This prospective study was carried out with the aim of investigating the prevalence of nosocomially contracted Clostridium difficile, which is an important cause of diarrhoea in patients in two intensive care units (ICU) and a burn unit in three teaching hospitals in Kuwait. Over a one-year period, stool/rectal swabs were taken from 344 patients in these three hospitals. The presence of Clostridium difficile and/or its toxin was detected by serial culturing of specimens on differential, selective, and enriched media and use of the TOX-A/B text, first on admission and then at weekly intervals until discharge. Of the 344 patients, 263 (77%) were evaluable. All these patients presented on admission negative stool culture/toxin. Of these 263 patients, 25 (9.5%) acquired Clostridium difficile during the period of their hospitalization (13 in one ICU, nine the other ICU, and three in the burn unit. Eight patients (32%) developed diarrhoea attributable only to Clostridium difficile and/or toxin, while the remaining 17 (68%) were asymptomatic. No patients suffered from pseudomembranous colitis. In these patients, diarrhoea was associated with the use of antibiotics, the main cause being third-generation cephalosporins. The prevalence of hospital-acquired Clostridium difficile infection/colonization was under 10%. Once acquired, diarrhoea developed in approximately one-third of such cases, which suggests that the Clostridium difficile infection/colonization endemic in the hospitals investigated is transmitted among hospitalized patients.
Rotimi V.A., Mokaddas E.M., Jamal W.Y., Verghese T.L., El-Din K., Junaid T.A.
Med. Principles Pract., 11:23-8, 2002
Although patients with extensive burns survive today ever more frequently, we still do not dispose of a durable and reliable permanent skin replacement. A pilot trial of a composite skin replacement (CSR) was carried out. The CSR was developed by culturing autologous keratinocytes on acellular allogenic dermis. This was grafted onto patients with massive burns and compared with a matched wound covered with split-thickness autograft. Twelve wounds in seven paediatric patients were grafted with CSR and a matched control wound was covered with a split-thickness autograft. The average age of the children was 6.4 ± 1.4 yr and their average burned body surface was 75.9 ± 5.0%. There were nine acute burns and three were reconstructive releases. Successful vascularization averaged 45.7 ± 14.2% at 14 days (range, 0-100%) in the study wounds and 98 ± 1% (range, 90-100%) in the control sites (p < 0.05). A reduced CSR take period appeared to correlate with wound colonization. All seven children survived. Although CSR did not engraft with the same reliability as standard autograft, this pilot trial is encouraging since it shows that successful wound closure with CSR is possible, even if it is not yet dependable. A more mature epidermal layer could possibly facilitate engraftment, and further trials will explore this possibility.
Sheridan R.L., Morgan J.R., Cusick J.L., Petras L.M., Lydon M.M., Tompkins R.G.
Burns, 27: 421-4, 2001
HOW LONG CAN CRYOPRESERVED
SKIN BE STORED TO MAINTAIN ADEQUATE GRAFT PERFORMANCE?
The preservation of skin graft for the purpose of delayed application continues to be essential to burn treatment and plastic reconstructive surgery. The demand for skin allografts has greatly increased and the responsibility for processing, storing, and evaluating the graft performance of preserved skin is now an important issue for banking organizations. The experiments described in this article were designed to determine how long cryopreserved cadaver skin could be stored while still maintaining adequate graft performance. A mouse recipient model was used. Cryopreserved human cadaver skin stored for 5, 6, or 7 yr was grafted on Balb/c mice, and primary take was evaluated by gross observation and predetermined histological criteria after 7 days. It was found that the graft performance of cryopreserved skin decreased with time. This was shown by in the lower percentage of samples with a high score of separate histological criteria after prolonged storage. However, paired comparison analysis between cryopreserved and fresh skin indicated that this decrease was not significant after a 5-yr storage; the decrease became significant after 6 yr. Linear regression analysis demonstrate that there was no correlation between the score of histological criteria and storage period for up to 65 months. These results are consistent with the paired comparison analysis. It is suggested that this in vivo model and analysis could be used as an evaluation procedure for the transplantation performance of banked skin.
Ben-Bassat H., Chaouat M., Segal N., Zumai E., Wexler M.R., Eldad A.
Burns, 27: 425-31, 2001
Tissue expansion is possibly the greatest advance in burn reconstruction in recent times, but there are few reports on serial tissue expansion for the reconstruction of burns in the head and neck, the topic considered in this paper. Fourteen children (mean age, 7.8 yr; age range, 3-11 yr) in a period of nearly 11 yr had a total of 67 expanders placed. Fourteen children underwent expansion on the first occasion, 14 again on a second occasion, 10 on a third occasion, and one on a fourth occasion. The rate of the major complication (expander extruding prior to termination of process of expansion) after the first, second, and third expansion was respectively 21, 25, and 14%. In all the cases, the burn scar was completely excised or reduced in size. Serial tissue expansion can certainly be taken into serious consideration as a useful method of reconstruction in head and neck burns.
Hudson D.A., Arasteh E.
Burns, 27: 481-7, 2001
The purpose of this paper was to assess the impact on the rehabilitation of burn patients in a tertiary burn centre of a skin care programme run by a skin care team. Although a matter of great importance, skin care is sometimes neglected in the general management of burns. Freshly healed burn skin is fragile, itchy, dry, and susceptible to sunburn. Without proper skin care, burn patients may have sleep and mood disturbances, depression, and poor compliance to treatment - all of which can jeopardize the rehabilitation process. Since February 1996, skin care at the Prince of Wales Hospital in Hong Kong has been managed by a team composed of a plastic surgeon, a dermatologist, an occupational therapist, and a nursing specialist. The role of the various members of the team is also discussed.
Ho W.-S., Chan H.H., Ying S.Y., Cheng H.S., Wong C.S.
Burns, 27: 489-91, 2001
Phosphorus burns may be a rarely encountered chemical burn, but they do occur, typically in battle, in industrial accidents, or owing to firework accidents. Death may result even if the burn area is minimal. Early recognition of the affected areas and adequate resuscitation is crucial. The 2765 admissions of burn patients between 1984 and 1998 considered in this article from Taiwan included 326 patients with chemical burns. Seven of the admissions were related to phosphorus burns. Our treatment protocol comprises 1% copper sulphate solution for neutralization and identification of phosphorus particles, copious normal saline irrigation, maintenance of moist wounds by means of saline-soaked thick pads, prompt debridement of the affected areas, and porcine skin coverage or skin grafts for acute wound management, plus intensive monitoring of electrolytes and cardiac function in our burns centre. Intravenous calcium gluconate is mandatory for correction of hypocalcaemia. Of the seven patients, one died of inhalation injury, while the others were scheduled for sequential surgical procedures for functional and cosmetic recovery. The cooling of affected areas with tap water or normal saline, the prompt removal of phosphorus particles with mechanical debridement, intensive monitoring, and maintenance of electrolyte balance are all critical steps in early management. Fluid resuscitation can be adjusted on the basis of urine output. Our phosphorus burn treatment protocol can be summarized as early excision and skin autografts.
Trong-Duo ChoU , Tz-Win Lee, Shao-Liang Chen, Yeou-Ming Tung, Nai-Tz Dai, Shyi-Gen Chen, Chiu-Hong Lee, Tim-Mo Chen, Hsian-Jenn Wang
Burns, 27: 492-7, 2001
Various aspects of wound repair involve the gelatinases, matrix metalloproteinase-2 and -9 (MMP-2 and MMP-9). Little is however known about MMP-2 and MMP-9 activity in impaired wound-healing animal models. The purpose of this paper was to compare serial gelatinase activities for 25 days after full-thickness excision wounds in genetically diabetic healing-impaired mice and their non-diabetic non-healing-impaired litter mates. Wound samples were frozen, homogenized, clarified by centrifugation, and analysed on zymography gels, and MMP bands were quantitated relative to a conditioned media standard from HT-1080 cells. After the mice were wounded gelatinase activity increased in both diabetic and non-diabetic mice. The levels of latent gelatinases peaked earlier in diabetic wounds, and there was more active MMP-2 and MMP-9 in diabetic mice wounds than in non-diabetic mice wounds. As the higher gelatinase activity in diabetic mice wounds was similar to the higher levels of gelatinase reported in difficult-to-heal wounds such as ulcers and burns, this diabetic mouse model could be useful in studies of these proteinases and their inhibitors in impaired wound healing.
Neely A.N., Clendening C.E., Gardner J., Greenhalgh D.G.
J. Burn Care Rehabil., 21: 395-402, 2000
Lawn-mower-related accidents are a frequent cause of injury. The most frequent types of such injury result from contact with the mower blades and from shrapnel-type injury caused by rocks and other objects scraped up and thrown by the rotating blades. Power lawn mowers can also be a source of burn injury. This paper reports on 27 lawn-mower-related burn injuries in 24 males and 3 females. Three of the persons suffering burn injuries were children. Burn extent ranged from 1 to 99% of total body surface area (mean, 18.1%). Two patients died. Hospital stay ranged from 1 to 45 days. Twenty-six injuries involved petrol (gasoline), which was frequently associated with refuelling accidents. Safety measures are very important and children should be kept away from lawn mowers that are in use. Stress is also laid on he proper use and storage of petrol.
Still J., Orlet H., Law E., Gertler C.
J. Burn Care Rehabil., 21: 403-5, 2000
In the past, patients with burn injuries tended to remain in hospital for long periods for completion of their wound care, whereas today considerations of cost-effectiveness often lead to patients being discharged before their burn wounds are fully healed. This situation emphasizes the need for home care nurses who are capable of managing complex burn care. This study evaluated patient outcomes in three different periods: 1. before visiting nurses participated in a burn care education programme; 2. after visiting nurses participated in a burn education programme; and 3. after implementation of a burn clinical pathway. A random sample of 54 patient records from the first two periods and the entire sample of 12 records from the third period were reviewed. The demographic variables included age, sex, race, percentage of total body surface area burned, and the burn mechanism. The outcome variables assessed were weight maintenance, wound infection, pain management, unplanned readmission to the burn unit, and the documentation of patient education. The findings of this study indicate the positive impact of education combined with the use of a burn home care clinical pathway.
Mamolen N.L., Brenner P.S.
J. Burn Care Rehabil., 41: 440-5, 2000