Annals of Burns and Fire Disasters - vol. XVII - n. 1 - March 2004
INCIDENCE OF URINARY TRACT AND BLOODSTREAM INFECTIONS IN GHOTBEDDIN BURN CENTER, SHIRAZ 2000-2001
Burn wound infection in general has been widely studied, but certain nosocomial infections in burn patients have received less attention. Invasive diagnostic procedures such as vascular and bladder catheterization make burn patients more susceptible to nosocomial infections. This study determines the rate of bloodstream and urinary tract infections associated with the IV line and urinary catheter in Ghotbeddin Burn Center (Shiraz, Iran) and compares these rates with those of the National Nosocomial Infection Surveillance System in the USA. The study was conducted over an 11-month period (December 2000-November 2001). All patients admitted to our hospital during that period for longer than 48 h who showed no evidence of infection at the time of admission were included in the study. Standard definitions from the Center for Diseases Control were used for diagnosis of urinary tract and bloodstream infections. One hundred and six patients qualified for the study. Of these, 91 acquired nosocomial infections (85.85%). The urinary catheter-associated urinary tract infection rate was 30 per 1000 urinary catheter days, while the IV line-associated bloodstream infection rate was 17 per 1000 IV line days. Comparison of the incidence rates between our centre and the American centre showed that our infection rate was high, while the device utilization ratio (urinary catheter and central line) was higher in the USA. The infection rate in Ghotbeddin Burn Center could be reduced by education, development of standardized guidelines for the use of invasive devices, and the introduction of a nosocomial infection surveillance system.
Askarian M., Hosseini R.S., Kheirandish P., Memish Z.A.
HETEROTOPIC CALCIFICATION IN BURN SCARS AND NON-HEALING ULCERS
The term heterotopic calcification indicates the abnormal deposition of calcium salts in tissues other than bone or enamel. Heterotopic calcification commonly occurs in burn patients either in peri-articular regions or in the muscles, but the finding of heterotopic calcification in the burn scar itself, in the presence of normal serum calcium, phosphate, and alkaline phosphatase, has not been previously reported. The cases are described of four adult male patients with lower limb heterotopic calcification in burn scars with an unusual presentation of non-healing ulcers (latency period, 15-20 yr). One case was a Marjolin’s ulcer, even if the lesion was away from the calcified area. Excision of the calcified scars and release of the contracture cured the non-healing ulcers, and this may prevent future recalcification.
Ebrahim M.K., Kanjoor J.R., Bang R.L.
WORK-RELATED BURN INJURIES IN ONTARIO, CANADA: HAS ANYTHING CHANGED IN THE LAST 10 YEARS?
Previous research conducted by our institution in Ontario (Canada) 10 years ago analysed the incidence and nature of occupation-related burns in patients admitted to our facility. Our intention in this paper is compare the current incidence and patterns of work-related burn injuries treated in our regional burn centre (“Current Group”) with the findings of a similar study 10 years ago (“Early Group”). A retrospective study of all burn centre admissions between December 1998 and December 2000 was carried out. Data from the Early and Current groups were analysed using the Chi-square test of homogeneity. During the study period, 355 patients were hospitalized. After exclusions, 100 occupational burn cases were identified (28%). The patients’ mean age was 39 ± 12 yr, and 90% were male. The mean total body surface area burned was 11 ± 13.7%. The commonest burn mechanism was electricity-related (32%), followed by flame (22%), scald (17%), tar (14%), contact (8%), and chemicals (7%). Four patients (4%) died of their injuries. There were no significant differences between the Current Group and the Early Group as regards incidence, age, gender, occupation, mechanism of burn, or mortality. It is concluded that as no change was found in the incidence or pattern of work-related burn injuries treated at our institute in the past 10 years, existing prevention strategies have not been effective.
Mandelcorn E., Gomez M., Cartotto R.C.
ANCIENT TRADITIONAL CHINESE MEDICINE IN BURN TREATMENT: A HISTORICAL REVIEW
This paper reviews burn treatment as traditionally practised in China. Such methods have a long and remarkable history. An account is given of its philosophy and scientific knowledge, basic principles, and treatment strategies as well as modifications during 1300 years of medical development. The specific features presented continue to influence modern traditional Chinese medicine practice as well as modern Chinese burn treatment, bringing considerable benefits in the treatment of burn victims.
Kopp J., Wang G.Y., Horch R.E., Pallua N., Ge S.D.
Y-V ADVANCEMENT WITH Z-PLASTY: AN EFFECTIVE COMBINED MODEL FOR THE RELEASE OF POST-BURN FLEXION CONTRACTURES OF THE FINGERS
Volar contractures of the fingers are the commonest of all sequelae in hand burns. They are treated with various plastic surgery techniques, and recently a combination of certain techniques has improved results. In this study, two well-known techniques (Y-V advancement and Z-plasty) were combined to improve the release of linear flexion contractures of the fingers, including the thumbs. A mathematical representation is given. Ninety-eight proximal interphalangeal joints (interphalangeal for the thumb) in 37 patients were treated with this technique, and the results were followed up for about 8 months. There were greater gains using the combined technique than using either technique alone. It is concluded that this model could act as an effective combination of basic techniques in the treatment of volar finger contractures.
Peker F., Çelebiler Ö.
BANANA LEAF DRESSING FOR SKIN GRAFT DONOR AREAS
Skin grafting is an integral part of burn wound management, and any way of reducing the pain experienced at skin graft donor sites is of interest. We developed banana leaf dressing (BLD) in our unit in India in 1996. This is an excellent, non-adhesive, pain-free, cheap, and easily available dressing material. We carried out a trial in order to compare the efficacy of BLD with that of the Vaseline gauze (VG) dressing used in the majority of burns centres for the dressing of skin graft donor sites. Thirty patients subjected to skin graft were included in the study. BLD was applied to one half of the donor area and VG to the other half. Dressing change was performed on day 8. Using the visual analogue scale we assessed pain score, dressing removal pain score, and ease of dressing removal score. The advantage of the early epithelialization of donor areas cannot be overstressed in burn patients. The epithelialization status of the donor area on day 8 post-op was noted, as also the day of complete epithelialization. The average pain score with BLD was found to be 1.1 ± 0.71, while that with VG was 6.9 ± 0.84. The average dressing removal pain score was 0.97 with BLD and 9.47 with VG. The average ease of dressing removal score was 1.1 with BLD and 9.53 with VG. In all cases the difference observed was statistically significant (p < 0.001). The mean complete epithelialization day was day 8.67 in BLD-covered areas, compared with 11.73 in VG-covered areas. This observation was highly significant (p < 0.001). Our study shows that BLD is clearly a completely non-adherent and painless dressing, and we strongly recommend its use in all skin graft donor areas.
Gore M.A., Akolekar D.
EVALUATION OF BANANA LEAF DRESSING FOR PARTIAL-THICKNESS BURN WOUNDS
Early and effective coverage with a non-adherent dressing that protects a burn from trauma and desiccation is an important factor in the healing of superficial and moderate partial-thickness burn wounds. In our country, India, cost is also a very important factor. In view of the pain and anxiety experienced by patients during and after dressing changes, we made a search for a new dressing material to be used in partial-thickness burn wounds. The banana leaf dressing (BLD) was subsequently developed and optimized by June 1996. An open controlled study was carried out to compare banana leaf dressing and boiled potato peel bandage (BPPB), the dressing used in our burns unit since 1994. Thirty patients (all under 40 years of age), with burn size less than 50% TBSA and involving comparable body areas with partial-thickness burns, were included in the study. BLD together with a topical agent was applied over the right-side extremity, while BPPB was applied with the same topical agent on the left-side extremity. Dressings were changed daily. Pain during dressing change, feeling of comfort, and ease of handling the dressing were assessed by the patients and carers awarding scores for each type of dressing. Analysis of these scores showed that BLD and BPPB caused easily tolerable, minimal pain during dressing changes in the majority of patients. The number of days required for epithelialization and eschar formation and the need for skin grafting over deep partial-thickness burns did not reveal any significant difference between areas treated with BLD and areas treated with BPPB. The two dressings were equally effective in protecting the wounds and in aiding healing. The efficacy of BLD and BPPB was therefore parallel in all respects. However, BLD is 11 times cheaper than BPPB. Banana plants are easy to grow, and the leaves are available throughout the year. The leaves of banana plants are large and offer an ample surface, which is non-adherent, waxy, and cool. The dressing, which can be prepared very easily with little training, is the cheapest available today. We strongly recommend the use of the banana leaf dressing for all partial-thickness burn wounds in our environment.
Gore M.A., Akolekar D.
BACKDRAFT AND FLASHOVER
Two particularly violent types of accident can occur in certain fire situations: backdraft and flashover. These two scenarios are defined, their causes and development are presented, and the necessary counteraction is indicated. (Text in French).
THE DOUBLE TRAUMA OF BEING BURNED (REGARDING AN OBSERVATION)
The trauma caused by a burn accident does not cease with the event itself - the psychological effects are long-lasting. The case is described of a security agent who was beaten up and then burned by a Molotov cocktail. His injuries were not however only physical as he subsequently suffered from post-traumatic stress. The paper considers his psychological condition and the mechanisms of psychic defence that had to be activated in order to enable him to regain his peace of mind. Family support is of paramount importance in such cases. (Text in French)
INFLUENCE OF INADEQUATE PREHOSPITAL AND PRIMARY HOSPITAL TREATMENT ON THE MATURATION OF SCARS AFTER THERMAL INJURIES
The aim of this paper was to verify or rule out the hypothesis of the negative effect of incorrect pre-hospital and primary hospital care on the maturation of scars after thermal injuries with a depth of IIb or more. A medium-term study was carried out to investigate the maturation of scars in children aged 3 months to 12 years who had different quality of treatment during non-expert first aid, pre-hospital care, and primary hospital care. Attention was focused in particular on the formation of hypertrophic scars and possible other complications during the functional and aesthetic stabilization of the scar. The basic problem is the need to improve care provided at first contact. This is true of surgical out-patient departments as well as hospitals in catchment areas. It is essential to eliminate mistakes made by physicians when indicating transport of a child to a specialized centre for burns medicine or a department capable of providing adequate care. This study confirms the direct relationship between the development of hypertrophic scars after thermal injuries and the quality of non-expert first aid, pre-hospital care, and primary hospital care in children with IIb or deeper burns.
Hamanová H., Broz L.