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Volume XVI |
Number 3 |
September 2003 |
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SUMMARIES
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THE MANAGEMENT OF AN EPIDEMIC FLAME BURNS DISASTER RESULTING FROM THE EXPLOSION OF KEROSENE APPLIANCES TREATED AT THE LAGOS UNIVERSITY TEACHING HOSPITAL, NIGERIA
(Ugburo A.O., Oyeneyin J.O., Atuk T.A., Desalu I.S., Sowemimo G.O.A - Nigeria)
This is a study of 94 patients in Nigeria who sustained flame burns resulting from explosions of kerosene contaminated with petrol between 10 October and 25 November 2001. Fifty-eight families were involved, with multiple family members affected. The incident was later discovered to have been due to contamination of kerosene from a storage tank at a fuel depot. Most of the accidents occurred while people were trying to refuel a lighted lantern. The ages of the 94 patients seen in hospital ranged from 3 weeks to 55 yr (mean age, 21.88 ± 1.41 yr). Many of the patients suffered severe burns with a mean percentage of burned body surface area (BSA) of 37.05 ± 3.22%. A significant percentage of the burns were full-thickness injury (mean percentage burned BSA, 19.95 ± 2.02). The right upper limb holding the lantern was usually more severely affected than the left in the person refuelling the lighted lantern. The incidence of inhalation injury resulting from inhaled kerosene and smoke due to the impossibility of rescuing the victims promptly - because of "burglar-proof security" - was 37% of all the patients. The majority of these patients died of inhalation injury, which was the single commonest cause of death (40% of fatal cases). Such disasters due to human error in the use of petrol-contaminated kerosene could be minimized by stringent control. The custom of refuelling a lantern while it is lighted should be discouraged by public education campaigns. There is also a need to improve the design of the hurricane lantern commonly used in rural areas and in developing countries.
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| 122 |
BURN INJURIES DUE TO FLAME OF ALCOHOL-BURNING CHAFING-DISH STOVES IN CHINA
(Xin-long Chen, Yan-ping Li, Dan-ping Zhang, Ping Zhang, Wei Zhang - People's Republic of China)
Burn injuries related to domestic fire are well generally reported, but burns caused by the flames of liquid-alcohol-burning chafing-dish stoves are rarely reported. Most Chinese people like to eat very hot dishes, especially in the cold winter period. The liquid-alcohol-burning chafing-dish stove is one of the most popular and convenient tools for Chinese people cooking such dishes, and liquid alcohol is always used as fuel, with the result that China has the highest rate of such burns in the world. Data from the burn unit at the 477th PLA Hospital in China were studied to find the number of admissions due to this kind of burn. During the period 1989-2000, out of 1856 admissions to our burns department, 169 (9.1%) were due to flame burns caused by an alcohol-burning chafing-dish stove. Of the 169 victims, 105 (62.1%) were adults, 23 (13.0%) were elderly, and 42 (24.9%) were children. The distribution of cases in relation to total body surface area (TBSA) involvement was 108 cases (63.9%) with TBSA burns of 0-5%, 46 (27.2%) with 6-10% TBSA, and 15 (8.9%) with Z 11% TBSA. Most flame burn injuries of this type were caused by misuse of the alcohol-burning stove. The annual number of flame burn admissions declined during 1989-2000 owing to a decrease in the use of such stoves and the increase of stoves burning solid alcohol. Further educational and legislative measures are required to prevent this type of burn.
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| 126 |
RESUSCITATION TREATMENT IN LYELL'S SYNDROME
(Napoli B., D'Arpa N., Iaia A., Masellis M. - Italy)
Resuscitation treatment is always necessary in Lyell's syndrome because - according to the most widely accepted classification - a characteristic feature of this reaction to drugs is extensive cutaneous de-epithelialization (over 30% total body surface area). The methods for calculating the quantity of fluid to infuse are considered in this paper, as also the choice of such fluids, especially in relation to the differences from the burns disease. In particular, the absence in Lyell's syndrome of the alteration of vascular permeability that is typical of burns and causes oedema makes it possible to administer from the beginning solutions containing colloids, such as fresh frozen plasma which both performs a reanimatory function and constitutes a specific treatment for the disease, since the immunoglobulins that it contains succeed in blocking the cell receptors of the apoptosis. Fresh plasma is administered also subsequently to the resuscitation phase, while other specific treatments (intravenous human immunoglobulin, cyclosporin A in the absence of serious hepatorenal alterations, local therapy with cultured homologous keratinocytes) block the evolution of the disease and prevent fresh evolutionary onsets and the further extension of cutaneous damage. The resuscitation formula used is presented. This is a general guideline, as all therapy has to be personalized, taking various parameters into consideration, the most important of which are the time interval between the first manifestation of de-epithelialization and commencement of infusive therapy, the patient's age, and concomitant pathologies. As Lyell's syndrome above all affects elderly persons already suffering from other pathologies (usually cardiovascular and renal), central venous pressure has to be monitored, although it is generally recommended to avoid using central veins because of the risk of septicaemia. The ejection fraction is a valuable indication of the risk of acute decompensation and should therefore be calculated as soon as possible by echographic assessment.
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| 131 |
HONEY COMPOUND FOR WOUND CARE: A PRELIMINARY REPORT
(Osman O.F., Mansour I.S., El-Hakim S. - Egypt)
In this study a new invention (Honey Compound), made of honey plus some natural additives, was investigated for its use as a topical wound agent. Honey Compound obviates problems with the topical use of honey for wounds and burns. Laboratory investigation and animal laboratory studies have demonstrated superior results with honey compound in its antibacterial, antifungal, and wound-healing promotion properties compared with pure bee honey and some other topical wound agents.
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| 135 |
FREE RADICAL CONTROL - THE MAIN MECHANISM OF THE ACTION OF HONEY IN BURNS
(Subrahmanyam M., Shahapure A.G., Nagane N.S., Bhagwat V.R., Ganu J.V. - India)
Background and objectives. Thermal injury of the skin is an oxidation injury and it is associated with biological and metabolic alterations. The use of honey in burn treatment results in biochemical alterations and may provide an insight into the mechanism of the action of honey in burns. The levels of serum lipid peroxide, serum ceruloplasmin, and uric acid in burn patients during treatment with silver sulphadiazine and honey therapy were studied. Methods. This was a single-blind prospective randomized control study involving a comparison of biochemical alterations during silver sulphadiazine treatment and honey treatment in burns. Results. In burn trauma, there is excessive activity of free radicals at the site of injury. This is reflected in elevated blood levels of lipid peroxide, ceruloplasmin, and uric acid. Honey treatment led to a decline in the levels of serum lipid peroxide, while there was a mild increment in serum ceruloplasmin levels; there was no significant effect on serum uric acid levels in comparison with patients treated with silver sulphadiazine. Conclusion. Honey treatment exerted a positive effect on the oxidative stressful state in burn trauma by effectively mopping up free radicals, compared with silver sulphadiazine, and resulted in rapid healing.
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| 138 |
BURNS IN THE FIRST TRIMESTER OF PREGNANCY BURNS
(Haddadin K.J., Haddad S.Y. - Jordan)
This is a prospective study of ten female patients with burns in the first trimester of pregnancy out of a total of 940 admissions treated in the burns unit of the Royal Jordanian Rehabilitation Centre, King Hussein Medical Centre, Jordan over the 5-yr period from 1/1/1996 to 31/12/2000. The commonest cause was an accidental direct flame burn due to gas, occurring in the home. The average total burn surface area was 36.6%. The maternal and foetal death rates were respectively 30 and 50%.
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| 140 |
THE ELIMINATION OF POST-BURN SCAR CONTRACTURES AND DEFORMITIES OF THE SHOULDER JOINT
(Moroz V.Y., Yudenich A.A., Sarygin P.V., Sharobaro V.I. - Russia)
Post-burn scar deformations and contractures of a humeral joint are observed in 20 to 50% of patients who suffer burns. Fifty-six patients with post-burn deformations and contractures of a humeral joint were treated in the Division of Reconstructive and Plastic Surgery at the A.V. Vishnevsky Institute of Surgery in Moscow. The analysis of the clinical material made it possible to develop a classification of scar contractures of this joint. Various methods of reconstructive operations using the intact skin from adjacent areas and free tissue transplantation are possible on this basis. The types of operation that were thus suggested permitted the elimination of contractures in the short term and the achievement of good functional and cosmetic effects.
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| 144 |
REHABILITATION OF THE BURN PATIENT AT THE DISCHARGE STAGE: OUR EXPERIENCE
(Arena D., Giraudo L., Conte S., Ottino O., Sarzi L. - Italy)
It is very important to follow up burn patients after their discharge in a long-term rehabilitation course. The Rehabilitation Department at the CTO in Turin (Italy) follows up patients after their discharge through the intervention of specialized local centres. This is possible thanks to the existence of a "communication channel" linking the various rehabilitation facilities.
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| 146 |
POST-BURN NIPPLE RECONSTRUCTION WITH MODIFIED FISHTAIL FLAP
(Abdel-Hamid Abdel-Khalek. - Egypt)
Post-burn deformities of the female breast pose a problem for plastic and reconstructive surgeons, as well as a psychological problem for the patient. Many methods of reconstruction of the nipple have been described in the last few years, but none is completely satisfactory. The main objectives are the reconstruction, suitable size, and forward projection of the nipple comparable to the other breast. In this study, using the modified fishtail flap, we reconstructed 37 nipples in 28 females suffering from post-burn deformed nipples, including destruction and malpositioning of the nipple areola complex. The patients were aged 17 to 25 yr. In all the patients we used the modified fishtail flap for nipple reconstruction, and a nipple projection between 3-4 mm was achieved. The post-operative results and follow-up have proved satisfactory to both surgeon and patients. We recommend the modified fishtail flap for the reconstruction of post-burn nipple deformities, as it provides excellent projection, size, and shape.
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| 151 |
TREATMENT WITH BURNSHIELD IN PATIENTS WITH CUTANEOUS BURNS. DEFINITIVE DATA
(Osti E., Osti F. - Italy)
The results are presented of a study of burn patients involving the use of Burnshield for cutaneous burns of varying degree caused by a number of agents. Our original aim was to look for useful materials in order to counteract pain in burn patients. The study has now also come to include the incidence of late complications (keloids and hypertrophic scars). Therapy with successive medication with Burnshield has been reported in experimental studies by Jandera and Arturson. The mean percentage of burned skin in our patients was 3.7% (range, 1-9%). All the patients were examined monthly and treated with Sameplast and/or Siloskin, depending whether the re-epithelialization zone post-burn still presented areas of granulation tissue in an active phase. Of the 18 patients included in the study, eight received therapy with Sameplast (one also with Siloskin). Therapy in these cases was initiated after re-epithelialization and continued on average for 4.1 months (range, 1-14 months). The use of Burnshield only until re-epithelialization reduced the incidence of late complications to 44.4% (8 patients out of 18). The results of the follow-up after re-epithelialization showed an overall incidence of late complications in only 22.2% of the cases.
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| 155 |
NITRIC ACID BURNS (CASE REPORT)
(Çelik E., Erog×lu S., Dinçler M., Karacaog×lan N. Uzunismail A. - Turkey)
Chemical burn injuries, including nitric acid injuries, are rarely encountered in routine daily practice. In this paper we wish to present two nitric acid burn cases in which the histories were not of accidental injury but of planned assault on the victim. In such cases, the victims are generally good-looking women. Nitric acid burns are frequently reported in the national and local press, especially in third-world countries.
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