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Volume XX |
Number 4 |
December 2007 |
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SUMMARIES
| 171 |
EDITORIAL:HOW WHO et al. DISCOVERED BURN SURGERY
(S.W.A. Gunn)
In 1967, exactly 40 years ago, on a fine summer Friday, I was operating at Vancouver General Hospital, and just over the same weekend I flew to Switzerland, starting on Monday my new job at WHO, suddenly beginning a new life.A new life that began with a shock. Almost overnight, from my usual circle of cutters and decision-making surgical friends in a hospital atmosphere, I found myself submerged among public health functionaries and decision-postponing specialists in an administrative stronghold. What a difference! No talk of surgery, no talk of personal patients, no excitement of running to an urgent bedside call; but much talk of millions with diarrhoea and of unseen malaria victims far away. Fortunately, however, also some talk on the mass casualties, destruction and fires following the then recent Skopje earthquake! Therefore a possibility for surgical action... just enough to soften my cultural shock. |
| 173 |
BURNS FROM A STOVE BURST: ANALYSIS OF 34 CASES
(Ahmad M., Hussain S.S., Malik S.A. - Pakistan)
Burns continue to be a major environmental factor responsible for significant morbidity and mortality in developing countries and, in particular, burns due to stove bursts are a major problem. Two types of stoves are available in Pakistan: gas stoves and kerosene stoves. The state is considered of patients burned by stove bursts in general, and also with specific reference to 34 adult patients admitted with stove burns to our hospital in Pakistan. Various treatment options were used, and the patients' treatment and outcome are reported. The continued commercialization of such stoves, and especially of the gas stove, is is a cause of serious and permanent consequences that represent a danger for the population. Proper care should be observed when handling them because, as always, prevention is better than cure. |
| 176 |
MONOBLOCK EXPANDED FULL-THICKNESS GRAFT FOR RESURFACING OF THE BURNED FACE IN YOUNG PATIENTS
(Allam A.M., El Khalek A.E.A., Mustafa W., Zayed E. - Egypt)
It has been emphasized by many authors that to obtain better aesthetic results in a burned facial area to be resurfaced - if it extends into more than one aesthetic territory - the units involved should be combined into a single large composite unit allowing the largest possible skin graft to be used. Unfortunately, the donor site for full-thickness grafts is limited in young patients and hence tissue expansion is used. A monoblock expanded full-thickness skin graft for facial resurfacing after post-burn sequelae excision was used in 12 young patients after expansion of the superolateral aspect of the buttock. Females made up the majority of the patients (75%) and the ages ranged between 8 and 18 yr. The operating time was 3-3.5 hours, in two sessions. Post-operatively, we recorded partial graft necrosis in two cases (16.7%) and infection in one (8.3%), and some minor donor-site-related complications were reported, such as haematoma in one patient (8.3%), wound infection in one patient (8.3%), and wide scarring in two patients (16.7%). At follow-up, eight of the patients (66.7%) were satisfied with their new facial look as the mask effect of facial scarring had been overcome. With monoblock expanded full-thickness graft we were able to resurface the face in nine cases (75%). A second complementary procedure to reconstruct the eyebrows or reshape the nose was required in two cases (16.7%). We concluded that the monoblock expanded full-thickness graft was a suitable solution for limitation of the donor site in young patients, as the resulting wound could be closed primarily with a scar that could be concealed by the underwear, with lim. |
| 181 |
L'APPORT DE LA GREFFE DE PEAU TOTALE DANS LE TRAITEMENT DES SEQUELLES DES BRULURES DE LA MAIN: A PROPOS DE 14 CAS
(Ettalbi S., Ibnouzahir M., Rachid M., Bahaichar N., Boukind H. - Maroc)
La main est fréquemment exposée aux brûlures, ce qui entraîne des séquelles cutanées. A partir d'une série de 14 patients suivis dans notre service sur une année, nous avons essayé d'établir la simplicité, l'efficacité et le rôle de la greffe de peau totale dans le traitement de ces séquelles (les organes nobles ne sont pas mis à nu). La greffe de peau totale associée à une rééducation efficace permet aux patients de reprendre la mobilité des mains dans les brefs délais. |
| 185 |
BURN SCAR NEOPLASM
(Kadir A.R. - Iraq)
Marjolin's ulcer is a rare and aggressive cutaneous malignancy that occurs in previously traumatized and chronically inflamed skin, especially after burns. The majority of burn scar carcinomas are seen after a lag period in burns that were not grafted following injury. Between 2000 and 2006, 48 patients with Marjolin's ulcer were treated in our centre (Sulaimani Teaching Hospital and Emergency Hospital). All the lesions were secondary to burns from various causes. The medical records of these 48 patients were reviewed prospectively. The mean age at tumour diagnosis was 40 yr and the ratio of male to female was 2:1 (67% males and 33% female). Upon histological examination, all the cases were diagnosed as well-differentiated squamous cell carcinoma. The scalp was most frequently affected (16 patients = 33.3%), followed by the lower limb (14 patients = 29.1%). Treatment of the neoplasm consisted of excision and grafting in 36 patients (75.0%), excision and reconstruction with flaps in eight patients (16.6%), and amputation in three patients (6.2%). A chemotherapy combination of the above treatments was used in two patients (4.1%). Local recurrence was noted in 16 patients (33.3%) out of the 48, and all died from these recurrences. |
| 189 |
A COMPARATIVE STUDY OF BURNS TREATED WITH TOPICAL HEPARIN AND WITHOUT HEPARIN
(Venakatachalapathy T.S., Mohan Kumar S., Saliba M.J. - India)
Following reports of heparin use in burn treatment, an ethics-committee-approved prospective randomized study with controls compared results obtained using traditional usual burn treatment without heparin with results in similar patients similarly treated with heparin added topically. The subjects were 100 consecutive burn patients (age, 15-35 yr) with second-degree superficial and deep burns of 5-45% TBSA size. Two largely similar cohort groups, i.e. a control group (C) and a heparin group (H) with 50 subjects per group, were randomly treated, the main difference between the groups being that 13 C patients had burns of 35-45% extent vs. only one such patient in H (p < 0.01). The 50 C patients received traditional routine treatment, including topical antimicrobial cream, debridement, and, when needed, skin grafts in the early post-burn period. The 50 H patients, without topical cream, were additionally treated, starting on day 1 post-burn, with 200 IU/ml sodium aqueous heparin solution USP (heparin) dripped on the burn surfaces and inserted into the blisters 2-4 times a day for 1-2 days, and then only on burn surfaces for a total of 5-7 days, prior to skin grafting, when needed. Thereafter, C and H treatment was similar. It was found that the H patients complained of less pain and received less pain medicine than the C patients. H needed fewer dressings and oral antibiotics than C. Significantly less intravenous fluid was infused in H: 33.5 litres in 39 H patients vs. 65 litres in 41 C patients, i.e. nearly 50% less (p < 0.04). The 50 H patients had four skin graftings (8%), while the 50 C patients had 10 (20%). Five 5 C patients died (mortality, 10%). No H patients died. The number of days in hospital for H vs. C was significantly less (overall, p < 0.0001): 58% of H were discharged within 10 days vs. 6% of C; 82% of H were out in 20 days vs. 14% of C; 98% of H vs. 44% of C were out in 30 days; and while 100% of H were discharged by day 40, 56% of C required up to another 10 days. The burns in H patients healed on average in 15 days (maximum period 37 days) vs. an average of 25 days (maximum > 48 days) in C (p < 0.0006). Procedures and costs in H were much reduced compared with C. Photographs of the differences between H and C are presented for the sake of comparison. It is concluded that heparin applied topically for 5-7 days improved burn treatment: it reduced pain, pain medicine, dressings, and use of antibiotics; it significantly reduced IV fluids (p < 0.04), days in hospital (p < 0.0001), and healing time (p < 0.0006); and it reduced skin grafts, mortality, and costs. |
| 199 |
DECREASE OF CIRCULATING DENDRITIC CELLS IN BURN PATIENTS
(D'Arpa N., Accardo-Palumbo A., Amato G., D'Amelio L., Napoli B., Pileri D., Cataldo V., Mogavero R., Lombardo C., Conte F. - Italy)
Burn injury is associated with immune suppression and the subsequent development of sepsis. Severe burn injury is associated with depressed immune response, including a functional impairment of Th1 lymphocytes and natural killer cells and a decrease in interferon-a production. Dendritic cells (DCs) are potent antigen-presenting cells and play a key role in T cell activation; they are essential in coordinating the host response to pathogens. Using three-colour flow cytometry, we determined the percentage of lineage-negative LIN-DR+ DCs in burn patients and healthy subjects. The percentages of DCs were lower in the circulation of septic than in nonseptic patients and healthy subjects at all times examined (14 days) after burn injury. In contrast, the DC percentage in nonseptic patients was low at day 1, increased from day 3 to day 10, and reverted to normal levels at day 14. The data from the present study suggest that the DC percentage decreased early after burn injury. In addition, in the presence of severe sepsis, the DC percentage remained lower until day 14. This DC reduction may contribute to the immunosuppression observed after burn injury. |
| 203 |
MILITARY AND CIVILIAN BURN INJURIES DURING ARMED CONFLICTS
(Atiyeh B.S., Gunn S.W.A., Hayek S.N. - USA)
Burn injury is a ubiquitous threat in the military environment, and war burns have been described for more than 5,000 years of written history. Fire was probably utilized as a weapon long before that. With the ever-increasing destructive power and efficiency of modern weapons, casualties, both fatal and non-fatal, are reaching new highs, particularly among civilians who are becoming the major wartime targets in recent wars, accounting for most of the killed and wounded. Even though medical personnel usually believe that a knowledge of weaponry has little relevance to their ability to effectively treat injuries and that it may in some way be in conflict with their status, accorded under the Geneva and Hague treaties, it is imperative that they know how weapons are used and understand their effects on the human body. The present review explores various categories of weapons of modern warfare that are unfamiliar to most medical and paramedical personnel responsible for burn treatment. The mechanisms and patterns of injury produced by each class of weapons are examined so that a better understanding of burn management in a warfare situation may be achieved. |
| 216 |
Case report: CYTOMEGALOVIRUS PRIMOINFECTION MAY BE ASSOCIATED WITH SEVERE OUTCOME IN BURNS
(Augris C., Benyamina M., Rozenberg F., Gaucher S., Wassermann D., Vinsonneau C. - France)
We report two cases of severe cytomegalovirus (CMV) primoinfection in seriously burned patients. The infection may have contributed to both patients' fatal outcome. This underlines the importance of research in viral aetiology, especially with regard to CMV, when immunodeficient patients - as burn patients are - develop unexplained fever. We propose a monitoring and a prevention strategy for CMV in the most severely burned patients. The prevention strategy involves the use of skin allografts and blood products in seronegative patients. CMV infection should not be underestimated in severely burned patients. |
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