Volume XVII

Number 3

September 2004

THE RIGHT TO HEALTH OF THE BURNT PATIENT AND FIRE VICTIM
(S.W.A. Gunn, MD, MS, FRCSC, DSc - Switzerland)
Health is a human right and remains inalienable under all circumstances, including burns and fire disasters. Unfortunately this right tends to become blurred and vulnerable particularly when the person himself, the patient, becomes vulnerable under sickness, thermal injury or other disaster situation. Even under the most efficient and well-meaning care the burn patient, especially the burnt child, feels diminished and dependent, and his rights tend to be overlooked, if not down-trodden. Formal instruments and international conventions, including medical Oaths and Declarations underpin the right to health of the burn victim and provide burn surgeons and health professionals with guidance and support for more efficient and more humanitarian care.

MASQUERADES: HIGHLY FLAMMABLE. TWO CASE REPORTS OF FLAME BURN INJURIES DUE TO MASQUERADES
(Olaitan P.B., Ogbonnaya I.S. - Nigeria)
Masquerades are a common cultural practice in Nigeria, and especially in Eastern Nigeria. Often these masquerades are performed during social functions, burials, house-warming parties, at Christmas and Easter, and indeed during most festivities. However, in relation to such events, some people accidentally suffer flame burns and present to our burns centre. The extensive injuries usually sustained are exemplified in the two cases presented. Education of the people remains a vital way to stop this problem.

PAEDIATRIC BURNS DUE TO FIRE WALKING AND ITS COMPLICATIONS. EXPERIENCE AT CHENNAI (TAMIL NADU, INDIA)
(Ramakrishnan K.M., Jayaraman V., Sankar J., Ramesh J. - India)
Fire walking is a ritual practised mainly in India. Paediatric burns secondary to fire walking are a challenging clinical scenario and their management requires teamwork by a group of dedicated medical and paramedical professionals. This article highlights the problems encountered in the management of paediatric victims following fire walking. <0.05). Klebsiella species was the pathogen most commonly isolated, constituting 34.4%. This was closely followed by Pseudomonas aeruginosa (29.0%) and Staphylococcus aureus (26.8%). The rate of isolation of Gram-negative organisms was more than twice that of Gram-positive organisms. More than 75% of the Gram-negative isolates were resistant to gentamicin, a commonly used antibiotic for Gram-negative infections, but sensitive to ceftazidime and pefloxacin. Gram-positive isolates were predominantly Staphylococcus aureus sensitive to azithromycin and pefloxacin. This study highlights the predominant bacterial pathogens and their antimicrobial profile among infected burn wounds in our centre.

EFFECTS OF DIFFERENT COMPONENTS OF SERUM AFTER BURN ON THE L-TYPE CALCIUM CHANNEL OF CULTURED MYOCARDIAL CELLS
(PYe B.L., Cheng T.M., Xiao J.S., Dai J.L., Wan Z.B. - People’s Republic of China)
Objective: The objective of the study was to observe the effects of different components of serum after burn on the L-type calcium channel of cultured myocardial cells. Method: Different components of serum were separated from the rat 6 h post-burn. The myocardial cells were separated from healthy rat and cultured in vitro, and the activity of the L-type channel was recorded by the patch-clamp technique. Results: After burn, the serum components enhanced the open action of the L-type calcium channel of cultured myocardial cells by increasing open-state probability, prolonging open time, shortening closed time, and enhancing current amplitude. Among the components, the low molecule (< 8 kD) fraction and lipid component were more effective. The effects of the lipid component could be suppressed by superoxide dismutase. Conclusion: After burn, some serum components could influence the activity of the L-type calcium channel, which might be an important cause of the dysfunction in cardiovascular system after burn.

NON-INVASIVE ASSESSMENT OF WOUND-HEALING PATHOPHYSIOLOGY BY TRANSCUTANEOUS INDICATORS
(Monteiro Rodrigues L., Martins Magro J., Contreiras Pinto P.,Mouzinho M., Almeida A. - Portugal)
The non-invasive assessment of post-burn wound recovery allows new insights into wound-healing pathophysiology. This pilot study enrolled thermal burn patients (n = 9) with autografted wounds. Grafted lesion (GL) and donor lesion (DL) areas were followed for 6 months by non-invasive measurement of local microcirculation, transcutaneous PO2, and transepidermal water loss (TEWL); the contralateral intact areas were used as controls. The results show that local flow changes in GL were significantly different (p < 0.05) from normal until week 6, while in DL differences still persisted at week 8. No differences between GL and DL were found for transcutaneous PO2 measurements. However, full functional recovery was achieved earlier in DL, while in GL statistically significant differences (p < 0.05) between the lesion and the control area were still present at week 26. TEWL evolution demonstrated that significant differences (p < 0.05) between lesions, compared with the respective controls, persisted in week 26, probably resulting from different recovery mechanisms. Globally, the present study helps to define the wound-healing functional profile of the lesions, highlighting the interest of the non-invasive assessment of wound pathophysiology in burn care and rehabilitation.

TREATMENT OF CUTANEOUS BURNS WITH BURNSHIELD (HYDROGEL) AND A SEMI-PERMEABLE ADHESIVE FILM
(Osti E., Osti F. - Italy)
TThe objective of this study was to estimate the effectiveness of the association of a transparent adhesive film possessing selective permeability with a hydrogel (Burnshield). This association was used in burn patients in order to reduce skin maceration, improve medication, control pain more effectively, and reduce the incidence of late complications (hypertrophic scars). The external part of the film is impermeable to fluid and micro-organisms but allows transpiration of water vapour from the cutis. The permeability to water vapour of a semi-permeable film in contact with liquids is measured in g/m2/24 h/37 °C and is defined as the moisture vapour transmission rate (MVTR). In our study we used a film with an MVTR equal to 1600. Over a period of about two years, we used this type of therapy in the first-aid treatment of 48 burn patients, four of whom were lost during therapy and four during the follow-up. The most frequent complication, which occurred at various stages during medication, was skin maceration (15 patients out of 44, i.e. 34%). Other complications we recorded during therapy were: infections in two patients (4.5%), vertigo in one patient (2.2%), and abundant fibrin production in one patient (2.2%). In some of the patients we found associated diseases and/or conditions: hepatic cirrhosis, one case; diabetes, one case; epilepsy, one case; pregnancy, one case (33rd week). Four patients were sent to the burns unit, respectively three with second-degree burns in the hand and one patient with second-degree burns in the abdomen and thigh with 12% total body surface area burned. In the re-epithelialization phase we recorded complications in eight patients - seven with residual inflammation (17.5%), and one with hypertrophic scars (2.5%). During the follow-up we recorded late complications in two patients out of 40 (5%). Same Plast Gel® gel was used in eight patients, of whom six out of seven with residual inflammation resolved their clinical picture, while in one patient, in spite of therapy, the residual inflammation evolved into hypertrophic scarring. Treatment with Same Plast Gel® in the two late patients with lesions reduced both thickness and extent, with minimal aesthetic and functional damage. The average follow-up period in all patients was 28.4 months (range, 14-35 months).

THE INTEREST OF Z-PLASTY IN THE TREATMENT OF CERVICO-FACIAL BURNS SEQUELAE
(Bouladaas M., Mourtada F., Lahlou M., Moudjir D.B.,Essqualli L., Alaoui F., Benchekroun L., El Jazouli N., Kzadri M. - Morocco)
Z-plasties make it easy to release contractures either by changing the orientation of the scar or by lengthening it, especially when it is retractile.

ASPECTS PSYCHOSOCIAUX DE LA BRULURE
(Ezzoubi M., Fihri J.F., Elmounjid S., Ettalbi S., Bahechar N., Boukind E. - Moroccol)
Dans le cadre de la préparation d’un programme national de lutte contre les brûlures, nous avons effectué une enquête afin de définir le profil psychosocial des patients brûlés. Il s’agit d’une étude prospective réalisée pendant deux mois (avril-mai 2003) sur une population des brûlés âgés de 0 à 79 ans, hospitalisés au service des brûles ou vus lors des soins ambulatoires. Dans notre série, 51 hommes ont été interrogés contre 49 femmes (sex ratio, 1:1). La majorité des sujets (61%) étaient des adultes, suivis des enfants d’âge préscolaire (21%). Dans notre étude nous avons comptabilisé 52% de patients ayant des habitudes toxiques. Douze patients avaient un terrain pathologique: trois étaient épileptiques, trois avaient fait des tentatives d’autolyse, et quatre avaient déjà été brûlés. Concernant le lieu de la brûlure, 66% ont eu lieu à domicile et il s’agissait d’un accident domestique dans 47 cas. Concernant le comportement psychologique lors de la phase aiguë, 84% des patients étaient anxieux et 44,4% ont développé une dépression. En phase séquellaire, 72% des patients étaient anxieux et 36% ont fait une dépression. Par ailleurs, 2% des malades ont développé une dénégation et 12% une revendication. La réaction d’adaptation a été modérée dans 13% des cas et il n’y a pas eu de régression dans 95% des cas. Les réactions de retrait ont été nombreuses. Ainsi nous avons noté que la brûlure serait plus fréquente soit chez les personnes de niveau socioéconomique très bas soit chez les gens ayant des habitudes toxiques et des antécédents pathologiques psychiatriques, psychologiques ou neurologiques. Au fur et à mesure de l’évolution de la brûlure, cette dernière peut occasionner chez les patients brûlés des troubles psychologiques et psychiatriques (angoisse, anxiété, dépression, troubles de comportement, dénégation, régression et stress posttraumatique) et des conséquences socioprofessionnelles (perte d’emploi, réaction d’évitement, clinophilie, rejet par la famille ou le conjoint). Sur le plan social la brûlure, par la longue durée des soins et par les frais de sa prise en charge, a des effets néfastes sur la situation financière du brûlé et de sa famille et ce dans un pays où l’assurance maladie et la couverture sociale ne sont pas encore généralisées.

A FIRE DISASTER AT A WEDDING IN A VILLAGE IN THE EASTERN PROVINCE, SAUDI ARABIA
(Al-Hoqail R. - Saudi Arabia)
This is a cross-sectional study of a fire disaster that occurred during a wedding in a village in the Eastern Province of Saudi Arabia on 28 July 1999. The number of persons involved was 169 - all women and children. By February 2000, 74 of the victims had died. The patients were initially distributed in 17 various provincial and national hospitals. The total number remaining hospitalized was 25 in October 1999 and 6 in February 2000. Fourteen patients were sent to the UK and the USA. Our recommendations include performing nationwide studies of fire incidents and the socioeconomic losses they inflict; documenting the historical evolution of fire prevention, control, and management laws; training more physicians, nurses, and first-aid personnel; effecting disaster site control over a larger zone; renovating available burn units to up-to-date standards; having advanced burn centres that satisfy calculated needs; establishing computerized communication between various burn units; achieving interhospital transfer of cases within 24 h; organizing public education for behaviour in the event of disasters, especially fire-related disasters; and developing a body of collaboration of regional Gulf countries as regards fire disasters.

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