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Volume XXI |
Number 3 |
September 2008 |
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SUMMARIES
| 115 |
THE ACTION OF MBC IN LOW- AND MIDDLE-INCOME COUNTRIES
(Masellis M. - Italy)
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| 119 |
NUTRITIONAL AND PHARMACOLOGICAL MODULATION OF THE METABOLIC RESPONSE OF SEVERELY BURNED PATIENTS: REVIEW OF THE LITERATURE (part II)
(Atiyeh B.S., Gunn S.W.A., Dibo S.A. - Lebanon)
Severe burn patients are some of the most challenging critically ill patients, with an extreme state of physiological stress and an overwhelming systemic metabolic response. Increased energy expenditure to cope with this insult necessitates mobilization of large amounts of substrate from fat stores and active muscle for repair and fuel, leading to catabolism. The hypermetabolic response can last for as long as nine months to one year after injury and is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation, and delayed reintegration of burn survivors into society. Reversal of the hypermetabolic response by manipulating the patient's physiological and biochemical environment through the administration of specific nutrients, growth factors, or other agents, often in pharmacological doses, is emerging as an essential component of the state of the art in severe burn management. Early enteral nutritional support, control of hyperglycaemia, blockade of catecholamine response, and use of anabolic steroids have all been proposed to attenuate hypermetabolism or to blunt catabolism associated with severe burn injury. The present study is a literature review of the proposed nutritional and metabolic therapeutic measures in order to determine evidence-based best practice. Unfortunately, the present state of our knowledge does not allow the formulation of clear-cut guidelines. Only general trends can be outlined which will certainly have some practical applications but above all will dictate future research in the field. |
| 124 |
HIGH-VOLTAGE PULSED GALVANIC STIMULATION: EFFECT OF TREATMENT DURATION ON HEALING OF CHRONIC PRESSURE ULCERS
(Ahmad E.T. - Egypt)
The purpose of the current study was to determine the optimal treatment duration of high-voltage pulsed galvanic current (HVPC) in treating chronic pressure ulcers. Sixty volunteers suffering from chronic pressure ulcers participated in the study for a treatment period of five weeks. They were divided randomly and equally into four groups (three treatment groups and one control group). Patients in the treatment group (G1, G2, G3) received HVPC respectively for 45, 60, and 120 min seven days a week, while patients in the control group received sham HVPC (45 min, seven days a week). The wound surface area (WSA) was used to measure outcomes before starting the study and after three and five weeks' treatment. It was found that there was a significant reduction in WSA in G2 (60 min) and G3 (120 min) compared to G1 (45 min) and the control group (sham HVPC). There was no significant difference between G2 and G3. Application of HVPC for 60 and for 120 min, seven days a week, therefore proved to be the optimal duration for enhancing chronic dermal ulcer healing. |
| 129 |
LES BRULURES ELECTRIQUES PAR HAUT VOLTAGE - A PROPOS DE 10 CAS
(Belmir R., Fejjal N., El Omari M., El Mazouz S., Gharib N., Abassi A., Belmahi A. - Maroc)
Les accidents électriques par haute tension (AEHT) provoquent des brûlures profondes par effet Joule le long des axes vasculo-nerveux entre les points d'entrée et de sortie, qui sont le siège de lésions délabrantes. Les Auteurs rapportent une série de dix cas d'AEHT admis au service de chirurgie réparatrice et de brûlés de l'Hôpital Ibn Sina de Rabat à travers laquelle ils étudient les caractéristiques épidémiologiques, cliniques et thérapeutiques. Tous les patients étaient des adultes de sexe masculin dont l'âge moyen était de 31 ans. Dans 70% des cas, ces brûlures étaient secondaires à un contact avec les distributeurs d'électricité avec une surface brûlée inférieure à 20%. Le traitement des lésions électrothermiques a nécessité des interventions itératives avec amputation des segments de membres nécrosés dans 70% des cas, dont les suites étaient marquées par des séquelles fonctionnelles invalidantes. La prévention des AEHT, en particulier pour les accidents du travail au sein des professions exposées, reste fondamentale. |
| 133 |
ACCIDENT D'ELECTRISATION ET HEMORRAGIE CEREBRO-MENINGEE : A PROPOS D'UNE OBSERVATION
(Chaibdraa A., Medjellakh M.S., Saouli A., Bentakouk M.C. - Algérie)
L'électrisation est un évènement accidentel qui diffère des autres pathologies occasionnant des brûlures graves, à cause de ses spécificités qui traduisent d'une part la destruction du revêtement cutané, mais également les effets directs ou indirects du courant électrique sur tout tissu de l'organisme rencontré lors de son passage, en particulier le tissu nerveux. Les manifestations neurologiques centrales sont nombreuses, en relation avec les effets de l'électricité sur le parenchyme cérébral ou une lésion associée à l'électrisation. Nous rapportons l'observation d'une hémorragie cérébro-meningée survenant au 3ème jour d'une électrisation grave. Cette complication est bien documentée dans la littérature traitant des accidents d'électrisation post-foudroiement. N'ayant pas rencontré de cas similaire publié lors des accidents dus au courant industriel, nous présentons cette observation, qui soulève le problème du mécanisme physiopathologique de survenue, difficile à trancher. |
| 138 |
AN ALTERNATIVE FOR LOCAL TREATMENT OF SUPERFICIAL BURNS
(Enescu D., Bratu T., Berechet-Comanescu P., Ionita D. - Rumania)
There is a wide variety of local therapeutical methods for partial superficial burns. Burns require meticulous local treatment as part of the complex therapeutic protocol. Local treatment for burns is essential, influencing the patient's evolution and future. All local burn treatment methods are adapted in relation to the particular aspects of the burn lesion (patient's age, aetiology, localization, associated pathologies). Immerci H3 was clinically tested for partial superficial burns treatment and the results were favourable. Healing was more rapid and there was a decrease in mean hospital stay and treatment costs. |
| 141 |
DIFFERENT SURGICAL RECONSTRUCTION MODALITIES OF THE POST-BURN MUTILATED HAND BASED ON A PROSPECTIVE REVIEW OF A COHORT OF PATIENTS
(Saleh Y., El-Shazly M., Adly S., El-Oteify M. - Egypt)
This study covered 40 patients (22 females and 18 males) suffering from post-burn hand deformities admitted to Assiut University Hospital and Luxor International Hospital (Egypt) from June 2004 to May 2006. Their ages ranged between 4 and 45 yr (mean, 24.5 yr). They presented a variety of post-burn hand deformities, e.g. dorsal hand contracture (14 cases), volar contracture (10 cases), first web space contracture (3 cases), post-burn syndactyly (2 cases), wrist deformity (3 cases), skin and tendon affection (2 cases), and complex deformity (6 cases). All the patients underwent a variety of surgical procedures specific to the individual post-burn hand deformity. Post-operative splinting of the hand for 10 days was performed in patients with skin graft to prevent recontracture. The post-operative physiotherapy programme started in the second week in order to achieve good functional results. The follow-up period ranged from 6 to 20 months. The results were satisfactory in most of the cases as regards the quality of coverage, which was achieved in the majority of cases. In one case there was partial loss of the skin graft, which healed by secondary intention; full range of motion was achieved in most patients, but not those with joint affections. On the basis of our results, we can conclude that the management of post-burn hand deformities depends on several factors. Initial treatment of the burned hand is of great importance for the prevention of secondary deformities. In secondary burn management the first step is the release of the contracture, which should be complete and include all contracted structures. The second step is the proper selection of methods of coverage for resultant defects, using either skin grafts or flaps depending on the presence of exposed tendons, nerves, or joints. The third step in order to obtain a very good function is the activation of an intensive physiotherapy programme immediately after the operation. |
| 150 |
SURGICAL TREATMENT OF DEEP BURNS
(Khadjibayev A.M., Fayazov A.D., Djabriyev D.A., Kamilov U.R. - Uzbekistan)
The results are presented of the treatment of 168 patients aged 1 to 60 yr with deep burns. The use of active surgical tactics in patients with deep and extensive burns was tested. It was found that the application of a method of active surgical tactics, in combination with different approaches of wound covering such as "combined auto- and allografting", "combined auto- and porcine-skin grafting", and "combined autografting with cultivated allofibroblast cell culture usage", reduced purulent-septic complications and improved the results of treatment. |
| 153 |
CARPAL TUNNEL SYNDROME FOLLOWING BURNS
(Hassan Z.1,2, Mullins R.F.1,2, Alam B.2, Mian M.A.H. - USA)
The commonest cause of carpal tunnel syndrome (CTS) is a congenital predisposition - the carpal tunnel is simply narrower in some people than in others. The development of CTS due to various burn causes has never been reported. This study describes some demographic features of all reported CTS cases following different types of burn in patients admitted to our burns centre in the USA. A retrospective case study was carried out to identify CTS following different types of burns among the patients admitted between January 2001 and January 2006. A descriptive data analysis was carried out to observe CTS following hand burns. There were 36 CTS cases in 28 patients presenting various kinds of burns in the upper extremities. The mean age of the CTS patients was 52 years (SD, 10.51 yr) and 79% were male. Of these, 57% had sustained thermal burns, 32% electrical burns, and the remainder had scalds or chemical burns. More patients (56%) had second-degree burns than third-degree burns and all but one of the patients with electrical burns had second-degree burns. This observation demonstrates that there were a considerable number of CTS cases following thermal burn injury compared to previous reporting. This study also suggests the need of a prospective study to examine the association between burns in the upper extremities and the likelihood of their progression to CTS and whether any specific type of burn is more likely to result in CTS. |
| 156 |
NEW BURNS CENTRE IN PARMA HOSPITAL, WEST EMILIA HUB
(Caleffi E., Bocchi A., Soncini I., Arena A. - Italy)
Parma Hospital is the Trauma Centre for SIAT (Trauma Patients Integrated Assistance System) in the West Emilia District in the regional trauma patient project. SIAT's goal is to provide the quickest and most appropriate treatment in major trauma patients. Extensive burns are a multi-organ pathology, i.e. a major life-threatening trauma. Our burn patients are treated on the "Hub and Spoke" model: triage and immediate transfer from the Spoke (first- and second-level Centre) to the Hub (third-level centre, i.e. the Parma Hospital Burns Centre). Burn treatment requires pre-hospital care (timely assistance, airways security, steady life parameters, adequate central or peripheral access, fluid administration, maintenance of body temperature, transport) and adequate hospital treatment (fluid resuscitation, pain therapy, gastroduodenal ulceration prophylaxis, escharotomies, and topical wound care). |
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