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Volume XVI |
Number 2 |
June 2003 |
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SUMMARIES
| 59 |
BURNET PROJECT: TELEMEDICINE IN BURNS CENTRES IN THE EURO-MEDITERRANEAN AREA. EUROPEAN UNION INITIATIVE - PILOT PROJECT
(Masellis M., Gunn S.W.A. - Italy)
The BurNet project is a pilot project of the Eumedis initiative. The Eumedis (EUro MEDiterranean Information Society initiative) is part of the MEDA programme of the EU and aims at developing the Information Society in the Mediterranean area. In the health care sector, the objective of Eumedis is: the deployment of network-based solutions to interconnect - using
user-friendly and affordable solutions - the actors at all levels of the ?health care system? of the Euro-Mediterranean region. The BurNet project aims to interconnect the Mediterranean Burn Centres (B.C.s) through an information network both to standardize courses of action in the field of prevention, treatment, and functional and psychological rehabilitation of burn patients and to co-ordinate interactions between B.C.s and emergency rooms in peripheral hospitals using training/information activities to optimize first aid provided to burn patients before referral to a B.C. Shared procedure protocols for the prevention, care, and rehabilitation of patients, both at individual and mass level, will help create an international specialized database and a Web-based teleconsultation system.
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| 69 |
BURNS FROM A STOVE BURST: ANALYSIS OF 34 CASE
(Iliopoulou E., Michelakis D., Michail A., Lochaitis A. - Greece)
The purpose of our retrospective study is to present statistical, epidemiological, and socioeconomic data related to Greek society and to compare data from other studies (1983-1987) and other countries. The paper refers to the period 1993-2001 (1840 admissions) and the data refer to age, sex, body location, immigrants, death rate, changes in the socioeconomic profile of burn injury, TBSA, and outcome, on the basis of the records in our department of plastic surgery. A comparison between the old statistics and the new clearly shows a development and improvement of the treatment of burn injury. The outstanding features of the new statistics are the decline in the workload in our clinic (from 241 admissions in 1997 to 146 in 2001), the decrease in overall mortality (from 11.7% in 1983-1987 to 5.43% in 1993-2001), and the rise in the proportion of jobless immigrants in the total number of patients (Greek to foreigner ratio). Our clinic provides 14 beds in a burns unit without any cardiorespiratory support equipment, where the physicians offer their knowledge and personal effort to the strenuous task of burn patient treatment. |
| 74 |
ANALYSIS OF BURNS: INJURIES TRATED DURING A ONE-YEAR PERIOD AT DISTRICT HOSPITAL IN INDIA
(Subrahmanyam M., Joshi A.V. - India)
A total number of 254 burn patients treated during the period July 2001-June 2002 were analysed. Of these, 158 were female and 96 male. The age of the patients ranged from 3 to 60 yr. The monthly admission rate ranged from 12 to 33, with the lowest number in July and the highest in October. One hundred and thirty admissions occurred between midnight and 4 a.m., and 13 patients were admitted 48 h post-burn. The extent of the burns ranged from 3 to 100% TBSA. The causes of the burns were flame in 228 cases (88.9%), scalds in 11 (4.3%), electricity and chemicals in six each, plus other causes in three instances. The burns were accidental in 210 cases (82.6%), suicidal in 38 (15.0%), and homicidal in six (2.4%). Altogether there were 174 deaths, with a mortality rate of 68.5%. There were 79 deaths in the first 48 h, 82 in the first week, 10 in the second week, one in the third week, and two after 6 weeks. The mortality rate was 100% in burns above 60% TBSA, 69% in 41-60% burns, and 12% in burns of less than 40%. |
| 77 |
HYPOTERMIA AND BURNS: A META-ANALYSIS
(Bravo Branas E., Gomez-Bajo G.J., Leyva Rodriguez F., Delgado Mora M., Valencia Gonzalez J., Varela Neira J.M. - Spain)
In order to estimate the importance of hypothermia in burn patients, bibliographic databases were searched for relative articles published in MEDLINE between the years 1966 and 2002. The search strategy was based on the terms "burns" and "hypothermia". We retrieved any kind of article referring to these concepts "limited to text word". The preliminary data obtained using these search criteria consisted of 108 references. A first analysis performed to apply the first inclusion criterion (referring to burn patients) showed that only 28 references were suitable for analysis. When the second inclusion criterion (implication of hypothermia) was considered only seven articles were found to be suitable for analysis. Data from these studies showed that from the pathophysiological point of view burn patients with a slow recovery from operative hypothermia exhibited impaired oxygen extraction and dependence of oxygen consumption on oxygen delivery over a wide range; the data also showed that patients unable to generate heat well in post-operative hypothermia were unable to produce the additional energy required to overcome sepsis. Considering the epidemiological aspects, about 2% of hypothermic patients had sustained burn wounds and 20% of deceased burn patients were hypothermic. Finally, an analysis of the therapeutic implications suggests that the infusion of hot crystalloids given via central venous access is safe and may be an acceptable adjuvant in attenuating hypothermia during operative procedures. |
| 81 |
TOPICAL ANTISEPSIS AND TRASPLANT OF KERATINOCYTE CULTURES IN SEVERELY BURNED PATIENTS
(Di Lonardo A., Maggio G., Gargiuoli F., Dioguardi D. - Italy)
In the light of experimental trials conducted on the cytotoxicity in vitro of some of the most frequently used topical antiseptics in the treatment of burn patients, we report our experience in the use of an antiseptic association consisting of silver sulphadiazine and gentamicin in various concentrations. This particular association has shown itself to be very effective as regards common bacteria that colonize burn areas. It also possesses very low cytotoxicity. This feature has favoured its use for antiseptic prophylaxis in burn areas reconstructed with autologous cultures of keratinocytes. The clinical results indicated that the use of topical antiseptics possessing low cytotoxicity led to a significant increase in the survival of keratinocytes compared with results using the antiseptic solutions frequently used in routine clinical practice. |
| 84 |
The sensitivity to honey of multidrag-resistant pseudomonas aeruginosa from infected BURNS
(Subrahmanyam M., Hemmady A.R., Pawar S.G. - India)
A total number of 44 strains of Pseudomonas aeruginosa isolated from infected burns showing multidrug resistance were studied for sensitivity to honey on the principle of minimum inhibitory concentration (MIC). All strains showed similar sensitivity to honey with MIC at 25% concentration, 39 strains at 20%, 15 at 15%, and three at 10%. The present study showed that strains of Pseudomonas aeruginosa resistant to routinely used and higher antibiotics were sensitive to the antibacterial action of honey. In the present era of multiple drug-resistant organisms, honey can be used as an effective, cheap, easily available, non-toxic, extremely useful, and reliable adjuvant without any adverse side effects in the treatment of burn wound infection. |
| 87 |
DEEP BURNS OF THE HAND: PREFERENCE AND QUALITY OF MESH OVER SHEET SKIN GRAFTS
(Roje Z., Petricevic T., Roje Z., Karanovic N. - Croatia)
Aim: To evaluate preferences and the quality of non-fully expanded mesh skin grafts compared with sheet skin grafts in the surgical treatment of deep hand burns. Method: Forty patients in the Division of Plastic Surgery and Burns in Split, Croatia, with clinically manifest deep hand burns of various aetiology were surgically treated during the period 1989-1997. The patients were divided into two subgroups. The first group (20 patients) was treated with early tangential excision and mesh non-expanded skin grafts. The second group (also 20 patients) was treated with early tangential excision and sheet skin grafts. All the patients were treated according to standard management protocol for the pre-, peri-, and post-operative period. The results of the treatment were estimated and the advantages and quality of non-fully expanded mesh skin grafts were compared with those of sheet skin graft for the same purpose. Results: The evaluation of the results was based on functional results, morbidity, appearance and manifestation of burn wound infection, type of skin graft, graft lyses, post-operative range of movement in small joints, scarring and contracture, aesthetic results, and quality of life. Detailed results are given. The main criteria for treatment success were the total number of operations until full healing of skin grafts, the percentage of healing in sheet and mesh non-expanded skin grafts, range of movement in small joints, occurrence of hypertrophic scars and post-burn contractures, web contractures, artificial syndactyly, and aesthetic appearance. In the follow-up period (5 years), all the patients were treated with pressure garments, plus individual physical and occupational therapy. Conclusion: The method of early tangential excision and skin grafting with non-expanded mesh graft in deep hand burns gave good functional and aesthetic results. Mesh non-expanded skin graft was used in cases of poor general health, manifest burn wound infection, and high percentage of total body surface area burned. The higher healing rate, reduced formation of haematoma and seroma, reduced burn wound infection, and good functional and aesthetic outcome showed that mesh non-expanded skin graft had many advantages over sheet skin graft. Early physical and occupational therapy and the use of pressure garments reduced the formation of scars and contractures, chronic joint stiffness, and other functional limitations. |
| 98 |
A STUDY ON COLLAGEN CONSTITUTE AND AFFECTED FACTORS IN HYPERTROPHIC SCAR AT DIFFERENT AGE PERIODS
(Lin Qiu, Xian-Qin Jin, Dai-Li Xiang, Yue- Xian Fu, Xiao-Fei Tian - People's Republic of China)
Objective: To investigate the difference in ratio of collagen in hypertrophic scar (HS) at different age periods and its causes, in order to provide a theoretical base for its special clinical treatment. Method: The expression of type I, type III collagen, and transforming growth factor-,1 (TGF-,1) was measured immunohistochemically in different-age HS and normal skin (NS). All the quantities were analysed. Messenger RNA (mRNA) expressions of collagenase (MMP-1) and tissue inhibitor of metalloproteinase (TIMP-1) were measured with the in situ hybridization technique. Results: 1. The ratio of type I/type III collagen and the quantification of type I collagen in HS increased compared with NS. The ratio of type I/type III collagen in the 1-19 years old HS group increased compared with the 20-50 years old group. 2. The expression of TGF-,1 protein in HS was enhanced. The expression of TGF-,1 in the 1-19 years old HS group significantly increased more than in the 20-50 years old group. 3. A significant increase of expression of TIMP-1 mRNA in HS was observed, but the expression of MMP-1 was lower both in HS and in NS. The expression of TIMP-1 mRNA and the expression of MMP-1 in the HS 1-19 years old group and the 20-50 years old group presented no difference. Conclusion: 1. The significant increase in TGF-,1, which stimulates fibroblast to synthesize more type I collagen and enhances the ratio of type I/type III collagen, may be a cause of the higher incidence of scarring in the 1-19 years old group (children and teenagers). 2. The higher expression of TIMP-1 mRNA and the lower expression of MMP-1 mRNA are among the factors causing HS. Expressions of TIMP-1 and MMP-1 in HS have no direct relationship to age. |
| 103 |
CASE REPORT: CLINICAL COURSE OF A CASE WITH BURN OF 40% TBSA IN A CHILD FOUR YEARS OLD
(Belba m., Osmani X., Dauti I., Isaraj S., Xhepa G., Belba GJ. - Albania)
A case is described of massive burns in a child four years old injured by flame. Special importance was concentrated on the treatment during the sepsis phase, with a complex therapy applying two or three antibiotics together. It is underlined that the initiation of antibiotic therapy in empirical manner is a correct and scientific act. This is because medical staff, thanks to their accumulated experience, are aware of the epidemiology of pathogens in their place of work. The results of the wound and blood cultures then allow the antibiotic therapy to be further consolidated. |
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