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Volume XXI |
Number 1 |
March 2008 |
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SUMMARIES
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FRICTION BURNS: EPIDEMIOLOGY AND PREVENTION
(Agrawal A., Raibagkar S.C., Vora H.J. - India)
This epidemiological study deals with 60 patients with friction burns between January 2004 and January 2006. The age group most affected was that between 21 and 30 years, with male predominance. Road traffic accidents were the commonest cause of friction burns (56 patients), and the lower limb was the most frequently affected part of the body. Patient management was performed according to the degree of the burn injury. It is suggested that most friction burn injuries are neglected on admission. They require proper care and can be prevented by the wearing of protective clothing, a helmet, and shoes while riding a motorcycle. |
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ETUDE BACTERIOLOGIQUE SUR 30 MOIS DANS UN SERVICE DE BRULES;s
(Chaibdraa A., Bentakouk M.C. - Algérie)
Le pronostic des brûlures est souvent tributaire de complications infectieuses. Les objectifs de cette étude préliminaire rétrospective sont une évaluation de la flore microbienne et ses fluctuations selon la durée d'hospitalisation chez les patients du Centre des brûlés adultes de Annaba (Algérie). Ce travail porte sur 633 prélèvements microbiologiques positifs obtenus entre juin 2003 (inauguration du service) et décembre 2005. Selon le site de prélèvement la répartition est: cutané (78%), hémoculture (9%), prélèvement trachéo-bronchique (4%), uroculture (3%), sonde urinaire (3%), cathéter(3%). Les germes isolés sont: les staphylocoques (58%), les Pseudomonas (20%), le Candida albicans (5%), l'Acinetobacter (3%) et les autres germes (14%). Parmi les staphylocoques et les Pseudomonas recensés, respectivement 19% et 11% sont isolés la première semaine, contre 43% et 52% au-delà de 21 jours. Ces résultats confrontés aux données de la littérature confirment la prédominance du staphylocoque et du Pseudomonas. Le risque de contamination à partir des techniques invasives de réanimation est commun à toutes les équipes. La prolifération bactérienne est en relation avec la durée d'hospitalisation. Ces constatations doivent nous inciter à tirer bénéfice de l'expérience des autres services, en particulier sur les moyens, accessibles, de prévention de l'infection nosocomiale. |
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LOCAL TREATMENT OF BURNS WITH HONEYCOMB EXPANDED POLYURETHANE (LIGASANO)
(Napoli B., Benigno A., D'Arpa N., Amico M., Conte F. - Italy)
The results are presented of the local treatment of burns with honeycomb expanded polyurethane. This method of treatment can be used both for the medication of burns of limited extent but variable depth and as a mattress for patients confined to bed. In the first case, the purpose of the treatment, which makes use of the product's absorbent and debriding capacity, is either to cure the lesion or to pave the way for the surgical operation. In the second case use is made of the product's exudate-draining and anti-pressure sore activity, which prevents the lesion from becoming deeper. |
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PROTECTIVE EFFECT OF HUMAN RECOMBINANT COPPER-ZINC SUPEROXIDE DISMUTASE (HR-CuZnSOD) ON INTERMEDIATE BURN SURVIVAL IN RATS
(Shalom A., Kramer E., Westreich M. - Israel)
Objectives. Superoxide dismutase, acting as a scavenger of oxygen free radicals, has shown mixed results in increasing survival from burn wounds. We previously demonstrated that human recombinant copper-zinc superoxide dismutase could increase the survival of failing ischaemic flaps in a rat model. Because of the similar pathophysiology of tissue ischaemia in flaps and intermediate zone burns, we conducted a later study employing two groups of rats with standardized intermediate burns, to ascertain whether or not human recombinant copper-zinc superoxide dismutase could increase intermediate burn zone survival in rats. The results showed that post-burn human recombinant copper-zinc superoxide dismutase failed to improve intermediate burn zone survival. We decided to undertake a new study to ascertain whether there was a protective effect of human recombinant copper-zinc superoxide dismutase in intermediate burns. Methods. This controlled study employed two groups of rats, one of which received prophylactic treatment with human recombinant copper-zinc superoxide dismutase before the induction of standardized intermediate burns. Results. The results showed that pre-burn human recombinant copper-zinc superoxide dismutase also failed to improve intermediate burn zone survival. Conclusions. Further studies are needed to fully understand the effect of oxygen free radicals in burn wound pathophysiology and to determine whether human recombinant copper-zinc superoxide dismutase has a place in the clinical management of burns. |
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ROLE OF MEBO (MOIST EXPOSED BURN OINTMENT) IN THE TREATMENT OF FOURNIER'S GANGRENE
(Al-Meshaan M., Abdul Hamid M., Quider T., Al-Sairafi A., Dham R. - State of Kuwait)
Objectives. Fournier's gangrene (FG), though rare, is a life-threatening extensive fulminant infection of the genitals, perineum, or abdominal wall caused by a mixture of aerobic and anaerobic micro-organisms. Early and aggressive surgical debridement of the necrotic tissue and complete antibiotic coverage are the gold standards in treating FG. The purpose of our study was to assess the role of MEBO (moist exposed burn ointment) in topical treatment of the wound secondary to surgical debridement. Methods. Eleven patients (age range, 40-75 yr; mean, 55 yr) were admitted to the clinical facilities of the Department of Urology at Al Sabah Hospital, Kuwait, suffering from Fournier's gangrene, in the 31-month period between January 2004 and July 2006. All these patients were treated with broad-spectrum triple antimicrobial therapy as well as extensive debridement of necrotic tissue. The resultant wounds were treated with MEBO in six randomly selected patients and with a placebo in the remaining five patients. Results. The duration of hospital stay was reduced by 41.7% in the MEBO-treated group (30.0 vs 51.5 days) and pain control of pain was faster, which could be attributed to the faster control of infection and wound healing in this group. Conclusion. A combination of appropriate antibiotic coverage and aggressive surgical therapy is mandatory for the treatment of FG. MEBO promotes the healing of the resulting, quite extensive wound, reducing pain and controlling infection. It is a also a cost-effective therapy as it accelerates healing and reduces hospital stay by 41.7%. . |
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TISSUE EXPANSION USED AS A METHOD OF RECONSTRUCTIVE SURGERY IN CHILDHOOD
(Tzolova N., Hadjiiski O. - Bulgaria)
Tissue expansion has developed as an important routine procedure in plastic and reconstructive surgery in the past two decades. It is used progressively in cases of reconstruction treatment for children and adults who do not have enough adjacent tissue for reconstruction of the skin surface that is defective as a result of a trauma, burns, or congenital deformation. When applied to children, the method of tissue expansion enabled us to achieve aesthetic and functional results that had not been obtained before with traditional procedures of reconstructive surgery. This paper presents the results of tissue expansion in 62 children in the period 2000-2006 treated in the Burns and Plastic Surgery Centre in Sofia, Bulgaria. Seventy expanders with different forms and different volumes varying from 50-1000 ml were used as treatment according to the specific goals for reconstruction. The indications for using tissue expanders for children were the following: skin and soft-tissue defects after deep burns and injuries, traumatic defects, and pigmented stains. The children in this study of tissue expansion were 39 boys and 23 girls. The higher percentage (64%) of injured boys was due to the higher occurrence of traumatism among boys. The anatomical areas subjected to tissue expansion in relation to the reconstruction of the primary tissue defects were as follows: scalp, face, neck, mental area, breast area, sacral area, back, and upper and lower extremity. More than one tissue expander was placed in the same area in five children during a single operational phase. We observed functional recovery and excellent aesthetic results in 85% of the patients who underwent the tissue expansion treatment. The lowest percentage of complications was reported in the group of children aged 4-7 yr, i.e. 3.22%. |
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TREATMENT OF POST-BURN SCAR DEFORMATIONS USING TISSUE EXPANSION AND ENDOSCOPY
(Sharobaro V.I., Moroz V.Y., Starkov Y.G., Yudenich A.A. - Russia)
Background. The essential drawbacks of conventional tissue expansion, a technique widely used in reconstructive surgery, are its significant duration and the high complications rate. The experience of our clinic covers 329 patients treated with this method from 1987 to 2006. The mean time of expansion was previously 72 ± 2 days (± SD) and the rate of local complications was 38.6%. We applied effective new approaches to this method in order to reduce its drawbacks, i.e. the endoscopic implantation of expanders, intensive expansion, and a modified technique of elevation of an expanded flap. Methods. Twenty-seven patients treated in the A.V. Vishnevsky Institute of Surgery between 2001 and 2006 for post-burn scar deformities underwent endoscopic implantations of 46 silicone expanders in various anatomical areas. High-grade tissue expansion was initiated immediately after implantation. The elevation of the reconstructed flap was performed, including defective tissues in the flap, after which the expander was removed and the expanded tissues were transposed. Results. With the help of the techniques developed, it was possible to reduce the mean expansion time from 72 days to 34 (less than half) and to reduce the complications rate from 38.6% to 6.5%. Conclusions. Endoscopic expander implantation, the accelerated technique of tissue expansion, and modified elevation of the expanded flap enabled us to considerably improve results in the treatment of post-burn scar deformities, using the tissue expansion method. |
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LE POINT SUR LA PHARMACOLOGIE DES AGENTS ANESTHESIQUES CHEZ LE BRULE GRAVE
(Siah S., Ababou K., Benziane H., El Jaoudi, Bensghir M., Bakali H., El Wali A., Ihrai I., Drissi N.K. - Maroc)
La pharmacologie des agents anesthésiques chez le brûlé est variable et imprévisible. Dans les premières 48 h, il y a une hypovolémie avec chute du débit cardiaque et des fuites plasmatiques. Après 48 h, il y a une hypervolémie avec augmentation du débit cardiaque, hypermétabolisme et la clearance des médicaments est augmentée. Parmi les facteurs de déséquilibre, on retrouve les variations des protéines plasmatiques. Deux protéines sont importantes chez le brûlé grave : l'albumine et l'alpha 1- glycoprotéine. Leur taux varie beaucoup au cours de l'évolution de la brûlure. Les agents anesthésiques dont la liaison avec ces deux protéines est prédominante verront leur pharmacocinétique modifiée. L'anesthésiste-réanimateur du service des brûlés va maîtriser ces notions pharmacologiques pour utiliser à bon escient les agents anesthésiques. |
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A GERIATRIC PATIENT WITH MAJOR BURNS: CASE REPORT
(Uygur F., Noyan N., Ülkür E., Çeliköz B. - Turkey)
As is predictable, mortality and morbidity among geriatric patients are higher in patients with major burns. Decreased radiopulmonary reserves and malnutrition characterized by protein/energy deficiency and ageing of skin are predisposing factors which increase mortality and morbidity. In this study, we present a 90-yr-old patient with 46% total body surface area of 2nd-3rd degree burns. We had to overcome difficulties which can be seen in elderly patients and which succeeded in our treatment. |
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THE AIDADIVA - A STATE-OF-THE-ART CRUISE-SHIP WITH NEW PROVEN PROGRESS IN FIRE SAFETY DEVICES
(Becker D. - Germany)
The steady growth of cruise travelling stimulates the building of more expensive and more comfortable cruise-liners. Shipping companies are obliged to invest more money in safety devices, and as recommended by specialists - such as our own Mediterranean Burns Council - in burns and fire disasters, which are the most feared of accidents at sea, such safety techniques for the prevention of fire disasters aboard ship have become ever more in demand. |
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