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Volume XIII |
Number 2 |
June 2000 |
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Summaries
| 67 |
MORTALITY OF THE PAEDIATRIC BURN POPULATION TREATED AT THE
VIRGEN DEL ROCIO UNIVERSITY HOSPITAL, SEVILLE, SPAIN IN THE PERIOD 1968-1999
(Gomez-Cia T., Franco A.,
Mallen J.M., Gimeno M.A., Fernandez-Mota A., Marquez T., Portela C., Lopez I. - Spain)
Changes in medical
treatment protocols have led to a significant reduction in the mortality of the paediatric
population treated at the Bum Unit of the Virgen del Rocfo University Hospital in Seville
(Spain) in the last 30 yr. An analysis was made of the probability of death in two groups
of patients under 9 yr with bums in:5 45 % body surface area: Group A (1451 admissions
between 1968 and 1977) and Group B (312 patients admitted between January 1993 and January
1999). In Group A, approximately one-hundredth of the patients admitted with the above
characteristics died, while in Group B the mortality rate was one in three hundred. The
findings in these two groups of patients during the two periods are compatible with those
published by other authors. Some changes in the clinical protocols might explain the
improvements achieved, e.g., resuscitation therapy adapted to each individual case, with
early use of colloids; strict hypercaloric and hyperproteic nutrition; early escharectomy
and subsequent closing of the wound. |
| 73 |
TREATMENT AND MORTALITY TRENDS AMONG MASSIVELY BURNED
PATIENTS
(O'mara M.S., Caushaj R,
Goldfarb I.W., Slater H. - Usa)
Despite advances in burn
care techniques, there remains a trend towards therapeutic failure in patients who sustain
burns in more than 60% total body surface area (TBSA). Predictors of survival that have
been seen include age, bum size, amount of full-thickness burn, inhalation injury,
mechanism of bum, timing and appropriateness of resuscitation, and concurrent
complications. We reviewed the data of patients with 60% or greater TBSA bums seen at our
Burn Trauma Unit over the past five years. The purpose of this was to evaluate our
practices as well as the success of current therapy. During the time period reviewed 39
patients were admitted with this significant level of injury. They were all treated with
appropriate resuscitation and early excision and grafting. All available demographic,
historical, therapeutic, and outcome data were gathered. Statistical analysis was
undertaken to identify variables, which presented significant differences between the
group of survivors and that of patients who died. Of the 39, 28 patients succumbed. Larger
burns, more full-thickness burns, inhalation injury, the need of escharotomy, and
anuria/oliguria were all associated with a decreasing chance of survival. Delay in arrival
at the burn trauma unit was also associated with poor outcome, as was earlier first
operative excision. Greater bums severity led to basic malfunctioning of the physiological
response, as seen in the inadequate effect of resuscitation: essentially, the more
extensive the burn the higher the likelihood of mortality. The key to improving our
ability to treat massively burned patients seems to lie in be;ter and prompter
resuscitation, better treatment of pulmonary injury, and better understanding of how to
halt the underlying deteriorating physiological process in more severe bums. |
| 77 |
ACUTE RENAL FAILURE IN SEVERE BURNS. CONCLUSIONS AFTER
ANALYSIS OF DEATHS DURING 1998
(Belba M. Belba G. -
Albania)
This article focuses on the
presence of acute renal failure (ARF) in deceased patients during 1998. We describe the
clinical situations in which ARF occurs. These include bum shock, massive necrotic tissue
(especially in electrical and chemical), burns, endotoxic shock from gram-negative
bacteria, and hypercatabolic states with multiple organ failure. We believe that there are
two essential aspects that medical staff must keep in mind in the treatment of severe bums
- prevention and the treatment of ARF. |
| 81 |
GASTROINTESTINAL HAEMORRHAGE IN BURN PATIENTS - THE
EXPERIENCE OF A BURNS UNIT IN SAUDI ARABIA
(Fadaak H.A. - Saudi
Arabia)
Gastrointestinal (G1)
ulceration complicated by haemorrhage used to be a potentially lethal complication of
major thermal injury. Prophylactic treatment with antacids or H2-receptor blockers has
dramatically reduced the incidence in many bum units. Early enteral feeding has recently
been shown to be an effective additional measure in stress ulcer prophylaxis. Our
experience with stress ulcer prophylaxis at the King Fahd Hospital of the University Burns
Unit (Saudi Arabia) in the management of 1040 patients over 14 yr is described in this
paper. The overall mortality was 5.38% (56 cases). Of the total admissions, nine patients
developed G1 bleeding (0.86%). The group with significant bums, i.e. bums in more than 20%
total body surface area, suffered GI bleeding in 3.28% of cases. The commonest
presentation was melaena during the terminal stages of septicaemia. Surgical intervention
to control bleeding was required in two out of the nine cases. Of the seven other patients
who died owing to thermal injury, massive bleeding was directly responsible for death in
only one patient. While septicaemia is a risk factor, it seems that prophylaxis with
H2-receptor antagonists and early enteral feeding significantly reduced the incidence of
bleeding in this series. |
| 84 |
THE COMPLICATIONS OF BURNS IN THE NEWBORN PERIOD
(S. Golubovic Z., Parabucki
D., Jawic G., Zamaklar D., Najdanovic Z., Rakic I. - Yugoslavia)
Over a four-yr period we
treated five children under one month of age for severe burns. All the burns were of
iatrogenic origin. The injury mechanisms were: 1. bathing the child in water that was too
hot; 2. use of a hot water bottle to increase the temperature in the incubator (two
cases); 3. use of a hot water bottle without an incubator; 4. incorrect fitting of the
thermocautery electrode to the child's crura. In all but one of the patients we used the
method of tangential excision after definite demarcation of the necrotic surface. To cover
the burn areas we used homograft skin from the parents and subsequently free skin
transplants from the babies themselves. On the basis of our experience we consider it
imperative to treat burns in neonates following the same principles as in older children.
Sepsis was a major complication in one case but was adequately treated with antibiotics.
Later complications were post-osteomyelitis sequelac and contractures in scars in the
groin region. |
| 87 |
THE SYSTEM OF ACTIVE SURGICAL MANAGEMENT OF SEVERELY
BURNED PATIENTS WITH DEEP BURNS AND COMBINED INJURIES (BURN AND BLOOD LOSS)
(Atyasov N.I. - Russia)
Purpose-oriented infusion
therapy and intensive treatment proved to be successful in restoring skin coverage in a
cohort of over 3000 severely burned patients prior to the development of irreversible
changes. Owing to the enhancement of the body's defensive mechanisms it became possible:
to shorten the period of wound cleansing of necrotic tissues; to accelerate the local
treatment of wounds in the presence of daily dressings in the pre-operative period and
speed up the healing of donor sites by means of improved reparative processes; to shorten
the time gap between repeated surgical operations, thus achieving a maximum overall gain
in time, which was extremely important for the patient's recovery; to minimize the
detrimental effect of autoinununization on graft take by reducing the number of repeated
surgical interventions (in the presence of infusions that increase in volume up to a
maximum level, as the patient's state improves); and to prevent the increasing threat of
peri-operative shock by performing preventive infusions under pressure at the most
traumatic moments. It was found opportune to cover the wounds with large-sized, closely
adjoining skin flaps, a procedure that yielded better functional and cosmetic results and
helped to restrict indications of allogenic and meshed grafts. The system was developed in
fifty-two dissertation papers, and its implementation in clinical practice helped to save
the lives of patients previously regarded as doomed to die. |
| 92 |
INTERDIGITAL BRIDGING FOR TREATMENT OF THE BURNED HAND
(Ullmann Y.,Lerner
A.,Shtein H.,Peled I.J. - Israel)
A simple method is
presented for bridging between burned fingers in order to keep the webs open during and
after surgery. This "trick" can be tried when Kirschner wires are used during
surgery for stabilization of the interphalangeal and metacarpophalangeal joints.
Horizontal wires are connected to the free ends of the intradigital wires by means of bone
cement. Stabilization of the skin grafts is easier, fewer bandages are needed, and good
preservation of the webs can be achieved. Our experience is based on the patient described
and on four others, in whom the method was used to treat burned hands. |
| 94 |
L'EXPANSION TISSULAIRE DANS LE TRAITEMENT DES SEQUELLES DE
BRULURES DE L'EXTREMITE CEPHALIQUE
(Adouani A., Zili H.,
Landoulsi A., Mouafak M., Lasta S. Brahem H., Zairi L, Moktar M., Seghir M. - Tunisie)
L'expansion tissulaire a
enrichi l'arsenal thérapeutique en chirurgie réparatrice. L'étude d'une serie de 57 cas
de séquelles de brûlures de l'extrémité céphalique, traitées par l'expansion
tissulaire, permet de dégager que ce procédé donne des résultats satisfaisants au
niveau du cuir chevelu, mais moins intéressants au niveau de la face et du cou,
essentiellement pour des raisons anatomiques. |
| 98 |
PIEDMONT FOUNDATION OF STUDIES AND RESEARCH ON BURNS: THE
LAST THREE YEARS OF RESEARCH ACTIVITY
(Teich Alasia S. - Italy)
An account is given of the
main activities of the Piedmont Foundation of Studies and Research on Bums. The results of
latest research are presented, together with important developments in the field of
pathological scarring, new methods of skin cryoconservation, and peripheral sensory nerve
regeneration after extensive bums. All the Foundation's efforts endeavour to promote close
and productive links between researchers and clinicians in the field of bums in order to
achieve significant advances in this important field of medical science. |
| 101 |
THE EFFECT OF THE DELAY PHENOMENON ON THE ZONE OF
STASIS,IN BURNS: AN EXPERIMENTAL STUDY IN RABBITS
(Isik S., Kopal C.,
Karakalioglu O., Selmanpakoglu N. - Turkey)
Twenty-five New Zealand
white rabbits (weight 3.0 ± 0.5 kg) were used to study the destiny of skin responding to
ischaernia in experimental bums. In the first group, dorsal delay flaps (4 x 10 cm) with
the caudal pedicle (N°5) were elevated in two stages and sutured to their donor sites. On
day 7 of elevation, dorsal acute flaps the same size were elevated counterlaterally to the
delay flaps. The extent of the distal necrotic areas was calculated one week later. In the
second group, delay flaps were elevated and rows of bums were created in the distal half
of the flap (N°10). A probe (0.5 x 1 cm of each) was heated in boiling water and applied
four times on the skin for 20 sec in such a fashion that a cross-shaped interspace area
(0.5 cm, in width) was achieved. The same pattern of bum was created on the normal skin
next to the flap. In the third group, delay flaps and acute flaps were elevated in the
abovementioned fashion and the same pattern of bum was created in the distal halves of the
flaps. Tests, including laser Doppler flowmetry, nuclear irnaging, and autoradiography,
were performed on days 1 and 7 post-bum. In the first group, the average necrotic area in
the acute flaps was 310.4 mm2, and all the delayed flaps survived. Bum rows
were then created 2 cm proximally to the distal edges of the flaps in groups 2 and 3. In
group 3, the distal necrosis of the acute flaps was significantly increased to 774 ± 138
mm2 on day 7. The laser Doppler flowmetry measurements revealed decreased
distal circulation in the acute flaps, and 4.5 ± 2.2 perfusion units in the delay flaps
on day 7 post-bum. The amount of necrotic change in burned areas in group 2, as calculated
from autoradiographies, was found to be 316 ± 62 mm2 in normal skin and 274 ±
45 mm2 in delay flaps on day 7. In group 3 the amount was 288 ± 54 mm2
in delay flaps and 680 ± 41 mm2 in acute flaps. To conclude, it seems that the
mechanism involved in the saving of ischaemic tissues does not significantly save the zone
of stasis in burns. |
| 107 |
RESUSCITATION APPROACH AND CLINICAL EVALUATION IN BURNS
VICTIM AFTER MASS ACCIDENTS - PART TWO. HAEMATOLOGICAL STUDY AND ANALYSIS
(Hadjiiski O., Rashkov V.,
Emanuilov L., Lubomirov M. - Bulgaria)
This study continues our
exploration of the treatment of patients with burns suffered in mass accidents (Part One
was published in the March 2000 issue of Annals of Burns and Fire Disasters). We
observed the changes in various laboratory parameters, such as the dynamic of the
haemoglobin and haematocrit levels, proteins, potassium, sodium, and the acid-base balance
related to the application of Baxter's modified scheme in the treatment of burn patients
in the first three days post-bum. Our results show a normalization of haematocrit and
protein levels, plus a stable electrolyte balance and satisfactory normalization of the
acid-base level |
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