine) were applied twice daily, except in the control group wounds. Evaluation and measurement were performed on days 2, 4, 6, and 8. The following results were found: the measurement of water loss from the wound surface is an objective non-invasive procedure to assess wound healing; MEBO appears to si,!~nificantly accelerate the healing process in partial-thickness burns, compared with the other local agents; measurement of wound moisture may give additional information regarding the wound healing process; MEBO creates a moisturizing environment for a longer period, which enhances wound healing compared with other substances; planimetry is an efficient method to calculate the burn area and the progress of healing in full-thickness burn wounds only; and there is no relation between pH and wound healing.
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CLINICAL INVESTIGATION OF CHANGES IN INTESTINAL MICROFLORA IN BURN PATIENTS AFTER EARLY ESCHARECTOMY EN MASSE
(Jun Chen, Yaping Zhang, Guangxia Xiao - People's Republic Of China)
In order to explore changes in intestinal microflora and their significance in burn patients undergoing early escharectomy en masse (EEEM), six kinds of intestinal microflora bacteria in faeces were investigated in 29 EEEM patients by microbiological methods and compared with those observed in 20 healthy controls. The results showed that there was a clear decrease in the total number of intestinal bacterial. The number of aerobes such as E. coli and Candida in EEEM patients increased more markedly than that of the control. The number of anaerobes such as Bacteroides, Bifidobacteria, and Fusobacteria in EEEM patients decreased more markedly than that in nomial controls, indicating that the ecology of the intestinal microflora was disrupted. Out of 29 patients eight suffered diarrhoea due to intestinal infection. We therefore concluded that the disruption of the ecology of the intestinal microflc,ra existed in the early stage after EEEM. It is characterized by anaerobic bacteria disruption, which can be a major cause of intestinal infection.
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EFFECTS OF TREATMENT WITH IMMUNOGLOBULIN ON BACTERIAL TRANSLOCATION IN BURN WOUND INFECTION
(Herek O., Oztork H., Ozyurt M., Albay A., Cetinkursun S. - Turkey)
The aim of this study was to evaluate the effects of inummotherapy on bacterial translocation in burn wound infection. Thirty-three male albino rats in three equal groups were used in the study. A sham burn group (Group 1) was exposed to 21 "C water. A burn + infection group (Group 11) and a burn + infection + immunoglobulin group (Group 111) were exposed to 95 'C water for 10 see, producing full-thickness bums in 30% total body surface area; Pseudomonas aeruginosa (I X 108) was inoculated immediately after the burn injury. Saline (I ml) was injected intramuscularly in Groups I and 11 as a placebo for four days. Immunoglobulin (500 mg/kg) was administered for four days in Group III after burn injury. All rats were sacrificed on day 5 post-bum. Cultures were performed of the mesenteric lymph nodes, liver, spleen, blood, and caecal contents. Blood samples (1.5 md) were taken for the determination of immunoglobulin levels. Bacterial translocation was not observed in the sham group. A significant increase in bacterial translocation was present in Groups 11 (9/11) and 111 (6/11) on the mesenteric lymph nodes compared with Group I (p < 0.0 1). In contrast, significant decreases in translocation to the spleen (1/11) and liver (0/11) were observed in Group III compared with Group 11 (8/11, 6/11) (p < 0.01, p < 0.05). A significant increase in the total number of bacteria was found in caecal stool cultures in Groups 11 and III compared with Group I ~p < 0.01). These results suggested that the incidence of bacterial translocation to the mesenteric lymph nodes does not significantly change with immunotherapy in burn wound sepsis, while the administration of immunoglobulin protects the immunological and intestinal equilibrium. Immunotherapy therefore prevents the spread of translocated bacteria from the mesenteric lymph nodes to other sites.
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BURNS IN PREGNANCY
(Napoli B., D'arpa N., Masellis M., Graziano R. - Italy)
Two cases are reported of bums in pregnancy. After a survey of the literature and a discussion of the incidence of bums in pregnancy, the physiopathology of spontaneous uterine activity is considered together with aspects of the treatment of bums and obstetric management in relation to maternal and foetal prognosis.
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EFFECT OF ASPIRIN ON INTERMEDIATE BURN SURVIVAL IN RATS
(Shalom A., Westreich M. - Israel)
Aspirin does not improve intermediate burn zone survival. It is possible that the active metabolites of cyclo-oxygenase are not important in intermediate burn zone survival, but other possibilities exist. It may be that administration post-burn does not reverse the noxious tissue events that cause cell death, or that aspirin must be given for a longer period of time. This suggests that aspirin is probably not beneficial in the clinical setting for the improvement of burn wound survival and healing.
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LIMB SALVAGE IN A BURN PATIENT WITH A MUSCLE-FREE FLAP
(Cavadas P.C. - Spain)
A clinical case is described of massive thigh burn with exposure of the femur in which the possible necessity of hip disarticulation was avoided. This drastic surgical treatment often proves necessary in very deep thermal burns of the lower limb that leave bones and joints exposed. In the case described, a rectus abdominis muscle free flap was applied after partial bone debridement of the femur. The case was complicated by the occurrence of an open pathological subtrochanteric, fracture. A solid intramedullary rod was successfully applied and the fracture consolidated. The patient recovered his ability to walk.
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TREATMENT OF POST-BURN DEFECTS IN THE UPPER MEMBER
(Martinez-Sahuquillo Marquez J.M., Jimenez Cordoba G., Martinez-Sahuquillo A. - Spain)
Defects in the burned upper member vary in relation to the following factors: the severity of the burn, inadequate management, and general or local complications. Accurate treatment can reduce the impact of the defects. Injuries in the joints, the arms, and the hands are considered. Various combinations of injuries are also described. The successive steps in the reconstruction process are presented.
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RECONSTRUCTIVE OPERATIONS FOR POST-BURN SCAR DEFORMITIES AND CONTRACTURES OF THE NECK
(Moroz V.Y., Yudenich A.A., Kafarov T.G., Sarygin P.V., Sharobaro V.I., - Russia)
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RESUSCITATION APPROACH AND CLINICAL EVALUATION IN BURN VICTIMS AFTER MASS ACCIDENTS - PART ONE
(Hadjiiski O., Rashkov V., Emanuilov J., Lubomirov M. - Bulgaria)
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IDENTIFICATION MEDICO-LEGALE DE VICTIMES DE BRULURES LORS DE CATASTROPHE AERIENNE
(Costagliola R., Telmon N., Duguet A-M., Rougt D. - France)
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