Volume XIV

Number 1

March 2001

ETUDE EPIDEMIOLOGIQUE ET PRONOSTIC DE 78 PATIENTS ADMIS DANS UN NOUVEAU ET PROVISOIRE CENTRE DE BRULES DIE L'HOPITAL DE CRUCES, BARACALDO, VIZCAYA, ESPAGNE
(Fdez. Samaniego F., Torrero V., Sancho M., Iglesias C., Pijoan J.I., Gabilondo F.J. - Espagne)
Les Auteurs décrivent le nouveau et provisoire Centre de Brulés qui appartient au Service de Chirurgie Plastique de l'Hopital de Cruces à Vizcaya en Espagne. Its analysent une série de facteurs en 78 patients admis dans le centre pendant la période d'un an (1999). La moyenne d'age des patients était de 43 ans (gamme, 1-87 ans), dont 52 étaient hommes et 26 femmes. Les jeunes d'age inférieur a 15 ans étaient six. La flamme et 1'ébouillantement constituaient le 93% des facteurs étiologiques. Les accidents domestiques et les accidents du travail ont été les plus frequents dans notre etude (51% et 45%, respectivement). La moitié des patients ont été admis dans le centre en moins de 2 h après 1'accident (gamme, 0-20 h). La provenance a correspondu a 46 de Vizcaya et le reste d'autres départements. La moyenne de la superficie brulée était de 22.6% (gamme, 3-100%). L'hospitalisation moyenne au Centre de Brulée était de 12 jours (gamme, 0-43 jours); la moitié restait moins de 11 jours. Le 50% avait une permanence totale A FH6pital de moms de 15 jours, avec une permanence moyenne de 17 jours (gamme, 0-48 jours). La mortalit6 6tait de 13 patients (16%). L'6tendue de la bralure, Page et 1'inhalation des fum6es ont 6t6 les facteurs qui ont influenc6 principalement dans la mortalit6. Les Auteurs r6vi.sent les complications qui ont eu lieu et les causes qui ont comribu6 a la morbidit6 et a la mortalit6. Finalement, its exposent leurs conclusions.

USE OF GLUCOCORTICOIDS IN A BURN PATIENT WITH ADULT RESPIRATORY SYNDROME
(Ramos G., Patiho O., Sanchez Luceros D., Bolgiani A., Brunoldi D.,Prezzavento C., Benaim F. - Argentina)
We present a male patient with burns in 23% body surface area. He developed adult respiratory distress syndrome (AF;DS) and septic shock during evolution. Although infection was under control, respiratory failure and vasopressor agent requirements did not improve until glucocorticoid treatment was initiated. Glucocorticoid treatment allowed us to take the patient off mechanical ventilation and suspend vasopressor agents during the first week of treatment. The use of glucocorticoids in burn patients, whether suffering from ARDS or septic shock, is controversial. However, it may be effective in the fibroproliferative phase of ARDS and septic shock with infection under control, as in the case presented.

EVALUATION OF "MICROMAT" DRESSING (VISCOSE POLYMER VEHICLE FOR CHLORHEXIDINE) IN PARTIAL-THICKNESS BURNS AND SKIN GRAFT DONOR SITES
(Bhattacharya S., Ahuja R.B., Topaz M., Tripathi C.D. - India)
In this study, "Micromat"® 0.5% (a chlorhexidine-impregnated viscose polymer dressing) was evaluated for treatment of partial-thickness burns and split skin graft donor sites with a dual objective: one, to compare the dressing with traditional methods, and two, to study viscose polymer as a vehicle for delivering chlorhexidine. Only fresh cases of partial-thickness burn injury between 10-25% total body surface area (TBSA) in patients over 12 years of age were included in the study. All consecutive split skin graft donor sites harvested with a Watson's modified Humby's knife were included for the other part of the trial. Thirty patients with partial-thickness burns and 30 split thickness skin graft donor sites were evaluated. In nine patients with 20% TBSA deep dermal injury, mirror-image areas of burns were available for comparison. In these, one side was dressed with 1 % silver sulphadiazine cream, which acted as a control. Burn dressings were changed after 72 h, or as warranted by the state of the wound and the patient's general condition. Additionally, in six patients with 20% TBSA burns, chlorhexidine estimation was performed in blood. In split skin graft donor sites, the proximal half was dressed with Micromat 0.5% and the distal half with ordinary paraffin gauze (Fairlie, Johnson & Johnson). The dressings were allowed to separate by showering after 10-11 days. We observed no difference in the healing rate or pattern between Micromat treated wounds and controls. Amongst the burn patients there was no conversion of partial-thickness injury to full-thickness in either group. Many burn wounds treated with Micromat were found to be dry at the time of dressing change. Also, there were no complications like wound sepsis or septicaemia requiring substitution of the local antimicrobial agent or a need for systemic antibiotic in any of the patients. Chlorhexidine could not be detected in the blood sample of any patient. Thus, for partialrhickness burn injury in up to 25% TBSA, treatment with Micromat compares favourably with 1% silver sulphadiazine cream, and For treatment of skin graft donor sites the results of Micromat and ordinary paraffin gauze are comparable, and the former has the added advantage of delivering an effective antibacterial agent. It was also observed that viscose polymer was an effective vehicle for delivering chlorhexidine. Micromat dressing was easy to handle and relatively non-adherent, and had a capacity to absorb the discharge.

ADVANTAGES OF AN ADHESIVE HYDROCELLULAR DRESSING IN THE TREATMENT OF PARTIAL-THICKNESS SKIN GRAFT DONOR SITES
(Reali U.M., Martini L., Borgognoni L., Brandani P., Andriessen A.)
This study describes the effective performance of an adhesive hydrocellular dressing versus paraffin gauze in the treatment of skin graft donor sites. A total of 50 patients were included in the study, each patient acting as his/her own control. An equal half of the donor site was treated with the trial dressing; the other half was treated with paraffin gauze. Cost-effectiveness, time to complete epithelialization, ease of dressing application, ease of dressing removal, and pain upon removal were assessed. The trial dressing demonstrated a statistically significant faster healing time (p < 0.000001) and enhanced patient comfort, and was shown to be cost-effective.

ANTIBACTERIAL ACTIVITY OF HONEY ON BACTERIA ISOLATED FROM WOUNDS
(Subrahmanyam M., Archan Hemmady, Pawar S.G.)

EXPERIENCE WITH EARLY TANGENTIAL EXCISION IN THE MANAGEMENT OF DEEP DERMAL BURNS ON THE DORSUM OF THE HAND
(Fadaak H.A. - Saudi Arabia)
Thermal injury of the hand deserves special consideration because it affects not only the patients' functional capability but also their long-term rehabilitative potential. The aim of treatment in dorsal hand injury is to restore wound coverage and movement within 14 days of injury, in order to avert sequelae. Early tangential excision and skin grafting coverage on deep dermal burns on the dorsum are predictably successful in restoring function in both the short and the long term. Since 1990 the author has practised this method for treating the burned hand. A total of 27 hands in 19 patients were available for treatment. The age of the patients ranged between 6 and 45 yr, with a male preponderance. Tangential excision and grafting were carried out during the second week post-burn in the majority of patients, mainly because of the severity of burn in terms of body surface area, which necessitated prolonged stabilization. There was partial graft loss in five hands, while none developed infection. All the patients were followed up for at least six, months, and at the end of one year eight hands were available for review. The grafted hands showed excellent recovery of early function and nearly normal appearance and feel; the patients had good compliance with physiotherapy and an early return to work.

SAUVETAGE D'UN COUDE PAR LAMBEAU ANTEBRACHIAL SUITE A UNE ELECTRISATION
(Chafiki N., Terrab S., Diouri M., Bahechar N., Boukind E.H.)
Les brûlures électriques par courant de haute tension sont génératrices de lésions graves, se concluant souvent par des amputations des membres. Nous rapportons un cas de sauvetage de coude sur membre supérieur précieux électrisé moyennant la couverture par un lambeau sur le pédicule radial et à flux antérograde avec un résultat fonctionnel acceptable. La prévention demeure la meilleure approche.

LA PLASTIE EN IC DANS LES SEQUELLES DE BRULURES DES GROSSES ARTICULATIONS A PROPOS DE 150 CAS
(Joiucdar S., Kismoune H., Boudjemia F., Bacha D., Agrane A. - Algérie)
Les brides retractiles des plis axillaires, inguinaux et poplites representent les sequelles les plus communes des brulures. Leur frequence est lice aux difficuites de 1'appareillage durant la cicatrisation, aux restrictions apportees à la reeducation par la douteur et Fatteinte generale lors de la phase aigue des brulures et aux aleas de 1'excision greffe precoce dans ces regions aux reliefs irreguliers et à grande mobilite. L'utilisation de la peau same voisine dans le traitement des retractions apres brulures est 1'orientation de choix de notre attitude chaque fois que c'est possible. La plastie en IC est un procede simple rapporte par Baux et collaborateurs dans le traitement des retractions axillaires apres brulures. Nous Favons etendue aux sequelles inguinales et poplitees. Le principe est Fincision simple de la bride perpendiculairement à son bord libre. C'est le I et la couverture par un lambeau de rotation, c'est le C dessine sur la peau saine. En fonction de 1'incision du I qui aboutit à a liberation complete, le lambeau de recouvrement est dessine, la largeur est determinee en fonction des rapports habituels longueur largeur et aussi des possibilites locales de peau saine. L'arrondi du lambeau en C fait qu'apres sa rotation, it recouvre les berges de 1'incision en I. La surface denudee par la levee du lambeau est fermee par approximation sous drainage on greffee, cette greffe se situant en zone non mobile. Le materiel d'etude porte sur 150 patients: 115 patients portaient des sequelles axillaires necessitant 203 plastics en IC en fonction des atteintes bilaterales droites et gauches et des atteintes des piliers anterieurs isolees on concomitantes; 23 patients portaient des sequelles inguinales necessitant 46 plasties en IC; et 12 patients prdsentaient des sequelles poplitees necessitant 18 plastics en IC. Au total 267 plastics ont ete pratiquees. Les complications - necrose, suppuration, lachage de suture, ainsi que les recidives - sont analysees. Cette technique simple et fiable derivant de la plastie en Z permet de resoudre une grande partie des brides des plis des grosses articulations

MARJOLIN'S ULCER OF THE SCALP: CASE REPORT AND LITERATURE REVIEW
(Malheiro E., Pinto A., Choupina M., Barroso L., Reis J., Amarante J.)
This paper presents the case of a 32-year-old woman with a large, infected, and ulcerated squamous cell carcinoma in the parieto-occipital region. A review of the literature regarding patients with burn scar carcinoma is also presented.

A COMPARATIVE STUDY OF CEREBRAL OEDEMA WITH MAGNETIC RESONANCE IMAGING AND PATHOLOGICAL EXAMINATION IN THE EARLY STAGES OF SEVERELY BURNED DOGS
(Li Haitao, Ying Dajun, Ding Shiyi, Bian Xiuwu, Yang Zongcheng, Sun Jiansen - China)
Fifty-two dogs were randomized into a control group, a simple burn group (SB), a burn with sodium lactate group (BSL), and a burn with glucose solution group (BGS). The manifestations of the dogs in the control group were compared with those in wounded groups in the early stages (6, 12, 18, and 24 h) after severe burn (50% TBSA III degree) using magnetic resonance imaging i;MRI) and pathological observation (gross appearance, light microscopy, and electron microscopy). The earliest finding of brain oedema was seen 12 h after burn in the BGS group, which exhibited brain swelling as an MRI characteristic. The decrease of the signal intensity ratio (SIR) on TIW1 was not observed until it was above 10%. SIR on T2W1 increased by 8.29% (p < 0.05) 24 h post-burn. It was difficult to distinguish grey matter from white matter at the boundary line, which could not be seen later. Histological changes of brain oedema were observed as early as 6 h post-burn, accompanied by swelling of endothelial cells and perivascular astrocytes. Vacuolation look place in neurons 12 h post-burn, with ischaemic necrosis of varying degree of the capillary endothelium, neurons, and axons. 'these changes became more marked with the lapse of time. The BGS group showed the most obvious consequences mentioned above 24 h post-burn. The results indicated that the model of brain oedema after severe burn had features of both vasogenic oedema and cellular toxic oedema as regards MRI and pathology.