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Volume XIX |
Number 1 |
March 2006 |
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SUMMARIES
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A PROFILE AND SPECTRUM OF FOUR CASES OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN A BURNS INTENSIVE CARE UNIT
(Zorgani A.A., Shahen A., Zaidi M., Franka M.. - Libya)
This report describes and evaluates four patients with hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas infections at the Burns and Plastic Surgery Hospital, in Libya, between August 1999 and August 2002. Neither rifampicin nor vancomycin was used to treat these patients. Inhalation injury with major burns (> 60% total body surface area), a major degree of burns (3rd degree), and septicaemia caused by both MRSA and multi-resistant P. aeruginosa invariably proved fatal. One patient responded well to antibiotic therapy, but the other three died in spite of similar therapy. Vancomycin and rifampicin should be established as the first choice to treat MRSA infection, and infected wounds need aggressive management with antibiotics prior to skin grafting. |
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HOW TO DECREASE THE INCIDENCE OF ESCHAR FORMATION DURING THE USE OF TOPICAL POVIDONE-IODINE OINTMENT IN THE TREATMENT OF BURNS
(Salih Sahib A.; Al-Kaisy A.A., Al-Biati H.A.K.J. - Iraq)
The aim of this study was to prevent eschar formation in thermally injured patients during the use of povidone-iodine ointment by modifying therapeutic protocols depending on normal events in healing process. Sixty thermally injured patients of different age groups, sex, and occupation with different burn sizes were involved in the study, allocated to two groups. Group A was made up of 17 patients treated with topical povidone-iodine ointment in addition to other prescribed drugs according to the burn unit regimen, while group B was comprised of 43 patients treated with topical povidone-iodine ointment for the first four days post-injury followed by topical silver sulphadiazine cream until discharge and with other prescribed drugs according to the burn unit regimen. In both groups the following were studied, using standard methods: oxidative stress parameters; thyroid, liver, and renal function test; microbiology; mortality rate; healing time and economic aspects. It was found that treatment of burn patients with topical povidone-iodine ointment for the first four days post-injury followed by topical silver sulphadiazine cream reduced the incidence of eschar formation from 100% to 2.3%, in addition to maintaining improvement in burn outcome when using povidone-iodine ointment during the full course of treatment. It is concluded that for the modification of treatment protocols in burns designed to obtain normal wound healing and at the same time to avoid the undesirable effects of the treatment given, the use of topical povidone-iodine ointment for the first four days post-injury, followed by topical silver sulphadiazine cream, was a good application. In addition, this study clearly shows the importance of the therapeutic targeting of oxidative stress in burn treatment, especially during the first four days post-injury, a period when blood levels of oxidative stress parameters are at a maximum. |
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PATTERN OF BACTERIAL INVASION IN BURN PATIENTS AT THE PAKISTAN INSTITUTE OF MEDICAL SCIENCES, ISLAMABAD
(Ahmad M., Shahid Hussain S., Ibrahim Khan M., Malik S.A. - Pakistan)
A prospective study was carried out in the Department of Plastic Surgery, Pakistan Institute of Medical Sciences, Islamabad, from January 2002 to December 2003. A total number of 142 patients were included in the study. The patients' mean age was 32.2 yr for males and 24.4 yr for females. The male/female ratio was 1.18:1.0. Micro-organisms from 86 patients were cultured for the first five days and in 77 patients from day 6 onwards. Staphylococcus aureus was found in 24.4%, which decreased to 18.2% after the first week. Pseudomonas aeruginosa was found in 27.3% of patients. Methicillin-resistant Staphylococcus aureus was observed in 11.7% of cases. No case of methicillin-sensitive Staphylococcus aureus was found. Seven patients, after admission day 6, showed no growth. Eighteen per cent of males and 16% of females died during their stay in hospital. This study highlights the predominant bacterial pathogens among the infected burn wounds treated in our centre . |
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ACUTE DORSAL HAND BURNS IN CHILDREN
(Argirova M., O. Hadzhiyski. - Bulgaria)
Hand burns in children, whether isolated or part of massive burns, require special attention. A crucial element in this respect is the preservation and full restoration of hand function. Most cases of severe sequelae after burns are associated with hand burns. From January 2002 to November 2004, 125 children with hand burns and other body burns were treated at the Centre of Burns and Plastic Surgery in Sofia, Bulgaria. This review presents our experience with 71 children with 89 burned hands in the region of the dorsal surface of the hand. Forty-nine hands had isolated dorsal surface burns, and 40 had combined burns, i.e. both dorsal and volar. Of all the hands treated, 69 had superficial burns, which epithelialized spontaneously. Twenty hands with deep dermal and full-thickness burns were subjected to sheet autografting. The review includes many details of the systematic approach to this type of burns. Optimal recovery of hand function can be achieved by accurate planning of treatment. Tracking of long-term results is also included in the general plan of behaviour in this type of burn. Our approach is conservative for superficial burns and active - with early excision and prompt closure with sheet autograft or, in extensive burns, allografting followed by covering with an autograft. |
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THE USE OF THE FAT-CUTANEOUS NECK FLAP IN RECONSTRUCTION OF THE FACE INJURED BY BURNS
(Sarygin P.V., Moroz V.Y., Yudenich A.A., Popov S.V. - Russia)
The face is a part of the body that is frequently affected by burn injury. Post-burn scar sequelae in this area often result in invalidity and psychological upsets for the patients. The methods of plastic surgery widely employed have their drawbacks. In particular, it is very important for surgical reconstruction of the face to find plastic material with the same properties: texture, colour, thickness, and natural elasticity. For this purpose, at the Division of Plastic and Reconstructive Surgery, A.V. Vishnevsky Institute of Surgery, Russian Academy of Medical Science, we use the fat-cutaneous neck flap mobilized according to the anatomical distribution of the vessels. We describe some typical clinical situations and possible variants of plastic surgery using the neck flap, based on the experience of surgical treatment in 248 patients. It is our opinion that application of the neck flap is preferable to other reconstructive techniques in the lower part of the face in patients with preserved skin in the neck and anterior surface of the chest. |
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FLUCTUATION OF PSYCHOLOGICAL STATUS IN BURN PATIENTS DURING HOSPITALIZATION
(Castana O., Makrodimou M., Katsaraki E., Apostolopoulou C., Alexakis D. - Greece)
This paper considers the fluctuations in psychological status that occur in burn patients in the acute phase, during hospitalization, and in the post-hospitalization period. The various disorders are reported. Psychiatric consultation is mandatory, along with psychological support, and appropriate medication should be prescribed. |
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THE TREATMENT OF LYELL'S SYNDROME: OUR EXPERIENCE
(Napoli B., D'Arpa N., Masellis M. - Palermo)
In view of the pathogenic mechanisms of Lyell's syndrome, we consider support-only treatment to be insufficient and believe it is necessary to administer i.v. human immunoglobulin. Because of the potentially severe side effects of the high doses usually recommended, we prefer to use low doses (no more than 5 g per day) in association with the administration of fresh frozen plasma, which offers the benefits of the high protein content in the albumin (with its resuscitatory function) and its globulin content (functioning as a specific therapy for Lyell's syndrome). We present the latest cases we have observed and treated using this protocol. |
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HAEMODYNAMIC DISORDERS IN THE COURSE OF ELECTRICAL BURNS. A PRELIMINARY REPORT
(Bujok G., Stru.zyna J., Knapik P. - Poland)
The results of Doppler haemodynamic investigations in electrically burned patients are described in this paper. A comparison with other burned patients is also provided. The following differences were found between the two groups: 1. diminished compliance of the myocardium in electrically burned patients; 2. markedly elevated ejection time measured by flow time. The results remain unclear and require further long-term investigations. |
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CASE REPORT: BURNS FROM ORTHODONTIC PLIERS
(Zagury A., Baruchin O., Scharf S., Baruchin A.M. - Israel)
A case of burn injury from orthodontic pliers resulting in a partial-thickness burn is presented. A brief description of the injury, a review of the pertinent literature, and general guidelines for out-patient management of such burns are also presented. |
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CASE REPORT: BILATERAL SHOULDER FRACTURES SECONDARY TO ACCIDENTAL ELECTRICAL INJURY
(Elena-Sorando E., Agulló-Domingo A., Juan-Garcia E., Amrouni B. - Spain)
Electrical injuries sometimes cause grave internal lesions that go unnoticed in an initial exploration. Low-tension electrical energy can produce burns of variable depth by flash or conduction, but we rarely find fractures. This case reports a case of bilateral shoulder fractures secondary to low-voltage injury which were undiagnosed in the emergency approach. |
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CASE REPORT: LIGHTNING STRIKE IN GOLF PRACTICE
(Elena-Sorando E., Galeano-Ricaño N., Agulló-Domingo A., Cimorra-Moreno G., Gil-Castillo C. - Spain)
The case is presented of a golfer who was struck by lightning while playing golf during a thunderstorm. The patient was found lying unconscious on wet grass with his clothes scorched and his spiked golf shoes torn. He had suffered dermal burns affecting the neck, thorax, abdomen, and upper and lower limbs (10% total body surface area), without any cardiovascular or respiratory disturbances. It may be hypothesized that the lightning current went over the outside of the patient, causing ignition of his clothes. Treatment included monitoring, adequate fluid management, debridement, and topical treatment (silver sulphadiazine). Complete healing of the wounds was achieved in two weeks. After three years' follow-up, the patient had no sequelae. |
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