||ETUDE STATISTIOUE, SUR UNE SERIE DE 1443 BRULES, DE CEUX OUI ONT EU BESOIN D'UNE ASSISTANCE RESPIRATOIRE IMMEDIATE OU PRECOCE
(Masse CI., Sanchez R., Perro G., Cutillas M., Bourdarias B., Castede J. CI., Le Roux S. - France)
La réanimation respiratoire fait partie intégrante de la prise en charge thérapeutique des brûlés, et ce, dès la phase initiale. Sur une série de 1443 brûlés, 268 ont dû être intubes et le plus souvent mis sous respiration artificielle dont 216 avant le cinquième jour, et les deux-tiers le jour même de la brûlure, parfois avant le transport en service spécialisé. Cette étude a pour objet, non pas de définir ce qui doit être fait, mais d'analyser ce qui a été fait dans une série homogène et un contexte thérapeutique donné.
||INCIDENCE, MANAGEMENT AND PREVENTION OF BURNS IN LIBYA
(Taguri S. - Libya)
There are two Burn Centres in Libya, serving a total of about 3 million people. An analysis is made of the incidence of burn injuries at one of these Centres, in Benghazi, which has 30 beds. The incidence is higher (70%) in females and children. About 70% of the bum injuries are minor ones occurring in the home. Minor bums are dealt with in the outpatients clinic. Moderate and severe bums are first treated in the bum shock room, before transfer to the burn ward. Prevention is very important. Audiovisual aids are most effective. A common research programme among the Mediterranean countries could help to make the authorities more aware of the problem and suggest appropriate legislation.
||TRANSPORTATION OF BURN PATIENTS
(Marichy J., Vaudelin Th., Marin-Laflltche I., Gueugniaud P.-Y., Bouchard C1. - France)
It is nowadays well known that an appropriately instituted first aid and medical transport can be important in minimizing the morbidity and the mortality from bum injury. In a recent study we analysed the mortality rate in relation with the transportation of the burned patients admitted to our Bum Centre. Despite the fact that around 60% of the burned patients have a medical transport, the mortality rate remains high (30%) when the patient is admitted between the fourth hour and the twenty-fourth hour after trauma. This fact emphasizes the need to conduct an educational programme not only for the non-medical population but above all for medical and paramedical teams.
||HISTORICAL LANDMARKS IN THE EVALUATION OF THE BURNS AND THE RELEVANCE OF PLASTIC SURGERY TO THEIR TREATMENT
(Polywatis G.E. - Greece)
The increasing knowledge about bums has given the impetus to develop more accurate methods of diagnosis and treatment. In the past, men treating bums believed that post-bum tissue oedema ought to be treated by avoiding fluid administration. Also numerous methods of treating bums, which were in vogue for years, have been rejected or modified.
Up to the end of the 19th century, free skin grafting was limited to cover only traumatic, or granulating areas, by small full thickness or by superficial epidermis grafts. But a revolution occurred when it became clear that the dermal pad is the most important part of the skin, and that the epithelium of the donor site regenerates from deep islands. Consequently suitable instruments have been devised to cut thicker grafts in large areas.
Today the story of the burned patient begins at the minute of his accident, and should continue to the day in which he finally resumes his place in society.
In addition to some other factors in the evaluation of the bums illness, the author proposes a more correct and simple terminology for the different kinds of skin grafts used today.
||ANALYSIS OF BACTERIOLOGICAL MONITORING IN PATIENTS AT THE PALERMO BURNS CENTRE: A FIVE-YEAR EXPERIENCE
(Pezzino T., Cucchiara B., Vitale R., Benigno A., Cucchiara P., D'Arpa N., Pirillo E. - Italy)
With regard to the five-year period 1982/87 an analysis was made of the evolution of the bacterial strains in swabs from burn patients and of any possible links between them. The results show that the micro-organisms most frequently observed were Staphylococcus spp. and Pseudomonas spp.. The infections caused by Staphylococcus spp. in 1982 accounted for more than 60% of the total number, reducing in successive years until 1985 (less than 40%), and stabilizing in the two years 1986/87 at about 41%. Pseudomonas spp. had its highest infection level (about 30%) in the two-year period 1982/83, and a minimum in 1984 (about 20%), while between 1984 and 1987 there was an increase in infections with opposite values compared to those of Staphylococcus spp. The frequency of Enterobacteriaceae was low, unlike that of the Corynebacterium spp, which appeared to be expanding and developing a marked resistance to antimicrobial agents; they were thus the cause of worrying in~ections.
||THE TREATMENT OF SUPERFICIAL BURNS WITH BIOLOGICAL AND SYNTHETIC MATERIAL: FROZEN AMNION AND BIOBRANE
(Lorusso R, Geraci V., Masellis M. - Italy)
An analysis is made of the manner of recovery, the capacity for preventing infection and the operative and economic advantages when using frozen amniotic membrane and a biosynthetic membrane (Biobranc), in the treatment of superficial bums. The parameters considered include: - type of burn - assessment of bacterial pollution at time of admission and at subsequent medications - assessment of adherence - time and manner of recovery. The results obtained from the comparative examination of burned surfaces which were similar from the point of view of type and depth of lesion made it possible to appreciate the effectiveness of the two epidermis substitutes as regards manner and quality of recovery. It is pointed out that amniotic membrane is economic and readily available, especially if repeated medications are necessary.
||SURGICAL TREATMENT AND REHABILITATION
(Dayoub A., Barakat 0. - Syria)
Reconstruction and rehabilitation constitute an additional part of burns treatment, concerned with dysfunction and changes in the aspect of the patients, due to cicatricial contraction after the injury.
By transplanting tissues, early surgical treatment, if,possible, can help the patient to resume his social work sooner.
The surgeon must thus be aware of the degree of bum and the amount of tissue damage. The wound heals more rapidly because of easy reepithelization. In such a case, only mild pigmentation or depigmentation occurs on the part involved, unless the patient has a tendency to sear formation. In deep second degree or third degree bums in which the dermis or the entire skin and subcutaneous tissues are destroyed, the wound usually takes longer to heal. It undergoes a process of sloughing, granulating, progressive fibrosis, and ultimately sear formation.
If proper measures have been taken to repair the defects, such as skin grafting or flap transplantation, cicatricial contraction will be minimized. There are usually two types of scar following bums, namely atrophic and hypertrophic scars. The most suitable time for operation is 6 months post-bum because at that time the scar is stable, with less engorgement and hypertrophic reaction, and becomes soft and brown.
||BURNS OF THE NECK
(Talaat H.A. - Egypt)
The face, neck and hands are the most frequent parts affected in extensive burn injuries. They are commonly very deeply burned. Local anatornic particulars have a decisive role in the management, the resulting deformity and degree of disability. These anatomic facts aic mainly:
the relative thickness of the skin
the presence of subcutaneous voluntary muscles: the expression muscles in the face, the platysma in palm
the functional anatomic areas, to be respected during planning of skin cover and reconstruction.
The present study includes a total of 1578 cases of fresh bum injuries admitted during a three-year period (Jan. 1985 - Jan. 1988). The neck was affected in 333 cases (2 1%). In the same period 115 cases suffering from burn neck contractures were referred to the Plastic Surgery Unit. The pattern of contracture was classified according to the site, extent and degree. The reconstruction was held long cnough to allow for softening of the scar. The choice of the operative procedure was decided according to the pattern, the available skin suitable for transfer and associated contracture affecting the face, chest wall or axilla. The operative procedures include Z-plasty with or without skin graft, local cervicoplasty, myocutancous flaps, fasciocutaneous flaps and free transfer.
||RECENT FASCIOCUTANEOUS FLAPS FOR REPAIR OF POST-BURN NECK, AXILLARY AND ELBOW CONTRACTURES
(Kadry M., Hassan A., Tewfik 0., Ismail M. - Egypt)
Deep burns are known to result in severe contractures over the neck, axilla and elbow. After release of the contracture the problem remains to cover the resulting raw area. Multiple techniques are available to cover such defects, ranging from the use of a split-thickness skin graft to the most elaborate repair with a free flap. Each of these techniques has its advantages as well as its hazards and limitations. It used to be the dream of every plastic surgeon to accomplish this goal by using local tissues which have the same texture, colour and thickness without the possibility of subsequent contracture. The fasciocutaneous flaps recently described seem to fulfil this goal. Three flaps recently described but not widely used are presented. Their anatomical basis, their clinical applications as well as their advantages and drawbacks are demonstrated for repair of post-burn axillary, cervical and elbow contractures.
||THE USE OF TISSUE EXPANSION FOR RECONSTRUCTION OF POST-BURN ALOPECIA
(Zaki M.S. - Egypt)
Controlled tissue expansion was used for scalp reconstruction in ten patients with post-burn alopecia. The time between the bum injury and reconstruction ranged between 3 and 21 years. Expanders with a remote valve were used in this series. They were introd ' uced either through a remote incision or by a paralesional approach. Multiple expanders were used when the dimensions of the defect exceeded 10 x 18 cm. The expanders were serially filled starting two to three weeks post-operatively. The expansion was carried out usually twice per week, guided by both patient tolerance and tissue response. The end of the expansion period is reached when the measured length of the expanded flaps can give the needed advancement to reconstruct the scalp defect. The clinical results showed that tissue expansion is an ideal technique for reconstruction of post-burn alopecia, and it has several advantages over other surgical procedures.
||REHABILITATION OF BURN PATIENTS IN THE BURN UNIT
(Brcit A. - Yugoslavia)
Early surgery of the bum wound, especially primary tangential excision, creates favorable conditions for effective early rehabilitation. A team for rehabilitation was organized to follow the patient from admission, during hospitalization and after discharge. The members are: surgeon, nurse, physio- and occupational-therapist, psychologist, dietitian, school teacher, play therapist, social worker and cosmetologist. For major bums, treatment in the Rehabilitation Centre follows discharge, although regular controls by the rehabilitation team are continued. Every patient is supplied with compressive garments (gloves, mask) or splints and conformers which are individually produced by the occupational therapist during treatment in the unit. Reconstructive operations are performed because of both functional and psychological needs. In children early reconstruction is often necessary in cases of development and growth impairment. The role of the family in the process of reintegration in normal life is obvious not only in children but also in adults. Bum Units should organize their own rehabilitation team and cooperate with Rehabilitation Centres, as in the present situation they have limited knowledge of specific burn rehabilitation.