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Volume XXIV |
Number 4 |
December 2011 |
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Summaries
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PROFIL EPIDEMIOLOGIQUE DES BRULURES D'ENFANTS ADMISAU CENTRE NATIONAL DES BRULES, MAROC
(Zahid A., Atannaz J., Alaoui M., Rafik A., Ezzoubi M., Diouri M., Chlihi A., Bahechar N.,Boukind E.H. - Maroc)
Ce travail rétrospectif analyse les particularités épidémiologiques de 543 cas de brûlures d'enfants, représentant 45,7% des admissions de notre centre, en vue de déterminer les éléments pouvant contribuer à renforcer la prévention, qui reste le traitement de choix de cette pathologie. La moyenne d'âge est de 4,25 ans avec une prédilection pour la tranche d'âge d'un à cinq ans, avec 42,5% des cas. Une atteinte masculine est retrouvée dans 63,5% des cas. La brûlure survient à domicile dans 85,1% et accidentellement dans 95% des cas. Les brûlures thermiques représentent 96,5% des causes dominées par les liquides dans 69,3% des cas. La surface cutanée brûlée est ? 20% dans 52,3%. La brûlure intéresse essentiellement les membres supérieurs (79,1%). 56,8% des enfants sont transférés par d'autres hôpitaux et le délai de prise en charge hospitalière est supérieur à 6 heures dans 65,5%. Le taux de mortalité a été de 13,2% |
| 175 |
THERMAL INJURY TO THE HAND: REVIEW OF THE LITERATURE
(Abu-Sittah G.S., El Khatib A.M., Dibo S.A. - Lebanon)
This paper is a comprehensive review of hand burn injuries. The different classifications of thermal burns, out- and in-patient care, indications for escharotomies as well as surgical management, skin substitutes, and paediatric hand burns are thoroughly reviewed. |
| 186 |
MANAGEMENT OF A CLINICAL AND SURGICAL CENTRE INRURAL CAMBODIA (2006-2011)
(Borghese L., Bianciardi F., Gavioli B., Valenti L., Masellis A. - Italy)
The activities of the Bambino Gesù Paediatric Clinical and Surgical Centre Takeo in Cambodia started in May 2006, after the signature of a formal agreement between the Royal Government of Cambodia and the hospital. The paediatric centre is currently composed of an out-patients section with diagnostic ultrasound facilities and an obstetrics and gynaecology section, 3 consulting rooms, 20 beds for clinical activities, 13 beds for surgery, 7 beds for the paediatric intensive care unit, 2 dressing rooms, 1 out-patients sterile section, a library for off- and on-line consultation, a playroom and laundry facilities, and an administration office. For the last five years its activity has neen steadily on the increase, and the local population are beginning to look on the Centre as a full-scale local and regional referral hospital. From the 190 cases handled in 2006, the Centre increased to 669 surgical procedures in 2010 and 341 in the first four months of 2011, with good prospects of exceeding 1000 operations before the end of 2012. Takeo Centre also developed a Mobile Clinic Project to assist children directly in rural areas lacking health facilities. Today the Centre is a new reality in Cambodia's healthcare system. |
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APPLICABILITY OF NEW SUPERVISED STATISTICAL MODELS TO ASSESS BURN INJURY PATTERNS, OUTCOMES,AND THEIR INTERRELATIONSHIP
(Sadeghi-Bazargani H. - Iran, Bangdiwala S.l. - USA, Mohmmadi R.- Sweden)
The aim of the study was to investigate the possibility of using supervised statistical models to assess burn injury patterns, outcomes and their interrelationship. Using burn study data, a preliminary principal component analysis was carried out and two separate clusters were observed. Observations were split into two classes and analysed by partial least squares (PLS) regression discriminant analysis to assess possible predictors of each class. To assess predictors of total body surface area burned (TBSA), the orthogonal projections to latent structures (OPLS) model was used after PLS regression. The identified classes were later designated as high-risk burn victims and low-risk burn victims. Female gender fell into the high-risk class. Many possible predictors were found to be associated with burn injury extent, after modelling the natural logarithm of TBSA by OPLS. The fitted model explained 76% of variation in Y. It excluded up to 9% of orthogonal variation captured in two orthogonal components. This seems to be the first application of the OPLS model in public health epidemiology. The results of this study were promising regarding the use of supervised models in injury pattern analysis. |
| 199 |
BURN TREATMENT FRAMEWORK IN ISRAEL
(Krieger Y., Shoham Y., Levi A., Bogdanov-Beresovsky A., Silberstien E., Sagi A. - Israel)
The treatment and hospitalization policies in various hospitals in Israel are influenced by injury severity and by the existence or non-existence of a designated burn treatment body. Severely injured burn victims requiring designated burn treatment are referred to one of Israel's five major burn units located in the highest level trauma centres that have an advanced burn treatment infrastructure. This national distribution of burn centres ensures designated treatment availability in various areas according to Israeli demographics, geography, and security threats. Israel does not have an obligatory burn report policy. Implementation of a national burn repository such as that in the USA will be able to give burn treatment specialists in our country a basis for comparison of treatment standards and allow for better care for burn victims. The Israeli Burn Association has a major role in the processes discussed in the manuscript. |
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COMPARISON OF THE OUTCOME OF BURN PATIENTS USINGACUTE-PHASE PLASMA BASE DEFICIT
(Salehi S.H., As'adi K., Mousavi J. - Iran)
In recent years, plasma base deficit has been used as a marker to determine the status of tissue perfusion in trauma patients and also to predict the outcome of these patients. This study was performed to investigate the effect of plasma base deficit in predicting burn patient outcome. Methods.This prospective cohort study was performed from October 2009 to October 2010 in the acute phase of burn patients who were admitted within 6 h post-injury to Motahari Burn Hospital in Iran. The patients were divided into two groups based on the plasma base deficit in the first 24 h post-injury: group A, in which the mean plasma base deficit was less than or equal to -6 (more negative), and group B, in which the mean plasma base deficit greater than -6. Statistical analysis was performed using SPSS v.16 software. Results. Thirty-eight patients were enrolled in each group. The mean plasma base deficit in group A (-7.76 ± 2.18 mmol) was significantly less than that in group B (-1.19 ± 2.82) mmol (p< 0.05). Although there was no significant difference between the mean of fluid resuscitation and urine output in the first 24 h after injury between the two groups (p > 0.05) and despite removal of interfering factors, there were significant differences between the systemic inflammatory response syndrome and the multiple organ dysfunction syndrome score and the percentage of sepsis between the two groups (p< 0.05). The mortality rate in group A (63.2%) was significantly higher than that in group B (36.8%) (p > 0.05). Conclusion. The plasma base deficit can be used as a valuable marker in the resuscitation of burn patients, along with clinical criteria. Physiological indicators (burn percentage, age, and mucosal burns) are not sufficient to predict mortality and morbidity in burn patients, and it is necessary to investigate the role of biochemical markers such as base deficit in determining the final outcome of burn patients. |
| 209 |
THE OVERALL PATTERNS OF BURNS
(Almoghrabi A., Abu Shaban N. - Palestine)
Burn patterns differ across the whole world and not only in relation to lack of education, overcrowding, and poverty. Cultures, habits, traditions, psychiatric illness, and epilepsy are strongly correlated to burn patterns. However, burns may also occur because of specific religious beliefs and activities, social events and festivals, traditional medical practices, occupational activities, and war |
| 214 |
IS EXPANSION OF ARTIFICIAL DERMIS A RELIABLERECONSTRUCTIVE OPTION?
(Tsoutsos D., Zapantioti P., Kakagia D., Salmas M., Marra A., Kyriopoulos E. - Greece)
Reconstruction of full-thickness defects with the use of artificial dermis has been well established in the recent literature. The capacity of artificial dermis to expand over a period of years, months, or even days is described. Three such cases are reported. Two females (aged 21 and 30 yr) post-burn contractures of the chest wall right breast hypoplasia and abdominal wall post-burn contractures. The third patient, a 14-yr-old male with a giant congenital naevus on the forearm, is also described. After excision of the contractures and the congenital naevus, the patients underwent staged reconstruction with the use of artificial dermal template and split-thickness skin autografts at monthly intervals. The 21-yr-old female also had a tissue expander placed submuscularly which six months later was replaced by a permanent silicone implant. Gradual expansion of artificial dermis within three weeks resulted in reconstruction of a breast of natural shape, size, and volume. In the second patient the artificial dermis was expanded over a period of months,until full-term pregnancy, while the third patient took years to achieve expansion naturally as he grew up. In conclusion, artificial dermis can be expanded over various periods of time (days to years), providing a reliable and safe alternative reconstructive method, particularly in areas where expansion is an absolute necessity for a good functional and aesthetic result. |
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