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Volume XV |
Number 2 |
June 2002 |
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SUMMARIES
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BURN INJURIES - TREATMENT OF BURN PATIENTS PRIOR TO ADMISSION TO THE EMERGENCY DEPARTMENT
(Siamanga H. - Greece)
When we speak of burns, we do not mean just superficial, localized injuries but also injuries involving all systems of the human body. The causes of burn injuries are thermal, chemical, electrical, and others. Burns can be divided into three categories: superficial burns (first-degree burns), partial-thickness burns (second-degree burns), and full-thickness burns (third-degree burns). The factors that determine the seriousness of a burn are: 1. depth; 2. extent; 3. localization; 4. age; 5. co-existing illnesses; 6. presence of inhalation burns; 7. co-existing injuries. With regard to the first-aid treatment of patients suffering from thermal or electrical burns, we hold the burned area under cold water in order to cool the affected tissues, unless the burns are extensive or third-degree. We never prick the blisters and we never remove clothing adhering to the wound. We place the patient on the ground if the clothing is on fire. The successive phases of burns treatment in the emergency department are described, as also immediate treatment.
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| 59 |
THE ADMISSION OF BURNED CHILDREN TO THE HOSPITAL MARIA PIA IN OPORTO
(Banquart Leitão, Abel Mesquita - Portugal)
A survey was made of 22 burned children treated in the Hospital Maria Pia (Oporto, Portugal) between February and August 1999. The criteria for admission were burns in up to 15% body surface area, absence of traumatic lesions, and age under 13 yr. Age, origin, accident details, burn agent, kind of lesion and body area, length of hospital stay, and surgical interventions were considered.
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| 61 |
PROPOSAL FOR A RECOVERY PROTOCOL FOR BURN PATIENTS IN THE ACUTE PHASE, WITH REFERENCE TO THE MOST RECENT MEDICAL AND SURGICAL TECHNIQUES USED AT THE TURIN BURN CENTRE
(Arena D., Giraudo L., Rossato A., Sarzi L. - Italy)
Recent improvements in surgical therapy and the availability of new covering materials have modified the timing of treatment during the recovery of burn patients. This article proposes a detailed scheme that considers all the possible variations and will be of use to treatment specialists.
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| 64 |
IS FLUID RESTRICTION NECESSARY FOR PATIENTS WITH CUTANEOUS BURNS AND ASSOCIATED LATER PULMONARY COMPLICATIONS?
(Yu-Wen Tang - Taiwan)
Patients who have both inhalation injury and cutaneous thermal injury require more resuscitation fluid in the acute stage than patients who have cutaneous thermal injury only. In the later interval after burn injury, pulmonary complications (infiltration, oedema, pneumonia, and adult respiratory distress syndrome) are usually noted in septic patients with critical conditions. Fluid restriction with intensive fluid monitoring is suggested in most reports. It is general practice to limit urine output amount to around 0.5 ml/kg/h, which is considered adequate. Since these patients usually present severe sepsis, poor renal and gastrointestinal (GI) functions, and nutritional problems, fluid intake should be increased rather than decreased. We believe that fluid restriction may aggravate renal and cardiac function, or do it no good, and that lung damage is not the cause of the reduced fluid demand. On the contrary, a large fluid supply may help to maintain a more stable and adequate blood supply to each part of the body, especially the GI system, kidneys, and lung. The whole body would benefit from it. In this retrospective study, we did not reduce the patients' fluid intake volume after pulmonary complications occurring late, and we continued to maintain urinary output at between 1 and 2.5 ml/kg/h or more, as before the onset of pulmonary complications. Intensive fluid monitoring and restriction of the daily fluid balance are important in this period. Compared with our previous cases (fluid restriction to maintain urinary output at around 0.5 mk/kg/h), we found that these patients had better GI function (oral feeding), nutritional support, and renal and liver function, as well as a shorter hospital stay. This method did not aggravate pulmonary complications. In conclusion, we believe that fluid restriction in cases of cutaneous burns with associated later pulmonary complications is not necessary.
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| 70 |
TREATMENT OF SUPERFICIAL BURNS, POST-BURN SCARS, AND KELOIDS WITH CONTRACTUBEX® GEL
(Dyakov R., Petrova M., Tzolova N., Argirova M., Hadjiiski O. - Bulagaria)
In the Pirogov Medical Institute Burns and Plastic Surgery Centre in Sofia, Bulgaria, the medical preparation Contractubex® gel manufactured by Merz was used for the treatment of superficial burns and for prophylactics and treatment of hypertrophic scars and keloids. In the period 1997-2001 Contractubex® gel was administered to 211 patients (169 children and 42 adults). The patients were divided into two groups on the basis of the treatment strategy: one group, composed of 121 children and 28 adults, received medication by simple spreading or gentle massage; the other group, consisting of 48 children and 14 adults, was subjected to ultraphonophoresis with Contractubex® gel. Nine variables were monitored for comparison. Superficial burns were found to heal in the same terms as expected with classical treatment. However, the cicatrices that formed looked different: they were pink rather than reddish, their involution was faster, and their elasticity was greater. It was found that fresh cicatrices regressed more quickly than older scars and keloids, although general complaints were considerably reduced. Massage twice a day was preferred to massage once a day. Ultrasound accelerated the action, with good results appearing notably earlier. We report very good results in 161 patients (76 %), good in 39 (19%), and unsatisfactory in 11 (5%).
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| 75 |
TOPICAL TREATMENT OF TOXIC EPIDERMAL NECROLYSIS USING OMIDERM? AND GLYCEROL-PRESERVED HUMAN CADAVER SKIN
(Acikel C., Eren F., Ergun O., Celikoz B. - Turkey)
The extensive epidermal slough seen in toxic epidermal necrolysis resembles that of partial-thickness burns. Temporary coverage of denuded skin with biological or synthetic dressing materials minimizes heat and fluid loss from the wound, prevents wound infection, reduces pain, and promotes re-epithelialization. A 36-year-old female with epidermal sloughing in 90% total body surface area was successfully treated in this way. All detached epidermis was removed and the denuded skin was temporarily covered with Omiderm® and glycerol-preserved human cadaver allografts. We observed that these synthetic and biological materials were equally effective as regards healing time and quality.
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| 79 |
OUR EXPERIENCE IN THE NUTRITIONAL SUPPORT OF BURN PATIENTS
(El-Gallal A.R.S., Yousef S.M. - Libya)
This paper presents our experience with enteral nutritional support when it is supplemented parenterally, and demonstrates its value in preserving the nitrogen balance and maintaining nutritional integrity in severely burned patients. Thirty Libyan burned patients (18 males, 12 females) were selected prospectively for this study among patients admitted with an extensive burned surface area (20-50%) over a 5-yr period (1995-2000) to our burn unit, which is based at Aljala Hospital in Benghazi, Libya. The selection was made to form two comparable groups. The patients were randomly assigned to a type of nutritional support: either enteral support supplemented parenterally (group A) or enteral support alone (group B). Apart from nutrition, burn management was the same for all patients in both groups. We used changes in the patients' body weight and total serum protein to assess the effectiveness of the nutritional support given. The results were compared and the outcome showed significant differences between the groups as regards their nutritional response.
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| 83 |
MODEL OF PSYCHOLOGICAL SUPPORT FOR BURN PATIENTS: ANALYSIS OF THE RESULTS OF EIGHT YEARS EXPERIENCE
(Di Pasquale A., Lisi A., Masellis M. - Italy)
Disease and pain propose, at varying levels of intensity, the dualistic alternation between two poles, that of being a body and that of having a body: the experience that one has of oneself oscillates in an equilibrium that continually needs to be re-established. Each of us has a mental image of our body that changes continually and is considerably modified at times of illness. The body has a communicative function and is experienced in its relation to other people, and not as something separate from its surroundings. Since 1993 a programme of psychological support for burn patients and their families has been operative at the Division of Plastic Surgery and Burns Therapy in Palermo, Italy. This programme accompanies patients and their families throughout the entire process of recovery and is intended to contain and prevent burn-related pathological behavioural reactions. In our eight years' experience we have found that true health comes from an equilibrium between the patients' physical image of themselves, their mental self-image, and their ability to set up positive reactions. The Division has therefore initiated a plan of care and procedures that considers patients in their mental, physical, and psychological dimension in order to respect and valorize their complexity and their capacity to plan their lives, with a view to an optimal functional return to society. The method used, i.e. that of research and intervention, has made it possible to achieve results that can be considered satisfactory both for the patients and for the hospital structures. With regard to psychological intervention, there are three types: for individuals, families, and groups. The mothers of burned children receive special support, as it is above all the mother who helps a child to adapt first to the hospital structure and subsequently to scar sequelae.
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| 90 |
CLINICAL COMPARISON BETWEEN PROPHYLACTIC AND EMERGENCY TRACHEOTOMY AFTER INHALATION INJURY
(Wei Lu, Zhao-fan Xia, Xu-lin Chen - People's Republic of China)
Objective: To make a comparative study of prophylactic and emergency tracheotomy after inhalation injury in 93 patients treated in our burns centre in the past eight years. Method: Between January 1993 and April 2001, 93 patients with moderate or severe inhalation injury subjected to tracheotomy were enrolled in the study. On the basis of the moment of tracheotomy, the patients were divided into two groups: a prophylactic tracheotomy group (21 cases) and an emergency tracheotomy group (72 cases). Results: The moments of tracheotomy in the prophylactic tracheotomy group and the emergency tracheotomy group were respectively 4.31 ± 3.04 h and 34.47 ± 2.79 h post-burn. In the emergency tracheotomy group, the vital signs related to the operation (arterial blood oxygen partial pressure, oxygen saturation, breathing rate, and heart rate) were manifestly abnormal before the operation and markedly improved after tracheotomy. The ratio of mechanical ventilation within two days after tracheotomy was 95.23% in the emergency tracheotomy group. Conclusions: 1. Positive symptoms often occurred 30-34 h after inhalation injury in patients with moderate and even severe inhalation injury, a finding that should be carefully considered. 2. Prophylactic tracheotomy in patients with moderate or even more severe inhalation injury is of great clinical significance, while emergency tracheotomy should be avoided. 3. It is of great advantage to use a respirator in the early stages after tracheotomy.
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| 93 |
PRESENTATION D'UN CAS DE RECONSTRUCTION PRIMAIRE DU DEFAUT DU A UNE BRULURE DE CONTACT DANS LA REGION DU COU
(Jovanovic M., Stefanovic P., Colic M., Jovanovic-Savic S., Mrvaljevic M. - Yougoslavie)
Dans ce travail les Auteurs présentent le cas d'un patient ayant une lésion profonde due à une brûlure qui se propage sur les structures profondes de la partie latérale du cou. Déjà à l'admission, on constate qu'il s'agit d'une lésion assez profonde pouvant affecter les muscles et les vaisseaux sanguins profonds du cou. Le dilemme qui s'impose c'est de réaliser la nécrectomie tissulaire précoce (où existe le risque de démarcation imprécise du tissu nécrotique) ou d'effectuer la nécrectomie ultérieurement (où existe le risque d'infection qui peut affecter rapidement les structures profondes du cou). La nécrectomie a été effectuée soigneusement trois jours après l'accident, mais il était difficile d'évaluer la profondeur du tissu nécrotique. La nécrose avait affecté le muscle sterno-cléido-mastoïdien ainsi que la tunique adventitielle de la veine jugulaire interne. Le défaut a été reconstruit par une greffe musculo-cutanée pectorale majeure avec des résultats fonctionnels excellents.
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