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Volume XXII |
Number 2 |
June 2009 |
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Summaries
| 59 |
HYPOPHOSPHATAEMIA IN BURNS
(CASTANA O., REMPELOS G., FAFLIA C., APOSTOLOU C., THEODORI A., ROMANA C., ALEXAKIS D., Greece)
Hypophosphataemia is defined as a phosphate level of less than 2.5 mg/dl (0.8 mmol/l). Many of the pathophysio- logical changes and therapeutic interventions in the first week post-burn affect serum phosphorus concentration. A retrospective study reviewed the medical records of nine severely burned patients, and a special reference of decreased phosphate serum level was not- ed. Serum phosphorus levels declined, with a nadir between days 2 and 6 post-burn. The severe hypophosphataemia that often fol- lows major burns returns to normal phosphorus levels on days 18 to 20 post-burn. Weight-based phosphorus dosing is safe to use in critically burned patients receiving nutritional support. Moderate doses effectively increase serum phosphorus concentrations. |
| 62 |
SEVERE BURN INJURIES COMPLICATING PSYCHOGENIC POLYDIPSIA
(XIN G., ZHANG Y., ZENG Y., ZOU L., ZOU X., WANG S., HE Y., PEOPLE’S REPUBLIC OF CHINA)
In rare cases, psychogenic polydipsia may develop as a post-burn complication, prevalently concerning females. Two such cases are reported, both in female patients. Their treatment and outcome are described. |
| 64 |
ASPECT EPIDEMIOLOGIQUE DES SEQUELLES DE BRULURES A MARRAKECH, MAROC, A TRAVERS DEUX OBSERVATIONS
(ETTALBI S., IBNOUZAHIR M., DROUSSI H., WAHBI S., BAHAICHAR N., BOUKIND E.H., MAROC)
La brûlure est un accident qui reste toujours très fréquent au Maroc, ce qui fait d'elle un problème de la santé pu- blique. Les brûlures, quand elles sont graves ou profondes, entraînent de façon quasi inéluctable des séquelles fonctionnelles et es- thétiques. A travers deux observations de deux enfants présentant des séquelles de brûlures graves, ayant retenti péjorativement sur leurs scolarités, on a essayé de mettre en évidence quelques facteurs incriminés dans cette tragédie (feu, petites bouteilles de gaz et le manque d'infrastructure, du personnel médical et paramédical, du matériel ainsi que de la prévention) comme étant une gran- de cause dans la survenue de ces séquelles. Le but de notre travail est d'énumérer ces différents facteurs intriqués, ainsi que de proposer quelques solutions, tout en insistant sur la prévention. |
| 68 |
TRAUMATISMES OCULAIRES PAR PETARDS: BILAN SUR TROIS ANNEES
(ZOUAOUI-KESRAOUI N., DERDOUR A., ALGÉRIE)
Les accidents dus aux pétards sont des accidents graves. Leur recrudescence ces dernières années en Algérie, essen- tiellement durant les fêtes du Mawlid Ennabaoui (fête de la naissance du prophète), mérite à notre sens d'entreprendre des bilans exhaustifs dont celui-ci dans le but d'une sensibilisation de toutes les compétences concernées. Nous avons réuni sur trois années consécutives (2002, 2003, 2004) 60 dossiers de malades ayant subi des accidents oculaires par pétards. Nos patients sont répartis en 42 consultations pour blessures légères et 18 hospitalisations pour blessures graves. Parmi ces derniers, neuf ont présenté des complications et séquelles graves (cinq cas de cécité par atrophie du globe oculaire, trois cas de cécité cornéenne et un cas de cé- cité par trou maculaire). Dans tous ces cas l'incapacité permanente partielle est au minimum de 30%. Au vu de ces données nous proposons des mesures d'éducation sanitaire et une sensibilisation du grand public aux traumatismes oculaires, par le biais de mé- dias appropriés: radio, télévision, affiches. |
| 72 |
L'INFECTION NOSOCOMIALE EN REANIMATION DES BRULES
(SIAH S., BELEFQIH R., ELOUENNASS M., FOUADI F.E., IHRAI I., MAROC)
L'infection nosocomiale bactérienne étant l'une des principales causes de morbidité et de mortalité chez le brûlé, nous avons réalisé une étude rétrospective portant sur 84 patients hospitalisés au sein du service de réanimation des brûlés de l'Hôpital Militaire d'Instruction Mohammed V de Rabat, sur une période de 3 ans, du premier janvier 2001 au 31 décembre 2003. Les cri- tères d'infection nosocomiale étaient ceux du Center for Disease Control d'Atlanta de 1988. Les taux d'incidence ont été calculés. La population infectée a été comparée à celle non infectée. L'écologie bactérienne du service a été décrite comme aussi l'antibio- type. Il ressort de cette étude la survenue de 87 infections nosocomiales chez 27 patients. L'incidence cumulative était de 103 in- fections pour 1000 jours de traitement. Pour ce qui est des caractéristiques des infections bactériennes, les sites infectés étaient la peau (77%), le sang (13,8%), les voies urinaires (8%) et les poumons (1,1%). Les principaux germes étaient: Staphylococcus sp. (33,3%), Pseudomonas aeruginosa (23%), Enterococcus faecalis et Acinetobacter (8%). Les staphylocoques étaient méticillo-résis- tants dans 22,2% des cas. Le Pseudomonas et l'Acinetobacter étaient multirésistants (60%). Dans notre étude les facteurs prédic- tifs de survenue des infections nosocomiales que nous avons retenus après l'étude comparative des populations infectées et non in- fectées ont été l'âge, le body mass index, l'abbreviated burn severity index et le remplissage initial. En isolant ces paramètres, nous avons pu établir une équation à valeur prédictive de survenue d'infection nosocomiale chez le patient brûlé. |
| 79 |
A COMPARATIVE STUDY OF THE WOUND HEALING PROPERTIES OF MOIST EXPOSED BURN OINTMENT (MEBO) AND SILVER SULPHADIAZINE
(JEWO P.I., FADEYIBI I.O., BABALOLA O.S., SAALU L.C., BENEBO A.S., IZEGBU M.C., ASHIRU O.A., NIGERIA)
Burns expose the deeper tissues of the skin or body to invasive microbes. Topical preparations for treating burn wounds, to be useful, should ideally have antibiotic power and promote healing. Silver compounds have been the mainstay of top- ical burn treatment for decades. However, most chemical substances retard wound healing. Several natural agents such as honey and moist exposed burn ointment (MEBO) are believed to protect wounds from infection and promote healing without causing any of the adverse effects of purified chemicals. In this study, we compared the wound healing properties of MEBO, a herbal prepa- ration of Chinese origin, with silver sulphadiazine (SSD), a long-standing conventional burn dressing. Ten adult Sprague Dawley rats were divided into two groups. They were housed in separate cages and received partial-thickness burn wounds on their dorsal skin. They were then treated with MEBO and SSD. The wounds were inspected daily until day 8, when all the animals were sac- rificed, perfused with normal saline, and had their wounds excised and prepared for histology. It was found that animals in both groups were well preserved. No clinical infections occurred. Wound healing was at an advanced stage by day 8 in all the animals. Clinical and histological examination showed that the two agents gave the animals comparable protection and healing possibilities. It is concluded that MEBO is a suitable and efficacious alternative to conventional silver-based topical therapies for treating partial-thickness burn wounds. |
| 83 |
THE ATTACK ON PSYCHOSOMATIC INTEGRITY: A STUDY OF THE PSYCHOLOGICAL SEQUELAE OF BURN TRAUMA
(CAVALERI V., EPIFANIO M.S., BENIGNO A., CONTE F., DI PASQUALE A., ITALY)
Burns pathology is characterized not only by insidious damage to the patients' outward appearance but also by the equally painful emotional difficulties they encounter as they reorganize their identity and their personal history. This exploratory survey, combining research work with medical action, considers the cases of 41 outpatients who were hospitalized and subjected to skin grafting. The patients were recruited through the database of the Palermo Civic Hospital Plastic Surgery and Burns Ther- apy Operative Unit. The questionnaires were compiled 6 and 12 months post-burn (12 months' observation). The main objective of the research was to investigate the quality of life of burn patients in relation to the way they handled their condition on the emotional level, in order to cope with the stress caused by the burn. |
| 88 |
PAIN RESPONSE AND PAIN CONTROL IN BURN PATIENTS
(CASTANA O., ANAGIOTOS G., REMPELOS G., ADALOPOULOU A., KOKKINAKIS C., GIANNAKIDOU M., DIPLAS D.B., ALEXAKIS D., GREECE)
Burn injury is totally correlated to pain, which depends on burn depth and extent, cause, age and the patient's gen- eral condition, and on the local therapy of the burn wound. In hospitalized patients adjectival and numerical scales have been used to measure pain. The management of pain is challenging to the therapist and extremely important for the patient. |
| 90 |
CHEILOPLASTY IN POST-BURN DEFORMED LIPS
(SAADELDEEN W.M., EGYPT)
The lip is a part of the face that is frequently affected by burn injury. Post-burn scar sequelae in this area often re- sult in cosmetic disfigurement and psychological upsets in patients, especially young adult females. A burn destroys the aesthetic features and lines of the lip. Plastic and reconstructive surgery of the face has a long history. Many local and regional flaps have been used for reconstruction of surgical or traumatic defects. Procedures to enhance the cosmetic features of the lips have been performed for centuries. Only within the past 25 years, however, has augmentation cheiloplasty become commonplace. Within that time, a number of different techniques have been developed. The goal of reconstruction is to achieve aesthetic results using plas- tic materials having the same properties as the affected area. This paper describes some clinical situations and possible recon- structive solutions. |
| 97 |
MASS BURNS DISASTER IN ABULE-EGBA, LAGOS, NIGERIA FROM A PETROLEUM PIPELINE EXPLOSION FIRE
(FADEYIBI I.O., OMOSEBI D.T., JEWO P.I., ADEMILUYI S.A., NIGERIA)
The aim of this paper is to review the basic principles of triage in mass burns disasters and discuss the experience of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria, in the December 2006 disaster at Abule-Egba, Lagos, Nigeria. It is hoped that the experience gained will help in the planning for and management of similar disasters in the develop- ing countries with limited facilities. Burn injury has been described as the severest form of trauma and its management is very challenging as it is often accompanied by numerous pathophysiological changes. Successful management requires expert manage- ment by well-trained personnel in equipped and dedicated centres. In mass disasters the total number of victims may exceed the capability of the facility and its staff and a system for sorting out the patients and caring for those that will benefit from the fa- cilities available needs to be developed. Other patients will either be sent to other medical facilities for further treatment or dis- charged after initial care for future follow-up. Documented experiences in the management of mass burns disasters from petrole- um pipeline explosions from developing countries are rare. However, petroleum pipeline explosions, especially in the Lagos area of Nigeria, are relatively common. These cases have been associated with a variety of factors. The resulting morbidity and mor- tality have been high. LASUTH has a dedicated burns centre, which has received and managed many burn patients. Triage is the medical process of screening patients according to their need of treatment and the resources available. The aims and objectives of triage are discussed, its various levels described, and the final goals elaborated. All the burn victims involved in the 2006 disaster were studied, together with the triage carried out at different levels and the consequent sorting of the patients. Standard burns man- agement was carried out. A total of 385 patients sustained burns of various degrees from the fire resulting from the explosion. On site, emergency department (ED) and intra-hospital triage were carried out. Ninety patients were brought to the LASUTH ED. Of these, 51 patients (56.67%) received first-aid treatment and were either discharged for out-patient follow-up or referred to second- ary health care facilities. Twenty-eight (31.11%) out of the remaining 39 patients with burns in more than 70% total body surface area (TBSA) were categorized as unsalvageable and 11 (12.22%) with less than 70% TBSA as salvageable. All the patients in the unsalvageable group died (i.e. 100% mortality), while one patient died in the salvageable group (mortality rate, 9.09%). The mor- tality rate for the ruptured petroleum product pipeline incident was 84.16%; the fatality rate for all patients seen at LASUTH was 32.22%. The need for caution in the handling of petroleum products is discussed and the effectiveness of the triage system used is highlighted. In conclusion, burns from flammable petroleum products can be very dangerous and proper triage should therefore be carried out, with salvageable patients being managed by experts in dedicated burns centres. |
| 104 |
CASE REPORT: POSTERIOR INTEROSSEOUS FOREARM FLAP IN RECONSTRUCTION OF FIRST WEB SPACE
(KOLA N., ISARAJ S., XHEPA G., BELBA M., BELBA G., ALBANIA)
Use of a fascial flap is often required for reconstruction of a skin defect on the dorsum of the hand. For this pur- pose, a distally based dorsal forearm fasciosubcutaneous flap based on the perforators of the posterior interosseous artery was de- veloped. The distally based dorsal forearm fasciosubcutaneous flap and especially the posterior interosseous artery flap are a con- venient and reliable alternative for reconstructing skin defects of the hand after the release of post-burn adduction contracture of web space I involving vital structure exposure. Although the posterior interosseous artery flap is suitable for covering dorsal skin defects of the hand and avoids interference with the forearm's two main arteries, the dissection of the vascular pedicle is frequently quite complex and tedious. |
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