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Volume XVIII

Number 4

December 2005

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SUMMARIES

173 A PARTNERSHIP IN BURN CARE EDUCATION - NEPAL AND AUSTRALIA
(Edgar D., Tonkin C., Baker T., Goodwin-Walters A., Wood F.. - Australia)
This paper describes some of the issues related to an education partnership which has been developed over the last four years between the Royal Perth Hospital Burn Team in Australia and the Bir Hospital Burn Team in Kathmandu, Nepal. The paper provides an insight into the preparation and collaboration required from both teams and describes some practical ideas to assist those who may be considering educating others in a developing burn service outside their catchment area.
177 CLINICAL AND AUTOPSY DIAGNOSES OF VISCERAL AFFECTIONS OF PATIENTS WHO DIED BECAUSE OF COMPLICATED BURNS WITH MULTI-ORGAN FAILURE
(Taran A., Baciu N., Rafulea V., German A. - Republic of Moldova)
The anatomicopathological investigations carried out in a total number of 186 cadavers during the last decade were reviewed. In these retrospective studies of necropsy protocols related to different affections of visceral organ systems that evolved asymptomatically, 30.1% involved the neurological system, 36.0% the uropoiesis system, 34.4% the gastrointestinal system, 52.0% the hepatobiliary system, and 39.7% the cardiovascular system, with a prevalence in the pulmonary system of 64.2%. A comparative analysis of the incidence of affections detected in various visceral organs (on the basis of necropsy data in the 186 burn patients) and the incidence of their clinical manifestations showed that in 35% of patients with extensive and deep burns all of these conditions developed asymptomatically and were diagnosed only through autopsy.
185 PAEDIATRIC BURNS IN THE ACUTE PHASE: SPECIFIC ASPECTS
(Grisolia G.A., Pinzauti E., Pancani S., Pavone M. - Italy)
This paper deals with specific aspects of paediatric burns in the acute phase and considers how the treatment of burned children differs from that of burned adults. The epidemiology of paediatric burns is reviewed. Particular aspects of the treatment of burned children are presented, with regard to treatment at the site of the accident, first aid, resuscitation, and local treatment. The importance of the accurate assessment of paediatric burns is stressed.
190 TREATMENT OF PALM BURNS IN CHILDREN
(Argirova M., Hadzhiyski O. - Bulgaria)
The timing and methods of treatment of palm burns in children vary widely. From January 2002 to November 2004, 492 children with burns - 125 of them with hand burns or other body burns - were hospitalized and treated at the N.I. Pirogov Clinic for Burns and Plastic Surgery in Bulgaria. Fifty-four children (for a total of 73 burned hands) presented isolated palm burns. Twenty-two hands were operated on. In this review we present the incidence, causes, treatment methods, functional results, and evaluation parameters of these patients.
194 TRANSPLANTATION OF COMPOSITE SKIN CONTAINING KERATINOCYTES CULTURED ON A FIBROBLAST-CONDITIONED ACELLULAR DERMAL MATRIX
(Xiao S.-C., Ben D.-F., Yang J., Tang H.-T., Wang G.-Q., Yang Y., Yu W.-R., Xia Z.-F. - People's Republic of China)
To evaluate the role of fibroblasts in composite skin reconstructed in vitro, four different types of composite skin (A, B, C, and D) were prepared. Human keratinocytes were seeded onto the epidermal side of an acellular dermal matrix (ADM) in type A. Keratinocytes were seeded onto the epidermal side of an ADM and human fibroblasts onto the dermal side in type B. Both keratinocytes and fibroblasts were seeded onto the epidermal side in type C. Type D consisted of fibroblasts on both sides of the ADM and keratinocytes on the epidermal side. The adherence of keratinocytes to the ADM was observed. The composite skin was then transplanted onto full-thickness skin defect wounds in nude mice. Results showed that the adherence of keratinocytes to the ADM was improved when fibroblasts were pre-seeded onto the epidermal side of the ADM. The composite skin was able to close full-thickness skin defect wounds. The take rates were respectively 44.1 7.8%, 47.3 5.4%, 75.2 8.8%, and 81.2 8.1% for types A, B, C, and D. The take rates of types C and D were significantly higher than those of types A and D. There was no significant difference in take rate between types C and D. In conclusion, composite skin consisting of keratinocytes cultured on a fibroblast-conditioned ADM was a good skin substitute.
197 MARJOLIN'S ULCER OF THE SCALP: A RECONSTRUCTIVE CHALLENGE
(Atiyeh B.S., Hayek S.N., Kodeih M.G. - Lebanon)
In the year 1828 Jean-Nicolas Marjolin described the formation of ulcers specifically in chronic burn scars, and in 1903 De Costa coined the term "Marjolin's ulcer", applying it to tumours arising in simple leg ulcers. The causes of this condition are described, as also treatment protocols, and a case report is presented.
202 MANAGEMENT OF KELOID AND HYPERTROPHIC SCARS
(Edriss A.S., Mk J. - Czech Republic)
Scar management for the prevention of excessive scar formation has always been important but never so important as it is today. Optimal management continues to be an enigma for surgeons, and the best modality of treatment has been debated for many years. However, most studies have unfortunately been either retrospective or case report descriptions. Advances in scar management have been hampered by confusing or ambiguous terminology. There is no consensus on what amount of post-traumatic skin scar formation is "normal" and what should be considered "hypertrophic". In the World Health Organization's ICD-9, there is no diagnostic code for hypertrophic scar - only keloid is listed. Yet the medical and scientific literature distinguishes them as different conditions. This confusion results in inappropriate management of scar formation, and occasionally contributes to decision-making related to elective or cosmetic surgery. Our experience suggests that there is no single treatment for scars that is adequate and that clinical judgement is very important when considering treatment and balancing the potential benefits of the various treatments available. The goal of treating scars is to restore functionality, provide relief of symptoms, enhance cosmetics, and prevent recurrence. This article is based on our scientific and clinical experiences and focuses on over-the-counter options to manage keloid and hypertrophic scars.
211 SERUM AMINO ACIDS (GLUTAMINE, GLUTAMATE, METHIONINE, AND ARGININE) FLUX AFTER CUTANEOUS THERMAL AND SMOKE INHALATION INJURIES IN RATS
(Tang Y.-W. - Taiwan)
Smoke inhalation injury remains a major co-morbid complication in burn patients. The mortality rate of patients with burns and smoke inhalation injury is reported to be much higher than that of patients with either injury alone. Patients with this combined injury need a more intensive and aggressive nutrition supply to help them survive. The present study, using rats, was designed to test amino acid flux in cases of combined injury (smoke inhalation injury and cutaneous burns). The purpose was to understand the amino acid flux after this combined injury. We tested four different amino acids, i.e. glutamate, glutamine, arginine, and methionine, and hypothesized that different amino acids would be affected differently. Our preliminary results showed that smoke inhalation injury alone did not cause a significant change in amino acid flux during the first five days after injury, but only some increase in arginine three days after injury. In the cutaneous burn and smoke inhalation injury group, all four amino acids decreased immediately and significantly. This result suggests that these four essential amino acids are all conditionally essential amino acids in this combined injury. However, in the simple smoke inhalation injury group, the amino acid supply was not as important, at least in the first five days after injury.
217 Letter to the editors: CONSERVATIVE TREATMENT IN AURICLE BURNS
(Caputo G., Monese C., Governa M., Barisoni D. - Italy)
Dear Sirs, We appreciated the article "Early management of the burned auricle" by Kamal A., Kamel A.H., and El Oteify M., recently published in Annals of Burns and Fire Disasters, 17: 197-200, 2004. Auricle burns still carry a high rate of infective complications: according to the literature about 10% of cases evolve into chondritis. Several theories are advanced to explain post-burn chondritis physiopathology. One theory sustains that full-thickness loss of skin and perichondrium exposes the cartilage to a high risk of chondronecrosis and subsequent infection. Another possible cause of chondritis is massive post-traumatic oedema and the small-artery thrombosis typical of partial-thickness burns. The interruption of skin continuity may also be regarded as a rupture of the physiological barrier to bacterial infections.
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