Volume XIII

Number 1

March 2000

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 bum ointment (MEBO) oil epithelial tissue repair and to assess the debriding effect of partial-thickness bum wounds, compared with other local agents commonly used. Eighty bum wounds on ten Ladrace-Pietrenne youngi pigs were induced by C02 laser and the following parameters were evaluated: alterations of the bum 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 bum 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 bum wounds only; and there is no relation between pH and wound healing.

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 bum 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.

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 bum wound infection. Thirty-three male albino rats in three equal groups were used in the study. A sham bum group (Group 1) was exposed to 21 "C water. A bum + infection group (Group 11) and a bum + 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 bum 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 bum 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 bum 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.

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.

EFFECT OF ASPIRIN ON INTERMEDIATE BURN SURVIVAL IN RATS
Shalom A., Westreich M. - Israel
Aspirin does not improve intermediate bum zone survival. It is possible that the active metabolites of cyclo-oxygenase are not important in intermediate bum 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 bum wound survival and healing.

LIMB SALVAGE IN A BURN PATIENT WITH A MUSCLE-FREE FLAP
Cavadas P.C. - Spain
A clinical case is described of massive thigh bum 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.

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.

ABDOMINAL WALL RECONSTRUCTION IN AN ELECTRICAL BURN WITH A MYOCUTANEOUS TENSOR FASCIAE LATAE ISLAND FLAR CASE REPORT
Cavadas P.C. - Spain
High-voltage electrical injuries often cause full-thickness defects in the abdominal wall, which are difficult to reconstruct. A case is reported of periumbilical reconstruction using a tensor fasciae latae (TFL) myocutaneous flap in an 8-yr-old boy who had sustained severe electrical injuries. The operative procedure is described, in which a right TFL myocutancous island flap was used. The treatment described led to satisfactory results.

MASS DISASTERS. BULGARIAN COMPLEX PROGRAMME FOR MEDICAL CARE FOR PATIENTS WITH BURNS AFTER FIRE DISASTERS
Hadjiiski O. - Bulgaria
A medical programme for action in the event of mass burns is described. It is the result of the observation of 20 mass accidents, with 155 victims, that occurred in Bulgaria in the period 1990-97. The programme is in line with the recommendations of similar programmes such as that of the Mediterranean Club for Burns and Fire Disasters and with national demands for such programmes. The programme is in two parts. It includes pre-hospital management at the place of the accident - non-medical medical aid, first medical aid, and pre-hospital transport - and hospital treatment in hospitals not specialized in burns, inter-hospital transport, and treatment in specialized burns centres.

EXTENSIVE KELOIDS IN THE AURICLE - SURGICAL TREATMENT BY MEANS OF AUTOLOGOUS GRAFTS
Masellis M., Ferrara M. M. - Italy
This article considers two cases of keloid formation in the auricle. Keloids usually affect the dermis and are characterized by the presence of thick collagenous fibres of vitreous and hyalinized aspect. Some related fibroblasts are also present. ln the early stages the formations tend to be more vascularized, especially in peripheral zones, while in the more mature phase they are more hyalinized. The removal of an ample keloid, as in the cases reported here, and the repair of an exposed area with a dermo-epidermal full-thickness skin graft cause both general and specific modifications in the healing process. The removal of an ample keloid, as reported here, and the repair of an exposed area with a denno-epidermal full-thickness skin graft cause both general and specific modifications in the healing process. The surgical techniques employed are described and the various problems involved are considered. Although only two cases are considered, the experience obtained makes it possible to repropose the treatment of keloids with the free skin graft technique, at least in cases located in the auricle, without the supplementary assistance of medical or physical therapy.