Burns and Fire Disasters - vol. XIII - n. 2 - June 2000
THE LAING ESSAY: ETHICAL ISSUES IN BURN CAME
This article covers a wide range of ethical issues related to burn care: autonomy (the
right to control one's own life), paternalism (where the physician's action is intended to
benefit the recipient whether the recipient consents or dissents), professional autonomy,
informed consent, legal competence, and responsibility. The funding of health care gives
rise to other considerations. Medicine has made great progress in recent years and
patients with massive injuries can now survive, but the quality of their lives poses some
difficult ethical problems. Mass disasters and war situations are also reviewed. The
ethical dilemma is thus summed up: "It is as ethically unacceptable for one
individual to deny another a chance of life as for society to assume that a severely
disfigured person cannot enjoy life."
Burns, 25: 199-206, 1999
THE EFFECT OF THE
ANTI-ALLERGIC AGENT AVIL ON ABNORMAL SCAR FIBROBLASTS
Abnormal wound healing leads to the formation
of hypertrophic scars and keloids. Such scars accumulate excessive extracellular matrix
proteins owing to two processes: increased synthesis and decreased degradation. With a
view to finding a therapeutic control for the formation of scars, a study was made of the
effect of avil (phenimarine maleate) on fibroblasts cultured from abnormal scars, compared
with normal skin. There was seen to be a decrease in the proliferation rate in cells from
normal skin (39%), hypertrophic scar (55%), and keloid (63%), treated with 8 mM avil (72
h). It was found that the rate of decrease in collagen synthesis in normal skin (44%),
hypertrophic, scar (74%), and keloid fibroblast (73%) correlated with changes in DNA
Venugopal J., Ramakrishnan M.,
Habibullah C.M., Babu M.
Burns, 25: 223-8, 1999
THICKNESS BURNS: AN ANIMAL MODEL FOR STUDIES OF BURN WOUND PROGRESSION
This paper presents a practical,
reproducible, and reliable model that was used to inflict partial-skin thickness burns in
New Zealand white rabbits for use in experimental studies on the influence of drugs on
burn wounds. The wounds were inflicted using a round aluminium stamp which was applied in
a contact area of 4 cm2 at a temperature of 80
°C for 14 sec. The stamp weighed 85 g. The depth of the lesions was measured using
HE-stained paraffin sections. In 80% of cases, the border of the necrotic zone was found
in the central third of the dermis, and in 100% in the central two quarters. These
findings were obtained when the animal hair at the burn infliction site was in the anagen
phase of the growdi cycle. Reproducible results can be achieved if the same parameters are
Knabl J.S., Bayer G.S., Bauer W.A.,
Schwendenwein I., Dado P.F., Kucher K., Horvat R., Turkof E., Schossmann
B.,Meissl G. Burns, 25: 239-45, 1999
STREPTOCOCCUS INFECTION IN BURNS
This prospective study was undertaken in
order to evaluate the incidence of beta-haernolytic Streptococcus infection in our burn
patients. Until December 1992 we used penicillin prophylaxis and we wished to make a
comparison of the two periods before and after suspension of penicillin prophylaxis.
Between January 1993 and December 1997 (i.e. after suspension of penicillin) 14 out of the
1213 burn patients we admitted to our hospital in Kuwait presented either colonialization
or infection with Streptococcus spp. Streptococci were isolated from burn wounds in ten
patients, from the throat in three, and in blood culture in one. Group A Streptococcus was
found in five, group C in three, and group D in six. The organisms were isolated ³ 72 h
post-burn in all patients but one. The infections were kept successfully under control by
means of antibiotics and no detrimental effects wore observed. There were no mortalities.
This study showed that only 1.1% of our burn patients presented Streptococcus, and only
one-third of these were group A. It therefore appears that the use of penicillin
prophylaxis in the first 5 days post-burn may serve no useful purpose and should be
discontinued in burn units where the incidence of this organism is limited.
Bang R.L., Gang R.K., Sanyal S.C.,
Mokaddas E.M., Lari A.R.A.
Burns, 25: 242-6, 1999
DEVELOPMENT IN THE
TREATMENT OF BURNS IN SOUTH AMERICA DURING THE LAST DECADES
This article reviews some 50 years in the
development of burns treatment in South America. The truly scientific approach to the
problem began in the 1930s, and affirmed itself more positively in the 1940s thanks to the
influence of the Latin American Congresses of Plastic Surgery, which started up in 1941.
The first specialized burns facilities date back to the 1950s. The advances then included
more adequate fluid replacement, early excision and grafting, enteral feeding, the use of
new topical antibacterial agents, better prevention and treatment of infection, a deeper
understanding of smoke inhalation injuries, and improved management of physical and
psychological rehabilitation. Burn care in South America has thus dramatically improved in
the last 25 years. The Latin American Committee for Prevention and Care of Burns, founded
in 1964, has become an important factor in the development of burns treatment in Latin
America. Many national burn associations have been created, and in 1991 the Latin American
Federation of Burn Associations was founded. Specialists in South American countries have
remained in the forefront of international scientific developments and represent an
important body of workers devoted not only to the day-to-day treatment of the burned but
also to the academic and scientific aspects of the burns disease.
Benaim R, Artigas Nambrard
Burns, 25: 250-5, 1999.
RELEASES BIOACTIVE FRAGMENTS FROM EXTRACELLULAR MATRIX MOLECULES
An investigation was made of the biological
role of small extracellular matrix fragments in wound healing. Some human burn eschar
tissue was digested with bacterial collagenase, and some small aminoacidic fragments were
inoculated in human dermal fibroblast cultures and in polyvinyl alcohol sponges that were
subcutaneously implanted in rats. We then performed proliferation assays on cell cultures,
and biochemical and histological analyses of the animal model. It was found that
fibroblasts treated with low concentrations of eschar fragments showed a significantly
faster duplication rate than controls. It was also found that the inflammatory response
was increased by eschar-derived fragments at post-operative day 2. Protein and
hydroxyproline synthesis, in contrast, was decreased at day 14. Our findings indicate that
the use of bacterial collagenase to debride necrotic tissue may lead to indirect healing
effects. These effects are due to the local release of bioactive matrix-derived fragments.
Radice M., Brun R, Bemardi
D., Fontana C., Cortivo R., Abatangelo G.
J. Burn Care Rehabil., 20: 282-91, 1999
BILATERAL FACIAL NERVE
PARALYSIS AFTER HIGHVOLTAGE ELECTRICAL INJURY
The case is described of a man who after
receiving a 12,000 V burn suffered bilateral facial nerve paralysis. An exhaustive search
of the literature has not yielded any similar cases involving electrical burns. The
patient began to develop facial weakness on post-burn day 7, with left peripheral seventh
cranial nerve paralysis and a corresponding though lesser deficit on the right. A course
of empirical antiviral therapy did not improve the patient's paralysis, suggesting that
the cause was not viral. Five months after the injury the patient showed remarkable
neurological improvement, but he was still not able to achieve tight closure of the
Vasquez J.C., Shusterman
E.M., Hansbrough J.F.
J. Burn Care Rehabil., 20: 307-8, 1999
THE SEARCH FOR
COST-EFFECTIVE PREVENTION OF POST-OPERATIVE NAUSEA AND VOMITING IN THE CHILD UNDERGOING
RECONSTRUCTIVE BURN SURGERY- ONDANSETRON VERSUS DIMENHYDRINATE
Many children undergoing reconstructive burn
surgery suffer from post-operative nausea and vomiting (PONV). A prospective, randomized
double-blind placebo-controlled test was conducted in order to compare the effects of
ondansetron and dimenbydrinate in the prevention of PONV in children. The patients were
divided into three groups, receiving either 0.1 mg/kg of ondansetron, 0.5 mg/kg of
dimenhydrinate, dr a placebo. It was found that there were statistically significant
reductions in the incidence of PONV in patients receiving ondansetron or dimenhydrinate,
compared with patients receiving a placebo. The differences between ondansetron and
dimenhydrinate were significant. The two treatments were thus equally effective, but
ondansetron was much more expensive than dimenhydrinate ($19.34 per dose for ondansetron
compared with $0.90 for dimenhydrinate).
McCall LE., Stubbs K.,
Saylors S., Pohlman S., Ivers B., Smith S., Fisher C.G., Kopcha R., Warden G.
J. Burn Care Rehabil., 20: 309-15, 1999
THE USE OF THE
MILLARD"CRANE" FLAP FOR DEEP HAND BURNS WITH EXPOSED TENDONS OR JOINTS
The "crane" flap was first
described by Millard in 1969. This procedure enables the surgeon to use a skin flap to
lift, transport, and deposit subcutaneous tissue to cover bones, joints, tendons, and
other vital structures. This type of flap is particularly indicated in deep hand burns
with exposed tendons and joints, which cannot be grafted. We compared results in six
patients treated with the crane flap and five with the conventional abdominal skin flap.
All the crane procedures gave graftable wound beds. The range of movement in all 11
patients six months after surgery did not show any statistical difference. None of the
crane-flap treated hands needed procedures to separate the digits or to debulk the flaps,
whereas all the conventionally treated patients required such procedures.
Matsumura H., Engrav L.H., Nakamura
D.Y., Vedder N.B.
J. Burn Care Rehabil., 20: 316-9, 1999.
BANKED SKIN IN THE PRAGUE BURNS CENTRE
In the Prague Burns Centre human allografts
and xenografts of porcine origin continue to be among the preferred means of temporary
burn wound cover, despite the progress that has been made in material sciences. True
closure is effected only with living autografts on isografts (identical twins). Our method
of preparing fresh porcine grafts has a 25-year history: dermo-epidermal sheets are
obtained in strips, which are then treated with a lavage using chemotherapeurics and
antibiotics, spread on sterile wet gauze, and stored in Petri dishes at 4 °C. Cell
viability is maintained for 10-14 days after transfer to patients. The Prague Skin Bank
started functioning in 1986. Our protocol for skin cryopreservation is as follows:
pre-treated skin is kept in aluminium vessels in containers with liquid nitrogen vapour,
and cryoprotective medium is used with 15% glycerol. At present we produce some 2 million
sq em of skin graft per year.
Broz L., Vogtovą D., Königovą R.
Acta Chirurgicae Plasticae, 41: 54-8, 1999