Annals of Burns and Fire Disasters - vol. XIX - n. 1 - March 2006 INTERNATIONAL ABSTRACTS
EVALUATION OF A PORCINE ORIGIN ACELLULAR DERMAL MATRIX AND SMALL INTESTINAL SUBMUCOSA AS DERMAL REPLACEMENTS IN PREVENTING SECONDARY SKIN GRAFT CONTRACTIONThe extent to which split-thickness skin grafts contract after being applied to their recipient bed is partly related to the proportion of dermis harvested from the donor site. The harvesting of thicker skin grafts can yield better cosmetic results in the recipient bed but lead to greater donor site morbidity. The combination of an autologous ultra-thin split-thickness graft with an underlying non-autologous dermal component may reduce secondary skin graft contraction without any further increase of donor site morbidity. The aim of this study from England was to assess the suitability of two porcine-derived biomaterials (PermacolTM and small intestinal submucosa) for use in combination with skin grafts in a Sprague-Dawley rat model. Full-thickness wounds (1 cm2) were created in Sprague-Dawley rats and grafted with skin in combination with PermacolTM or small intestinal submucosa either as a one-stage operation or following a two-week period of vascularization of these derma matrices before a second-stage operation to cover with skin. Skin graft viability and wound area were assessed at weekly intervals until four weeks after graft application. Both PermacolTM and small intestinal submucosa were able to support an overlying skin graft but neither had any beneficial effect on skin graft contraction in this model compared with skin grafts alone. MacLeod T.M., Sarathchandra P., Williams G., Sanders R., Green C.J. SYNCOPE AND BURNSSyncope is a frequently occurring condition that may result in serious injuries, including burns and head injuries. There has been as yet no specific discussion of syncope and burns in the literature. A retrospective case-note review was made of consecutive patients admitted to a tertiary burns centre in China over a 3.5-yr period. Altogether, 559 patients were admitted during this period. Six of these presented burns related to alterations of consciousness, excluding alcohol/drug ingestion and epilepsy. The rnean percentage body surface area burned was 9.7%, the mean duration of hospital stay was 28.5 days, and the mean length of stay per percentage surface area burned was 4.0 days per percentage body surface burned. The mean extent of the injury in syncopal patients was slightly larger than in general burns patients (8.4%) but the length of stay was double. This was partly related to the fact that surgery was delayed owing to investigation of the syncope episode. Focused investigations would be useful to reduce the overall length of hospital stay and the number of investigations. Chiu T., Pang P., Ying S.Y., Burd A. SELF-INFLICTED BURNS: AN EIGHT-YEAR RETROSPECTIVE STUDY IN FINLANDThe purpose of this Finnish study was to study differences in the characteristics of burn patients who had attempted suicide, compared with other burn patients admitted to the Helsinki Burn Centre in the period 1989-97. Burn patient records were extracted from a computerized register and a psychiatrist examined the medical records and singled out the cases of attempted suicide. Out of the total of 811 burn patients, 46 (5.7%) had attempted suicide. The median burned surface area of suicide attempters (24.0%) was markedly higher than in the other patients (6.0%, p < 0.001). Flame was a much commoner cause of burns in suicide attempters (82.1%) than in non-suicidal cases (44.5%, p < 0.001). Before the burn incident, suicide attempters were more often unemployed (28.2% vs. 12.9%) or on disability pension (30.8% vs. 7.1%) (p < 0.001). The proportion of patients with self-inflicted burns among all burn patients was not high, but the notably greater severity of their burns makes them an important clinical subgroup for further study. Palmu R., Isometsä E., Suominen K., Vuola J., Leppävuori A., TREATMENT OF WHITE PHOSPHORUS AND OTHER CHEMICAL BURN INJURIES AT ONE BURN CENTRE OVER A 51-YEAR PERIODThis report from the USA, having pointed out that chemical burn injury meets the criteria of the American Burn Association for treatment in a specialized burn facility, describes the treatment over a 51-yr period of 276 patients with chemical burn injury including 146 white phosphorus injury. The study compares the incidence, cause, and outcome of chemical burn injury over time and reviews the management of white phosphorus injury. Data for the period 1986-2000 were obtained by making a retrospective chart review. Data for the period 1950-1985 were obtained using previous studies and retrospective chart reviews. Chemical burn injury comprised 2.1% of all admissions between 1969 and 1985, and 2.07% of those between 1986 and 2000. The mean body surface area involved was 19.5% in the first 19 years of the study compared with 8.6% over the last 15 years. Mortality rose from 5.4% between 1950 and 1968 to 13.8% between 1969 and 1985. Mortality between 1986 and 2000 was nil. Mean hospital stay fell from 90 days in the first 19 years of the study to 15 days in the most recent 15-yr period. The chemical responsible was white phosphorus in 146 cases. It is concluded that over time the proportion of burn centre admissions due to chemical injury was constant, while the mean total burn size, full-thickness burn extent, length of hospital stay, and mortality decreased. In peacetime, the chemicals responsible are similar to those seen in civilian burn centres. The experience of this American centre with burns caused by white phosphorus is unique and needs to be maintained in case of future conflicts. Barillo D.J., Cancio L.C., Goodwin C.W. EFFECT ON CARERS OF SUICIDE ATTEMPT BY FIREThis paper, in French, considers the psychological effects and the reactions in the team of carers looking after survivors of suicide attempts by fire. Such an attempt is generally provoked by immense psychic suffering. How is the team to react? There is a constant interaction between the patient and the carers. The care given to the damaged body triggers a set of conscious and unconscious mechanisms which the carers must keep constantly in mind. Fredj H. EPIDEMIOLOGY IN THE BURNS CENTRE AT MEKNESThis paper from Morocco presents the epidemiology of burns patients treated in the burns centre at Meknčs in Morocco, one of the only two in that country (the other is in Casablanca). Aspects considered include the origin of the patients, circumstances of the accident, transfer delay, place of accident, pre-hospital taking in charge, evolution of patients, and identification of problems. Meknčs Burns Centre is very old, which gives rise to a number of problems. Some possible ways of improvement are suggested. Larouz S., Fortin J.L., Courtier F. BACTERIOLOGICAL MONITORING AFTER BURN INJURYThis paper from the Czech Republic recalls that of the many possible complications in burn victims, the most frequent and most serious is infection. Post-burn bacteriological monitoring of such patients is an essential part of complex care. Burn areas must be microbiologically monitored by the semiquantitative imprint method and it is important to bear in mind that colonization is proportional to the duration of the patient’s hospital stay. In burn units bacterial resistance to antibiotics is usually higher than in other departments. For this reason it is important to consider antibiotic treatment and to observe sensitivity closely by obtaining bacteriological results and studying the current epidemiological situation. Burns patients risk infection from the burn areas, from the respiratory and urinary tracts, and from central venous catheters. The attending physician must be in daily contact with the bacteriological laboratory. Vránková J., Adámková V. THE ROLE OF THE SKIN BANK IN THE TREATMENT OF SEVERELY BURNED PATIENTSThe accessibility of a suitable temporary cover is a key factor in the treatment of severe skin loss. Biological covers have the longest tradition in wound healing, and skin banks have long been active in their production and distribution. As long ago as 1973, J. Moserová had developed a methodology for harvesting porcine xenografts, and short- and long-term storage methods were subsequently developed. The Prague Burns Centre skin bank goes back to 1986. In the Prague centre, where the authors of this paper work, allografts from living donors - usually the patient’s family members - are used very rarely. In their bank they have therefore specialized in harvesting porcine xenografts, which are produced in three different forms: fresh, deep frozen in liquid nitrogen, and glycerolized. Porcine xenografts act as a biological cover, creating a barrier against infection and evaporation and protecting the wound from desiccation. They are mainly used in the treatment of superficial burn wounds, as a temporary coverage in excised wounds, and as a dressing in release incisions. Every year, in the Prague centre, more than 10,000 strips are used, meaning an area of some 200 square metres. Since 1991 a cultivation laboratory has been part of the skin bank, where great interest is shown in the cultivation of human epidermal cells (keratinocytes). Cultured epidermal grafts were the first human tissue prepared in vitro to be successfully transplanted. In Prague, for the treatment of deep dermal skin loss, they use either autologous keratinocytes, which can create permanent coverage, or allogeneic cells, which stimulate spontaneous healing. Cultured keratinocytes are used to treat burn patients as well as trophic defects. Dvořánková B., Brož L., Pafčuga I., Kapounková Z., Königová R. DEATH CAUSED BY SUN-RELATED BURNS DUE TO FIG LEAF TANNING LOTION - CASE REPORTThis paper from Brazil reports on the increasing number of patients who are victims of deep sun-related burns associated with the use of fig leaf tanning lotion. The case is described of a 22-yr-old female patient who presented with second-degree burns in 92% body surface area (practically her entire body area except for the scalp and the area covered by her bikini) 48 h after sunbathing using this kind of tanning lotion. The patient developed signs of severe sepsis (severe leucopenia and slight anaemia) and died within eight days of hospitalization. Gabriele J.F., Crisóstomo M.R., Zeitoune G.C., do Valle Freitas Serra M.C., Gomes D.R., Terra Cunha N. FULL-THICKNESS SKIN GRAFT FOR BURNED FACEThis Egyptian report describes eight cases observed since the year 1999 of post-burn complications in the face managed using full-thickness skin grafts: seven females and one male child suffering from post-burn keloids, scarring, and face deformity. Expansion of donor site and application of full-thickness skins graft were used to cover extensive burn surface areas. The procedures used were simple and the results are discussed. Basha H. |