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Volume XXVI |
Number 2 |
June 2013 |
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Summaries
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EPIDEMIOLOGY OF MAJOR BURNS AT THE LEBANESE BURN CENTER IN GEITAWI, LEBANON
(Ghanimé G., Rizkallah N., Said J.M. - Lebanon)
Burn care is one of the few areas in medicine considered both medically and surgically challenging, with burn injuries affecting people of all ages and both sexes. Between May 1992 and March 2012, 1,524 patients were admitted to the Lebanese Burn Center in Geitawi, with an average length of stay (LOS) of 36.5 days. The most frequently encountered injuries were thermal burns, generally resulting from domestic accidents. Of our patients, 47% were from rural areas and burned body surface (BBS) was the most serious factor, with 36% of all those admitted having suffered burns of 20% to 40% of their total body surface area (TBSA). Our team of experienced physicians, nurses, nutritionists and physical therapists was essential to successful burn care and outcomes were improved with adequate early fluid intake. The main causes of death were multiple organ failure due to hemodynamic instability, followed by respiratory failure from inhalation injury. A week after the injury, risk of infection was the main threat to the burn victims. Although this threat was compounded by malnutrition and immunodeficiency, excessive use of antibiotics was not justified. The fatality rate was about 18% and correlates with higher TBSA burns.
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| 63 |
POST-BURN PRURITUS: NEED FOR STANDARDIZATION OF CARE IN NIGERIA
(Otene C.I., Onumaegbu O.O. - Nigeria)
It is generally agreed among burn care specialists that pruritus (itching) is a very common and distressing complication of burn injuries that results in extreme discomfort. There is no consensus on treatment modality worldwide but there are generally accepted methods of managing amelioration. This survey aims to study the knowledge, attitudes and practices of Nigerian burn specialists who manage various degrees of burn injuries in our environment. The purpose is to find out whether there are any uniform modalities of care for these patients, with the view of possibly providing standardization. To this end, a structured questionnaire was designed and distributed to plastic surgeons from across Nigeria. Findings showed that 88.6% of the plastic surgeons had no form of assessment tool or method for evaluating post-burn pruritus, leaving only 11.4% believing they had a method of assessing the severity of post-burn pruritus. With regard to treatment, 57.1% would use oral medications as first-line treatment, 22.9% would use injectables, 8.6% would use topical agents, 5.7% would only reassure the patients and another 5.7% would use a combination of oral and topical agents together. 85.7% of these plastic surgeons and burn care specialists did not have any form of anti-pruritic regimen, as only 14.3% indicated having this. Hence, there is no standardization in the management of pruritus in Nigeria and there is an urgent need for a management protocol.
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| 68 |
POSSIBLE RISK FACTORS ASSOCIATED WITH BURN WOUND COLONIZATION IN BURN UNITS OF GAZA STRIP HOSPITALS, PALESTINE
(Al Laham N.A., Elmanama A.A. Tayh G.A. - Palestine)
The epidemiological pattern and risk factors of burns and burn infections varies widely in different parts of the world. This study aims to determine the epidemiologic pattern of burn injuries and possible risk factors associated with burn infections in burn units of Gaza strip hospitals. A total of 118 patients were included in the study. The data collected included: patient age and gender, the causes, site, degree, and TBSA of the burns, as well as surgical operations, length of hospital stay, and microbiological profile of samples collected from patients, the environment, and from health care staff. Pediatric and adult patients accounted for 72% and 28% respectively. 58.5% of all patients were male and 41.5% were female. The most common etiological factors in children were scalding, while in adults these were open fire and flammable liquids. The mean TBSA was 12% with a range from 1-90%. Second and third degree burns accounted for 78% and 22% respectively. The area of the body most often affected was the torso (39%), followed by the lower limb (29.7%), and upper limb (17.8%). The predominant microorganisms isolated from burn wounds were Pseudomonas aeruginosa, Enterobacter spp. and Staphylococcus spp. The study showed the highest risk groups to be children and males, and enabled us to identify possible risk factors that can help in future efforts toward prevention and minimizing nosocomial infections in burn units of Gaza strip hospitals.
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| 76 |
DISTRIBUTION OF GENES ENCODING TETRACYCLINE RESISTANCE AND AMINOGLYCOSIDE MODIFYING ENZYMES IN STAPHYLOCOCCUS AUREUS STRAINS ISOLATED FROM A BURN CENTER
(Emaneini M., Bigverdi R., Kalantar D., Soroush S., Jabalameli F., Noorazar Khoshgnab B., Asadollahi P., Taherikalani M. - Iran)
Staphylococcus aureus (S. aureus) is one of the most common organisms associated with infections among burn patients and has shown a frequent and rapid development of antibiotic resistance. The presence of genes encoding aminoglycoside modifying enzymes (AME) and tetracycline resistance were detected by PCR and multiplex-PCR. Among the 151 S. aureus isolates recovered from the burn patients, 96 (63.6%) were detected to have mecA gene. The rate of tetracycline resistance genes associated with mecA was 61% (92/151). Forty nine isolates (32.4%) contained tetM, 26 (17.2%) possessed only tetK and 21 (13.9%) contained both tetM and tetK. The presence of the aac(6')-Ie-aph(2'')-I gene was determined in 18 isolates, aph(3')-IIIa in 8 isolates, both the aac(6')-Ie-aph(2'')-I, aph(3')-IIIa and the ant(4')-Ia genes in 69 isolates, both aac(6')-Ie-aph(2'')-I and ant(4')-Ia in 6 isolates, and both the aph(3')-IIIa and the ant(4')-Ia genes in 8 isolates. Most of the strains which harboured the mecA gene also contained the tet and AME genes.
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| 81 |
DIAGNOSTIC CLINIQUE ET PARACLINIQUE DES INFECTIONS OSTÉOARTICULAIRES DIGITALES DANS LES BRULURES THERMIQUES DE LA MAIN
(Zaoui A., Mahdhi N., Ben Maitigue M., Maaref K., Jemni S., Bouaziz M.A., Regaieg H., Dakkem M., Zine E Abidine M., Ben Fredj M., Khachnaoui F., Rejeb N. - Tunisie)
Les infections ostéo-articulaires digitales de la main brûlée sont particulières car longtemps méconnu. Leur diagnostic n'a pratiquement jamais été abordé dans la littérature. On distingue d'une part les ostéoarthrites survenant à la phase aiguë de la brûlure chez le patient grand brûlé, sédaté où le diagnostic est difficile en réanimation car la clinique n'est pas parlante et d'autre part les ostéoarthrites découvertes à la phase de rééducation, où douleur, tuméfaction, raideur et signes radiologiques sont nets. Le diagnostic de ces infections doit être précoce à fin de préserver la fonction de la main.
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| 86 |
HYPOGLOSSAL NERVE PARALYSIS IN A BURN PATIENT FOLLOWING MECHANICAL VENTILATION
(Weissman O., Weissman O., Farber N., Berger U., Grabov Nardini G., Zilinsky I., Winkler E., Haik J. - Israel)
Traumatic injury resulting in isolated dysfunction of the hypoglossal nerve is relatively rare and described in few case reports. We present a patient with isolated unilateral palsy of the twelfth cranial nerve (CN XII) resulting from recurrent airway intervention following extensive burn injuries. The differential diagnosis for paralysis of the CN XII is also discussed herein. This case illustrates the significance of comprehensive diagnostic evaluation and the need for refined airway manipulation in patients that require multiple endotracheal intubations.
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| 90 |
COMBINED USE OF NEGATIVE PRESSURE WOUND THERAPY AND INTEGRA® TO TREAT COMPLEX DEFECTS IN LOWER EXTREMITIES AFTER BURNS
(González Alaña I., Torrero López J.V., Martín Playá P., Gabilondo Zubizarreta F.J. - Spain)
Deep and extensive burns of lower extremities present a difficult challenge to healthcare professionals. After debridement, bones, tendons or joints are frequently exposed and cannot be covered by simple autografts. Moreover, in the case of major burns, damage to the surrounding areas of skin and the severity of the patient's overall condition, often count against using pedicled or microsurgical flaps. In dealing with such complex wounds, which are difficult to treat, several authors have recommended the combined use of Integra® and negative pressure wound therapy (NPWT). They emphasize that NPWT eliminates wound exudate, promotes neovascularisation and cell migration through the Integra® matrix while increasing its stability and adherence to the wound bed, as well as decreasing the time needed for its total integration. The case presented here is of a patient with major third-degree flame burns to the lower extremities. After debridement, the external and internal malleolus bilaterally became exposed as well as the partially debrided tendons (Achilles, extensor digitorum longus, long and short peroneus, anterior and posterior tibialis). After ruling out the use of local or microsurgical flaps due to the patient's poor general condition and the presence of burns debrided to the fascia over both lower extremities, we elected to manage the patient with a combined treatment using Integra® and NPWT. After three weeks of treatment, the surface layer of the Integra® matrix was replaced with autografts. Due to partial loss of the skin grafts, a second autograft was needed. At present the patient is completely healed; he can walk with full flexion-extension of both ankles.
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| 94 |
THE USE OF BIOBRANE® TO DRESS SPLIT-THICKNESS SKIN GRAFT IN PAEDIATRIC BURNS
(Farroha A., Frew Q., El-Muttardi N., Philp B., Dziewulski P. - United Kingdom)
Biobrane® is commonly used in paediatric burns to cover partial thickness burns and donor sites of split thickness skin (SSG). The purpose of this study is to evaluate the use of Biobrane® in dressing SSG adjacent to skin graft donor sites or partial thickness burns. A retrospective review was undertaken to determine the use of Biobrane® in dressing SSG, where the grafted areas were adjacent to donor sites or partial thickness burns. Between 2009 and 2012, we reported five cases of using Biobrane® to dress SSG, where the grafted areas were adjacent to partial thickness burns and two cases where the grafted areas were adjacent to donor sites. Biobrane® promoted adherence of the SSG to the wound, prevented shearing, and allowed fluid drainage. At the same time, Biobrane® also facilitated healing of the adjacent donor sites or partial thickness burns.
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| 98 |
ADVANTAGES OF COLLAGEN BASED BIOLOGICAL DRESSINGS IN THE MANAGEMENT OF SUPERFICIAL AND SUPERFICIAL PARTIAL THICKNESS BURNS IN CHILDREN
(Mathangi Ramakrishnan K., Babu M., Mathivanan, Jayaraman V., Shankar J. - India)
Collagen based dressings for acute burn wound management have been extensively used in India, particularly in the city of Chennai. Due to the high levels of humidity in our city, closed dressings become infected and treatment with topical antimicrobials, like Silver Sulfadiazine cream, quickly become desiccated. Collagen membrane dressings were manufactured by the biomaterial laboratory of the Central Leather Research Institute (CLRI), Government of India in Chennai, and then the process was patented. Collagen was extracted from bovine skin and Achilles tendons, and then reconstituted. This was used on burn wounds as dressings after clearance from the Institutional Review Board and Ethics Committees of the Hospital and CLRI. Continued research in this field to enable resulted in the design of silver sulphadiazine loaded alginate microspheres which were embedded in the reconstituted collagen. Controlled delivery of silver sulphadiazine. This collagen membrane was used in chronic infected burns. Low molecular weight heparin was given subcutaneously to improve wound healing in burn injuries and collagen membrane dressings were also applied. After several trials the process technology was patented. The advantages and disadvantages of the collagen membrane cover is elaborated in a group of 487 pediatric burn patients. The trial was conducted at the burn unit of Kanchi Kamakoti Childs Trust Hospital (KKCTH) in Chennai, India.
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