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Volume XXIII |
Number 4 |
December 2010 |
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Summaries
| 171 |
QUALITY OF LIFE, BODY IMAGE, AND PSYCHIATRIC COMPLICATIONS IN PATIENTS WITH A BURN TRAUMA:
PRELIMINARY STUDY OF THE ITALIAN VERSION OF THE BURN SPECIFIC HEALTH SCALE-BRIEF
(SIDELI L., PRESTIFILIPPO A., DI BENEDETTO B., FARRAUTO R., GRASSÌA R., MULÈ A., RUMEO M.V., DI PASQUALE A., CONTE
F., LA BARBERA D. - ITALY)
Burn patients may suffer both physical and psychopathological consequences and their quality of life and the presence of psychopathological symptoms should be evaluated. The Burn Specific Health Scale - Brief (BHSH-B) is a tried and tested instrument for assessing burn patients' quality of life. The aim of this study is to propose the Italian translation of BSHS-B and presents the preliminary results of an exploratory study. The Italian version of the BSHS-B was administered to a sample group of 50 burn victims. Reliability was verified by Cronbach's alpha, and construct validity was evaluated through correlation with the Short Form 36 Health Survey Questionnaire (SF-36) and the Self-report Symptom Inventory - Revised (SCL-90). The entire scale and two out of three domains showed Cronbach's alpha values higher than 0.8. Significant correlations were identified between BSHS-B subscales and the SF-36 subscales Physical Pain and Social Activities. Several psychopathological SCL-90 subscales correlated with BSHS-B subscales Heat Sensitivity and Body Image. It was concluded that our translation of BSHS-B was reliable and showed good construct validity. The drawbacks of this study are the limited size of the sample and the wide variety of types of burn injuries. |
| 177 |
NOSOCOMIAL INFECTION IN SULAIMANI BURN HOSPITAL, IRAQ
(QADER A.R., MUHAMAD J.A. - IRAQ)
Wound infections are common problems in burn units and mostly originate from nosocomial contamination. The development of infections in burn cases is serious because of their effects on the course of the disease and patient outcomes. Many burned patients die as a result of infection during their hospital courses. The rate of infection in burn cases is extremely high in developing countries. For these reasons, we carried out a study of the bacteriological profiles and a comparison of antimicrobial resistance patterns of predominant bacteria, over a period of one year. The study was conducted during a period of 12 months (from May 2008 to April 2009) at the Sulaimani Burn, Reconstructive and Plastic Surgery Hospital, Sulaimani, Iraq. In the present study, a total of 1126 samples of swabs and blood were processed from 760 admitted patients (505 female and 255 male). Bacteria isolates were found in 935 samples (83%) and only 180 wound swabs were sterile (16%); the others became contaminated in the lab and no test was performed (1%). Total bacteria isolated: 1402 organisms (average number of organisms per sample, 1.5). Staphylococcus aureus was the commonest cause of bacterial burn wound invasion, accounting for 34% of cases, while Pseudomonas aeruginosa caused 18%. The total percentage of multidrug-resistant organisms among all organisms was 51% (715/1402); a percentage of 87.1% was recorded with reference to methicillin-resistant Staphylococcus aureus among all cases of Staphylococcus aureus (176/202); non-fermenting bacteria among all non-fermenting bacteria were 28.8%. |
| 182 |
RETROSPECTIVE COMPARISON OF TWO YEARS IN A PAEDIATRIC BURNS UNIT, WITH AND WITHOUT ACTICOATTM
AS A STANDARD DRESSING
(STRAND O., SAN MIGUEL L., ROWAN S., SAHLQVIST A. - SWEDEN, SPAIN, ITALY)
The Karolinska Burn Unit in Stockholm, Sweden, carried out a retrospective case review in order to compare the cost of the current protocol of care - in place since mid-2002 - with a previous protocol in paediatric burn patients. The study compared the years 2004 and 2007 with the year 2001. 2004 was the first full year in which the unit staff used ActicoatTM (Smith & Nephew Wound Management, Hull, England), IntraSite GelTM (idem), and Allevyn AdhesiveTM (idem) in the treatment of paediatric burns patients. In 2001 the unit used MepitelTM (Molnlycke, Göteborg, Sweden) together with a saline solution and peroxide for cleansing. This study examined differences in both labour and material costs, measured from the hospital's perspective. Our results show that the main impact of the new protocol was on length of stay for hospitalized patients. In 2001 the mean in-patient stay was 12.5 days; in 2004 the mean stay was 5.6 days and, in 2007, 4.5 days (p < 0.001). It is hypothesized that the reason for this significant reduction in length of stay is that most of the patients treated with Acticoat were sent home earlier to be treated as outpatients because there was less need for sedation and/or analgesics, and because the risk of infection was perceived to be less. Pure hospitalization costs per in-patient were approximately Swedish kronor (kr) 67,725 in 2001 (1 kr = approx. ? 0.1 or US$ 0.15) and kr 30,305 and kr 24,440 in 2004 and 2007, respectively. This represents a saving of 55% and 64% with respect to 2001 costs. |
| 186 |
AN AETIOLOGICAL SURVEY OF BURNS IN ABUSERS OF VARIOUS KINDS OF DRUGS ADMITTED TO THE TABRIZ SINA HOSPITAL BURNS WARD IN IRAN
(MAGHSOUDI H., RAGHIFAR R. - IRAN)
A five-year prospective study (March 2003-March 2008) of burn victims hospitalized in a major burns centre in Iran was conducted in order to survey the aetiology and outcome of burns in patients who were drug addicts. Three hundred and thirty patients addicted to drugs were identified and stratified by age, sex, burn size, presence or absence of inhalation injury, kinds of abuse agents, and cause of burn. The mean patient age was 27.9 yr, and the male:female ratio was 7.6:1. There were 60 deaths overall (18.18%), the majority (47) among patients with flame burns. The mortality rate was significantly higher in multi-drug abusers than in single-drug abusers. Except for burn incidence, there were no significant differences between males and females. The mean burn size, 30.9%, was significantly larger in non-survivors than in survivors (57.8% versus 27.8%; p < 0.001). Inhalation injuries were strongly associated with large burns, and were present in all flame-burn fatalities. Flame burns were the most common type of burns in drug-addicted patients: incorrect use of a lighter and match and falling onto a brazier were the most common causes of flames. There were 11 deaths related to electrical injuries. Large burn size was the strongest predictor of mortality followed by the presence of inhalation injury. The most common agent of abuse was opium, followed by heroin and hashish; there was no difference between males and females in relation to the type of agent of which abuse was made. |
| 194 |
LES TROUBLES RESPIRATOIRES CHEZ LE BRULE
(FASSI FIHRI J., EZZOUBI M., BOUKIND E.H. - MAROC)
A travers une revue de la littérature, cet article se propose d'exposer les particularités des troubles respiratoires chez le brûlé. Ces troubles sont liés à un mécanisme direct, lorsque l'arbre respiratoire est lésé par le transfert d'énergie thermique du à la brûlure et/ou par un mécanisme indirect, lorsque la fonction respiratoire et ventilatoire du poumon est perturbée par les phénomènes loco-régionaux ou généraux du brûlé. Ces troubles respiratoires sont aggravés par l'inhalation des gaz contenus dans la fumée d'incendie. Le diagnostic de ces troubles est clinique et paraclinique. Il doit être précoce et continu. Les patients nécessitent de différents moyens thérapeutiques tels que l'oxygénothérapie, la libération des voies respiratoires, l'amélioration de la mécanique ventilatoire et de la fonction respiratoire, l'antibiothérapie ou la chirurgie des séquelles. Cette prise en charge doit nécessairement être multidisciplinaire. |
| 199 |
EFFECT OF ANTIOXIDANTS ON THE INCIDENCE OF WOUND INFECTION IN BURN PATIENTS
(SAHIB A.S., AL-JAWAD F.H., ALKAISY A.A.- IRAQ)
Background. Thermal injury causes the destruction of the physical skin barrier that normally protects the body from invasion by micro-organisms and induces an immunocompromised state that predisposes burn patients to infection, sepsis, and multiple organ failure. Reactive oxygen species contribute to burn-mediated immune suppression, and as the use of antioxidants has a positive effect on immune function, this may reduce the incidence of wound infection and related complications in burn patients. Patients and methods. One hundred and eighty burn patients of either sex and different ages, suffering from burns of varying percentage, were involved in the study. They were allocated to six groups: A, B, C, D, E, and F, each of 30 patients. Groups B, C, D, E, and F were treated with antioxidants (vitamins E and C, zinc sulphate, allopurinol, melatonin, and N-acetylcysteine, respectively) while group A was treated without antioxidants, according to our hospital policy. Thirty healthy subjects (group G) were also involved in the study as a control group for comparison. In each group, serum malondialdehyde and serum glutathione levels, microbiological values, healing time, and the mortality rate were measured using standard methods. Results. Administering antioxidants to burn patients produced significant improvements in the parameters studied compared with burn patients not given antioxidants. Conclusion. The study clearly showed the beneficial effect of antioxidants in the treatment of burn patients, as evidenced by the reduced incidence of wound infection and the shortening of healing time, in addition to the lower mortality rate. It is therefore recommended to add antioxidants to the treatment list of burn patients. |
| 206 |
RECONSTRUCTION D'UNE CARBONISATION DU POUCE PAR LAMBEAU CHINOIS
(KHALES A., ACHBOUK A., MOUSSAOUI A., BELMIR R., TOURABI K., OUFKIR A., IHRAI H.- MAROC)
La main en tant qu'organe majeur de la préhension peut être le siège de brûlures graves qui compromettent sa fonction. Bien qu'elle ne représente que 2% de la surface corporelle la brûlure de la main est grave et difficile à traiter, vu la vulnérabilité et la complexité de son appareil locomoteur. Nous rapportons dans ce travail le cas d'un patient victime d'une carbonisation de la main. Huit mois après le parage et la couverture par lambeau inguinal, le patient bénéficie d'une reconstruction du pouce par lambeau chinois associé à une greffe osseuse. Le résultat s'est avéré satisfaisant. Le lambeau chinois prouve par son apport vasculaire et par sa facilité technique qu'il est un moyen très intéressant dans la reconstruction du pouce - ou des doigts en général - surtout dans un contexte de brûlure. |
| 208 |
EVALUATION AND COMPARISON OF COMPOSITE AND SPLIT-THICKNESS SKIN GRAFTS USING CUTOMETER MPA 580
(SÍN P., STUPKA I., BRYCHTA P. - CZECH REPUBLIC)
Background. In our preliminary experiments we found that composite skin grafts consisting of allogeneic acellular dermis and thin epidermal autologous grafts applied to the excised burn wound in one stage led to better results in terms of viscoelastic properties than autologous split-thickness skin grafts. Patients and methods. In ten burn patients we applied composite skin grafts consisting of allogeneic acellular dermis and thin epidermal autologous grafts and followed the quality of the reconstructed skin cover with a special device, Cutometer MPA 580, over a period of four years. Results. The cutometric curves demonstrated better viscoelastic properties in composite skin grafts than in conventional split-thickness skin grafts after four years. We found Cutometer MPA 580 to be an advantageous device for the objectification of improved quality of reconstructed skin cover. Discussion. Among the various methods the cutometer showed the advantage of being a non-invasive, precise, and objective method of measuring skin's viscoelastic properties. The Vancouver Scar Score is a subjective evaluation of skin viscoelasticity. Conclusion. Our prospective clinical study clearly demonstrated that cutometric measurement produced objective results in contrast to clinical evaluation, the Vancouver Scar Score, and other non-quantitative methods. Our hypothesis that composite skin grafts consisting of allogeneic acellular dermis and thin epidermal autologous grafts applied onto the excised burn wound in one stage led to better results in terms of viscoelastic properties than autologous split-thickness skin grafts was fully confirmed. |
| 214 |
DIFFICULTÉS DE PRISE EN CHARGE DES BRÛLURES ELECTRIQUES PAR HAUT VOLTAGE: À PROPOS D'UN CAS
(MEJJATI H., TOURABI K., ARROB A., MOUSSAOUI A., IHRAI H. - MAROC)
Les brûlures électriques à haut voltage sont caractérisées par leur potentialité évolutive avec une extension en profondeur et une destruction tissulaire étendue dont les conséquences fonctionnelles sont considérables. La prise en charge de ces brûlures électriques se trouve toujours compliquée par un problème essentiel représenté par la difficulté diagnostique qui sous-évalue régulièrement la profondeur et l'étendue de ces lésions: en effet la nécrose cutanée s'étend progressivement jusqu'au quatrième jour à cause des thromboses vasculaires extensives, et par conséquent le diagnostic d'étendue et de profondeur de ces brûlures est difficile avant le quatrième jour. Nous présentons le cas illustré d'un jeune patient admis dans notre formation pour des brûlures à haut voltage ayant bénéficié d'un traitement chirurgical à la phase aiguë et une réparation secondaire |
| 216 |
CASE REPORT: AN ATYPICAL CAUSE OF ALKALI CHEMICAL BURN: A CASE REPORT
(BOUTEFNOUCHET T., MOIEMEN N., PAPINI R. - UNITED KINGDOM)
It has already been reported that wet ash turns into a strong alkali agent, which can cause full-thickness skin burns. A case is presented which has the particularity of sustained, self-inflicted contact with wet ash. The coal used was the self-igniting type normally used for burning scented weed or for smoking the hubbly bubbly or shisha pipe |
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