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Volume XXV |
Number 3 |
September 2012 |
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Summaries
| 115 |
EPIDEMIOLOGY OF PAEDIATRIC BURNS IN IRAN
(Karimi H., Motevalian A., Motabar A.R., Safari R., Parvar M.S., Vasigh M. - Iran)
We surveyed the epidemiology of the patients in a tertiary burn care centre (the Motahari Burn Hospital) in Tehran in the 4-yr period 2005-2009. Scalding was the major cause of burn injury for patients under the age of 6, while there were many more flame and electrical burns in late childhood. Males were mainly affected (male to female ratio, 1.7:1). Most burns occurred in the summer, probably due to older children's increased outdoor activities during school vacations. Most of the injuries took place in the kitchen. Age was directly related to the higher total body surface area and mortality rate. Explosion of propane gas at home had a high incidence. Length of hospital stay increased in relation to the burn surface area. Infants were found to be at greatest risk for burn injuries, while older children were at higher risk for severe burns. Before arriving at the hospital, 22 patients had received traditional therapy in the home which was not effective and caused some problems. Pre-hospital care by emergency medicine service personnel was complete and effective. 374 patients had positive results for wound culture (42.9%). The most frequent bacteria found in burn wound cultures was coagulase-negative Staphylococcus (66.8%). Blood culture was positive in 12% of the patients with positive burn wound culture and the most frequent bacteria in blood culture was Pseudomonas aeruginosa. The overall mortality rate was 10.6%. Treatment and prevention programmes should target high risk groups. Important criteria include older age, flame burn, presence of inhalation injury, total body surface area burned above 40%, and sepsis.
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| 121 |
SELF-INFLICTED BURNS IN MOSUL: A CROSS-SECTIONAL STUDy
(Al-Zacko S.M. - Iraq)
A cross-sectional study was conducted to investigate the different characteristics of attempted suicide by self-inflicted burn cases compared with other accidental burn cases admitted to the Burns Unit in Al-Jumhoori Teaching Hospital in Mosul over a one-year period from March 1, 2011 to March 1, 2012. Of 459 burn cases, 103 (22.44%) had self-inflicted burns. The mean total body surface area of suicide attempters was 61%, markedly higher than in other cases (20%) (P= 0.0001). Among all self-inflicted burn cases, burns were caused by flame, while scald was the commonest cause (56.5%) in accidental burns. There was a significant difference in the sex ratio between self-inflicted burn cases (1:11.9) and accidental burn cases (1:1) (P = 0.0001). Case fatality rates for self-inflicted burn and accidental burn cases were 80.6% and 14.9%, respectively. The overall mean ages for self-inflicted burn and accidental burn cases were 24.3 and 15.6 years, respectively. Compared to all other burn cases, self-inflicted burn cases had a significantly larger mean percentage of surface body area burned (61.0±28.2 versus 20.7±15.8; P = 0.0001). In conclusion, self-inflicted burns remain a common cause of admission to our burn unit. The extent of burns is often large, since most suicide attempters use an accelerant that accounts for the high mortality in this group.
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| 126 |
CHEMICAL BURNS FROM ASSAULT: A REVIEW OF SEVEN CASES SEEN IN A NIGERIAN TERTIARY INSTITUTION
(Tahir C., Ibrahim B.M., Terna-Yawe E.H. - Nigeria)
Chemical burns represent a major challenge for reconstructive surgeons. They are caused by exposure to acids, alkalis or other corrosive substances which result in various degrees of injury. This report highlights the challenges faced in managing such patients in a Nigerian teaching hospital. The medical records of seven patients (four females and three males) treated for chemical burns injury from January 2001 to December 2010 were retrospectively reviewed. All patients were younger than 30, with a mean age of 23.3. Most of them (85.7%) had sustained full thickness burns ranging from 8% to 33% of their body surface area. All cases were result of assaults. The male to female ratio was 1:1.3, and the average duration of hospital stay was 7.5 months. The face was affected in all patients. Patients presented with multiple deformities, like ectropion of eyelids, keratopathies, blindness, nasal deformities, microstomia, loss or deformities of the pinna, mentosternal contractures, and severe scarring of the face. Twenty-nine surgical procedures were performed, which included nasal and lip reconstruction, ectropion release, commissuroplasty, contracture release, and wound resurfacing. Management of chemical burns, especially in a developing country lacking specialised burn centres with appropriate facilities, is challenging. Prevention through public awareness campaigns, legislation for control of corrosive substances, and severe punishment for perpetrators of assaults using these substances will go a long way in reducing the incidence of chemical burns.
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| 131 |
BURNED CHILDREN PAY A COSTLY PRICE FOR CARELESSNESS AND WRONG BEHAVIOURS
(Khalil A.A.M., El-Hadidy A.M., Zeid T. - Egypt)
Burns are among the most devastating injuries of all and they are responsible for higher hospitalization, morbidity, and mortality rates than other injuries in children. In addition, the management of burns and their sequelae is extremely expensive. Carelessness and wrong behaviours are the main players in burn injuries, especially in children, independently of their socioeconomic level. These burned children pay a costly price. The purpose of this study is to analyse the mechanisms of burn injuries in children in order to highlight the importance of behavioural changes for the reduction of burn injuries in children.
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| 135 |
REVIEW ARTICLE: VENTILATOR-ASSOCIATED PNEUMONIA IN MAJOR BURNS
(Rogers A.D., Argent A.C., Rode H. - South Africa)
Major burns victims are particularly susceptible to pneumonia, especially ventilator-associated pneumonia (VAP). VAP remains a prominent cause of morbidity and mortality, despite improvements in intensive care and burns surgery in recent times. Length of ventilation, type and size of burn (especially inhalational burns) are related to the incidence of VAP. Other risk factors (number of re-intubations, theatre visits) are also important. Effective preventative strategies should be adhered to, and protocols should be implemented to aid in the diagnosis and treatment of VAP. Clinical criteria, radiology, and broncho-alveolar lavage should be used to determine the causative organism, and there should be a low threshold for the early initiation of empiric therapy, based on the prevailing resistance patterns in the unit. Major burns should be managed in centres where there is ready access to multidisciplinary resources and expertise.
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| 140 |
STAPHYLOCOCCAL SCALDED SKIN SYNDROME DUE TO BURN WOUND INFECTION
(Farroha A., Frew Q., Jabir S., Dziewulski P. - United Kingdom)
Introduction. The staphylococcal scalded skin syndrome is an acute exfoliation of the skin caused by exfoliative toxins A and B. Although Staphylococcus aureus is a common cause of burn wound infection, SSSS following burn wound infection is rare. Method. A retrospective review of all SSSS cases admitted to a regional burns service between January 2008 and January 2012 was undertaken. Results. Two cases of SSSS were reported during this time period as occurring following burns injury. The first case was a 17-month-old boy who had been hospitalized for a conservative treatment of 6% total body surface area (TBSA) mixed depth scald burns. On day four he developed exfoliation of 85% TBSA. The second case was a ten-month-old boy who sustained a 1% TBSA scald burn and was managed conservatively in the community by his general practitioner. On day five, he developed exfoliation of 80% TBSA. Staphylococcus aureus was isolated from the burn wounds in both cases. Conclusion: These two cases show that it is vital for burns surgeons and intensive care specialists to be aware of the possibility of SSSS occurring in patients with burn injuries with its potential devastating effects.
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| 143 |
EARLY EXCISION AND GRAFTING VERSUS DELAYED EXCISION AND GRAFTING OF DEEP THERMAL BURNS UP TO 40% TOTAL BODY SURFACE AREA: A COMPARISON OF OUTCOME
(Saaiq M., Zaib S., Ahmad S. - Pakistan)
This is a study of 120 patients of either sex and all ages who had sustained deep burns of up to 40% of the total body surface area. Half the patients underwent early excision and skin autografting (i.e., within 4-7 days of sustaining burn injury) while the rest underwent delayed excision and skin autografting (i.e., within 1-4 weeks post-burn). Significant differences were found in favour of the early excision and grafting group with regard to the various burn management outcome parameters taken into consideration, i.e. culture positivity of wounds, graft take, duration of post-graft hospitalization, and mortality.
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| 148 |
EXPRESSION OF FIBROCYTE MARKERS BY KELOID FIBROBLASTS: AN INSIGHT INTO FIBROSIS DURING BURN WOUND HEALING - A PRELIMINARY STUDY
(Mathangi Ramakrishnan K., Meenakshi Janakiraman M., Babu M. - India)
In extensive burns it becomes difficult for fibroblasts to migrate from the periphery of the healthy tissue and colonize the injured area. Even under such circumstances healing takes place, and this is attributed to the differentiation of circulating fibrocytes which enter the wound site. This normal cell type is identified in keloid fibroblasts: it expresses fibrocyte markers and secretes extra cellular matrix proteins. In-vitro collagen contraction assay reveals that fibrocytes contract collagen gels with an efficacy similar to normal fibroblasts. The contribution of fibrocytes to the formation of keloid fibroblasts in post-burn healing is discussed. |
| 152 |
THE MENACE OF POST-BURN CONTRACTURES: A DEVELOPING COUNTRY'S PERSPECTIVE
(Saaiq M., Zaib S., Ahmad S. - Pakistan)
A study was carried out regarding 213 patients of either gender and all ages who presented with post-burn contractures. The commonest site of contracture was the neck. 92 patients (43.19%) had received their initial burn injury management in general surgery units in tertiary care hospitals compared to 43 patients (20.18%) in district headquarter hospitals. Only 26 patients (12.20%) were managed in plastic surgery/burn wards, and 52 patients (24.41%) received no regular treatment from any hospital. The majority of patients (n=197) had a history of conservative management, with only 16 patients (7.51%) having a split thickness skin graft for part of their initial burns. None of the patients had the appropriate anti-deformity splintage in the affected parts or any physiotherapy during the acute phase of their burns.
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| 159 |
PRISE EN CHARGE D'UN AFFLUX MASSIF DE BRÛLES LORS D'UNE SITUATION DE CATASTROPHE PAR INCENDIE AU MAROC
(Siah S., Hatimi E.M., Ihrai H., Drissi Kamili N. - Maroc)
La brûlure est l'une des lésions les plus fréquemment rencontrées lors de catastrophes naturelles ou lors de catastrophes d'origine humaine (incendies de lieux publics d'origine accidentelle, ou en temps de guerre ou encore lors d'attentats terroristes). La prise en charge et le triage de brûlés en nombre reste un problème difficile; ceci souligne la nécessité d'une réflexion et de prévisions de ces crises en insistant sur la formation des médecins et des soignants. Les défis à relever sont multiples: les soins aux brûlés requièrent un nombre important de personnel qualifié; les évacuations doivent être planifiées en fonction de la gravité de la brûlure et des lésions associées; les stocks et lots de dotation (en particulier en topiques anti-infectieux et en cristalloïdes) doivent être suffisants et adéquats. Les services hospitaliers de l'Hôpital Militaire d'Instruction Mohammed V de Rabat doivent pouvoir être rapidement adaptés pour accueillir et surtout isoler ces patients. L'hypothèse d'une catastrophe par incendie avec afflux massif de brûlés à l'hôpital militaire d'instruction Mohammed V de Rabat ne doit laisser place à aucune improvisation.
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