Annals of Burns and Fire Disasters - vol. XIX - n. 3 - September 2006 INTERNATIONAL ABSTRACTS
HIGH-FREQUENCY OSCILLATORY VENTILATION IN BURN PATIENTS WITH THE ACUTE RESPIRATORY DISTRESS SYNDROMEThis paper from Canada deals with high-frequency oscillatory ventilation (HFOV), which improves gas exchange while providing lung protective effects during ventilation of patients with the acute respiratory distress syndrome (ARDS). The aim of the study was to review experience with HFOV in adult burn patients with oxygenation failure secondary to ARDS. A retrospective review was made of all burn patients treated with HFOV at a regional adult burns in Ontario. HFOV was used 28 times in a total number of 25 patients (mean age, 44 ± 16 yr; percentage TBSA burns, 40 ± 15; 28% incidence of inhalation injury) suffering from severe oxygenation failure due to ARDS (PaO2/FiO2 ratio 98 ± 26; oxygenation index (FiO2 x 100 x mean airway pressure/PaO2) 27 ± 10) following 4.8 ± 4.4 days of conventional mechanical ventilation. After switching from conventional mechanical ventilation to HFOV, significant improvements were seen in the PaO2/FiO2 ratio within 1 h and in the oxygenation index within 24 h. HFOV was applied for 6.1 ± 5.8 days. HFOV was maintained in 26 surgical procedures in 14 patients, in whom a mean of 18 ± 9% TBSA burns were excised and closed. The only HFOV-related complications HFOV were three episodes of severe hypercapnia. In-hospital mortality was 32%. It is concluded that HFOV was safe and highly effective in the correction of oxygenation failure associated with ARDS in burn patients; it can also be used successfully used as an intra-operative ventilation modality for burn patients. Cartotto R., Ellis S., Gomez M., Cooper A., Smith T. IS SUPRA-BAXTER RESUSCITATION IN BURN PATIENTS A NEW PHENOMENON?Baxter favoured the use of 4 cm3/kg/% TBSA as a guideline for post-burn fluid resuscitation. Recent studies would however appear to indicate that nowadays patients generally receive more than the “Baxter” formula. This phenomenon, defined by Pruitt as “fluid creep”, potentially has significant consequences, including abdominal and extremity compartment syndromes and severe pulmonary insults. The purpose of this paper from the USA is to establish whether this supra-Baxter resuscitation is a new phenomenon. A retrospective chart review of two cohorts of patients was performed. Group 1 consisted of 11 patients admitted between 1975 and 1978 to a burns centre in Seattle. Group 2 consisted of 11 patients admitted in 2000 who were matched for age, sex, and percentage total body surface area burned. Group 1 patients received 3.6 ± 1.1 cm3/kg/% TBSA of fluid in the first 24 h, while in Group 2 patients received 8.0 ± 2.5 cm3/kg/% TBSA, which was 100% more than the Baxter formula. There was no difference in median age, weight, or 24-h urine output between the two groups. These data show that the “fluid creep” phenomenon is relatively new. Friedrich J.B., Sullivan R.S., Engrav L.H., Round K.R., Blayney C.B., Carrougher G.J., Heimbach D.M., Honari S., Klein M.B., Gibran N.S. RATE OF ELONGATION PROVIDED BY MULTIPLE SUBCUTANEOUS PEDICLE RHOMBOID FLAPS - AN EXPERIMENTAL STUDY IN THE RAT INGUINAL SKINThe aim of this Turkish paper was to investigate the rate of elongation that was provided by multiple subcutaneous pedicle rhomboid flaps. The lower extremities of 20 male Sprague-Dawley rats were strained and fixed on a table, providing a tension line over the inguinal area. Two rhomboid-shaped adjacent flaps with subcutaneous pedicles were designed over this tension line. Each flap measured 1 cm in length and the distance between two flaps was 0.5 cm. Overall pre-operative length was 2.5 cm. The flaps were incised and freed from the stretched skin. The tension line over the inguinal area was relieved by relaxation incisions. The resulting defects were closed by suturing the rhomboid flaps in V-Y advancement along the tension line and in Y-V advancement along the relaxation incisions. The final elongation was measured and the results were subjected to statistical analysis. It was found that all the relaxation incisions were effective in relief of tension over the inguinal area and in lengthening the tension line. The pre-operative lengths of 2.5 cm length ranged between 5.7 and 6.3 cm post-operatively (mean SD, 5.99 ± 0.17 cm). The mean difference between pre- and post-operative measurements was 3.49 cm (corresponding to 139.6% gain in length). The subcutaneous pedicle rhomboid flaps easily closed all defects caused by relaxation and elongation. Statistical analysis revealed that two adjacent subcutaneous pedicle rhomboid flaps were sufficient to close defects generated by the relaxation incisions that produced a 139% gain in length (p < 0.001). The conclusion of this experimental study is that that multiple subcutaneous pedicle rhomboid flaps are potentially a good alternative technique in the treatment of long contracture bands as regards rate of elongation and simplicity. Ertas N.M., Küçüçelebi A., Bozdogan N., Erbas O., Çelebioglu S. UPDATE ON THE USE OF COLLAGEN/GLYCOSAMINOGLYCATE SKIN SUBSTITUTE - SIX YEARS OF EXPERIENCES WITH ARTIFICIAL SKIN IN 15 GERMAN BURN CENTRESThe artificial skin substitute Integra® has been in successful clinical use in burns therapy for more than ten years, and numerous case reports have described the positive effects of treatment with Integra® as a skin substitute. This study considers the use of Integra® in Germany. Fifteen German burns centres were contacted over a period of six years, with interviews in 1999, 2001, and 2003. The goal was to focus on problems associated with the use of artificial skin and to create a manual for Integra® therapy, including indications and pre-, intra-, and post-operative treatment. The information received was surveyed and it was found that there was a change in the indications for therapy with artificial skin towards extensive full-thickness burn patients and especially for post-traumatic reconstruction. Guidelines are suggested for the usage and handling of Integra®, which is shown to be an important reconstructive dermal substitute for severely burned or post-traumatic patients if correctly handled by a skilled surgeon. Heitland A., Piatkowski A., Noah E.M., Pallua N.
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