Volume XVIII

Number 1

March 2005

RETROSPECTIVE ANALYSIS OF 200 SEVERE POST-BURN CASES IN CAMBODIA AND BANGLADESH
(Borghese L., Latorre S., Montagnese A., De Stefano C. - Italy)
The experience is reported of two years’ surgical activity carried out in hospitals for civil war victims in Battambang (Cambodia) and in an NGO hospital in Dhaka (Bangladesh) with regard to the treatment of non-acute burn patients. The aim of this report is to demonstrate that work in field hospitals deficient in means and equipment achieves the same results as those usually obtained in western hospitals. Our experience covers the surgical treatment of 200 patients with scars due to fire, acids, and land mines. We mainly treated patients with scars compromising or preventing the normal activity of limbs and extremities, with the aim of restoring correct functionality and an aesthetically satisfactory appearance.

INCREASE OF THE CURE RATE OF BURN PATIENTS BY IMPROVING BURN WOUND MANAGEMENT METHODS
(Liu X., Luo Q., Peng Y., Wang J., Huang Y., Yang Z. - People’s Republic of China)
In order to summarize the progress of burn wound management of the patients in our burn ward and its correlation with the improvement of treatment results in the past 44 years, the general data (hospitalization time, cure rate, operation times) of 12,568 cases were analysed in terms of three periods, namely 1958 to 1980, 1981 to 1990, and 1991 to 2002. The beneficial effects of the systemic application of recombinant human growth hormone, post-burn immediate escharectomy en masse, the external application of epithelial growth factor, and the coverage of split-thickness skin donor sites with razor-thick skin on wound healing and overall therapeutic results were also analysed. It was found that there was an increase in the number of burn patients admitted to our burn ward in recent decades. The overall cure rate, especially that of major burn patients, increased significantly with the improvement of burn wound management. Hospitalization time was shortened and wound-healing time reduced. The analysis suggested that escharectomy en masse as early as possible, systemic application of growth hormone, and external application of epithelial growth factor are beneficial to early burn wound healing.

COMPARISON OF ESTIMATED ENERGY REQUIREMENTS IN SEVERELY BURNED PATIENTS WITH MEASUREMENTS BY USING INDIRECT CALORIMETRY
(Tancheva D., Arabadziev J., Gergov G., Lachev N., Todorova S., Hristova A. - Bulgaria)
Severe burn injuries give rise to an extreme state of physiological stress. No other trauma results in such an accelerated rate of tissue catabolism, loss of lean body mass, and depletion of energy and protein reserves. A heightened attention to energy needs is essential, and the significance of adequate nutritional support in the complex management of patients with major burns is very important. The purpose of this study is to compare the results obtained by three of the most popular methods of estimating energy requirements in severely burned adult patients with the measurements of resting energy (REE) expenditure by indirect calorimetry (IC). A prospective study was carried out of 20 patients (male/female ratio, 17/3; mean age, 37.83 ± 10.86 yr), without accompanying morbidities, with burn injuries covering a mean body surface area of 34.27 ± 11.55% and a mean abbreviated burn severity index of 7.44 ± 1.58. During the first 30 days after trauma, the energy requirements were estimated using the Curreri, Long, and Toronto formulas. Twice weekly measurements of REE by IC were obtained. It was found that the Curreri and Long formulas overestimated the energy requirements in severely burned patients, as found by other investigators. However, no significant difference was found between the daily energy requirements calculated by the Toronto formula and the measured REE values by IC. It is concluded that the Toronto formula can be used as an alternative method for estimating the energy requirements of patients with major burns in cases where IC is not available or not applicable.

ROLE OF THE ANTIOXIDANT EFFECT OF VITAMIN E WITH VITAMIN C AND TOPICAL POVIDONE-IODINE OINTMENT IN THE TREATMENT OF BURNS
(Al-Kaisy A.A., Salih Sahib A. - Iraq)
Objective. Burns represent a major health problem worldwide, with high mortality and morbidity and economic loss even with small burns. Changes in medical treatment protocols depending on a new mechanism involved in the pathogenicity of burns, i.e. oxidative stress (such as the use of povidone-iodine alone or in combination with vitamin E and vitamin C) may improve the outcome and reduce the economic loss. Patients and methods. Thirty-eight thermally injured patients of different age groups, sex, and occupation with different burn size, admitted to the burn unit in Baquba General Hospital, Iraq, were involved in this clinical trial. The patients were allocated to three groups: group A (8 patients), treated according to hospital policy; group B (17 patients), treated with topical povidone-iodine ointment; and group C (13 patients), treated with topical povidone-iodine ointment with systemic once daily 400 mg vitamin E and 500 mg vitamin C in addition to the classical antibiotic used by our hospital. In each group of oxidative stress parameters, the thyroid, liver, and kidney function test, microbiological studies, the mortality rate and healing time measurements, and economic studies were performed using standard methods. Results. Treatment with topical povidone-iodine ointment or in combination with systemic vitamin E and vitamin C was found to be of significant benefit in improving oxidative stress parameters, the mortality rate, healing time, and cost, and was free of any adverse thyroid, hepatic, or renal effects. Conclusion. Treatment of thermally injured patients with topical povidone-iodine ointment significantly improved oxidative stress parameters, indicating its antioxidant effect. Further investigation is needed to explain the exact mechanism by which povidone-iodine exerts this antioxidant effect. Treatment with topical povidone-iodine ointment alone or in combination with systemic vitamin E and vitamin C significantly improves the outcome of thermally injured patients in a safe way, thanks to the newly emerged mechanism - oxidative stress - involved in burns pathogenesis.

BURNS AND DIABETES
(Shalom A., Friedman T., Wong L. - Israel)
Diabetes is often considered a risk factor for poor wound healing and increased complication rates for plastic surgery procedures. Burn injury in diabetic patients may have implications for the length of stay and number of operations required. We therefore we examined the characteristics of diabetic patients admitted to our burn unit and the impact of their condition on their hospital course. Charts of all patients with diabetes admitted to the burn unit from 1995 to 2000 were reviewed (n = 73). Demographic data, percent body surface area burned, anatomical location of the burn, number of surgical procedures required, length and cost of stay, and outcome were noted. The control population included 150 consecutive patients without diabetes treated during the same period. Diabetic patients were older and underwent a higher number of surgical procedures, with increased length of stay and increased mortality, despite an equivalent body surface area burned. They had a higher incidence of scald burns in the lower extremities than the non-diabetic population. This work shows that diabetic patients constitute a unique group. They are significantly older, have an increased rate of surgical interventions, increased hospital stay, and significantly increased mortality compared to a control group with similar surface area burns. This group is also more likely to have scald burns in the lower extremities, mostly due to diabetic neuropathy. This work emphasizes the importance of education and prevention programmes directed towards this group of patients, in order to decrease morbidity, mortality, and hospital costs.

THE USE OF OSSEOINTEGRATED EPISTHESES IN SEVERE FACE BURN SEQUELAE
(Ferrara M.M., Cervelli V., Bottini D.J., Colicchia G., Masellis A. - Italy)
Four cases are presented of severe face burn sequelae with mutilation of one or both pinnae, treated using osseointegrated epistheses. In the light of over 10 years’ use of this technique, applied in other forms of anatomical deficits in the head such as congenital malformations, demolition owing to extensive neoplasias, and serious traumatic sequelae, it is recommended that burn patients should be carefully considered from both the psychological and the technical point of view. It is suggested that such patients should be analysed by a specific team consisting of a plastic surgeon, a psychologist, and a prosthetist who assess their expectations, analyse their actual reactions, and above all judge their degree of acceptance of an episthesis. A description is provided of the advantages of the technique, which is mainly indicated when the mutilated area presents a deficit of tissues capable of being reconstructed using traditional surgical techniques.

ADULTERATED KEROSENE BURN DISASTER: THE NIGERIA EXPERIENCE
(Ferrara M.M., Cervelli V., Bottini D.J., Colicchia G., Masellis A. - Italy)
Four cases are presented of severe face burn sequelae with mutilation of one or both pinnae, treated using osseointegrated epistheses. In the light of over 10 years’ use of this technique, applied in other forms of anatomical deficits in the head such as congenital malformations, demolition owing to extensive neoplasias, and serious traumatic sequelae, it is recommended that burn patients should be carefully considered from both the psychological and the technical point of view. It is suggested that such patients should be analysed by a specific team consisting of a plastic surgeon, a psychologist, and a prosthetist who assess their expectations, analyse their actual reactions, and above all judge their degree of acceptance of an episthesis. A description is provided of the advantages of the technique, which is mainly indicated when the mutilated area presents a deficit of tissues capable of being reconstructed using traditional surgical techniques.

ARMED CONFLICT AND BURN INJURIES: A BRIEF REVIEW
(Atiyeh B.S., Hayek S.N., Gunn S.W.A. - Lebanon)
Burns and fire disasters are sad but common and obligatory components of armed conflicts, and with the increasing sophistication of weaponry and of chemical and nuclear devices the problem is not set to disappear; on the contrary. Indeed, with the (fortunate) decrease of major international wars but with the (unfortunate) increase of smaller ethnic and sectarian but equally treacherous conflicts, burns are bound to remain a constant problem. Yet the profession is ill prepared for such dark challenges.

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