|
 |
Volume XXVI |
Number 3 |
September 2013 |
|
|
Summaries
| 115 |
BURN INJURY: WHAT'S IN A NAME? LABELS USED FOR BURN INJURY CLASSIFICATION: A REVIEW OF THE DATA FROM 2000-2012
(Kearns R.D., Holmes 4th J.H., Cairns B.A. - USA)
Through the years, the burn injury has been described using a variety of labels. These labels have ranged from one word terms to phrases including degrees of injury or more descriptive terms. A search was conducted relying on a common general internet search engine. After multiple searches varying the keywords, the top 100 searches identified the most prevalent terms or phrases, ranging from the common to the more obscure. The search was repeated using the most prevalent terms or phrases identified in the common internet search engine, focusing on either the title or abstract for all papers indexed in PubMed. This process narrowed the attention to the most common terms or phrases used by the academics in their published work. This work therefore focused on measuring the specific terms being used today and their frequency of use in the peer reviewed papers indexed in the PubMed system. It is difficult to focus on the unique aspects of any given profession when there is confusion surrounding a common vocabulary. By identifying and noting in the academic literature the most commonly used labels, a point of reference can be created for future work. Furthermore, having a common and accurate set of labels that are uniformly applied across the profession is critical for academia to include in training and education programs for physicians, nurses, and paramedical staff.
|
| 121 |
HIGH VOLTAGE ELECTRICAL BURN INJURIES IN TEENAGE CHILDREN: CASE STUDIES WITH SIMILARITIES (AN INDIAN PERSPECTIVE)
(Mathangi Ramakrishnan K., Babu M., Mathivanan, Ramachandran B., Balasubramanian S., Raghuram K. - India)
From 1992 to 2012, a total of 911 paediatric burns were admitted and treated at Kanchi Kamakoti Childs Trust Hospital Intensive Burn Care Unit, of these 28 children had suffered electrical injuries and burns. 7 teenagers suffered high voltage electrical burn injuries: 2 were involved in train accidents which caused fatal electrical injuries, and 5 had electrical burn injuries caused by similar types of accidents, requiring Paediatric Intensive Care Unit (PICU) care, repeated surgeries and extensive rehabilitation. A common factor among these latter 5 patients was that they were injured by overhead high electrical voltage cables. Their management was labour intensive and highly costly. In this report, the type of accident, the electrical voltage that produced burns and the treatment details are elaborated. Findings included similarities in age and type of accident, and failure to implement safety procedures and apply standard norms of high voltage transmission feeder lines.
|
| 126 |
EARLY DETECTION OF PNEUMONIA AS A RISK FACTOR FOR MORTALITY IN BURN PATIENTS IN MENOUFIYA UNIVERSITY HOSPITALS, EGYPT
(Mgahed M., El-Helbawy R., Omar A., El-Meselhy H., Abd El-Halim R. - Egypt)
Pneumonia is common among critically ill burn patients and is a major cause of morbidity and mortality among them. Prediction of mortality in patients with severe burns remains unreliable. The aim of this research is to study the incidence, early diagnosis and management of nosocomial pneumonia, and to discuss the relationship between pneumonia and death in burn patients. This prospective study was carried out on 80 burn patients (35 males and 45 females) admitted to Menoufiya University Hospital Burn Center and Chest Department, Egypt, from September 2011 to March 2012. Our findings showed an overall burn patient mortality rate of 26.25 % (21/80), 15% (12/80) incidence of pneumonia, and a 50% (6/12) mortality rate among patients with pneumonia compared to 22 % (15/68) for those without pneumonia. The incidence of pneumonia was twice as high in the subset of patients with inhalation injury as among those without inhalation injury (P< 0.001). It was found that the presence of pneumonia, inhalation injury, increased burn size, and advanced age were all associated with increased mortality (P< 0.001). In the late onset pneumonia, other associated factors also contributed to mortality. Severity of disease, severity of illness (APACHE score), organ failure, underlying co-morbidities, and VAP PIRO score all have significant correlations with mortality rate. Pneumonia was an important factor for predicting burn patient mortality. Early detection and management of pneumonia are absolutely essential.
|
| 136 |
THE PROPERTIES OF THE "IDEAL" DONOR SITE DRESSING: RESULTS OF A WORLDWIDE ONLINE SURVEY
(Lars P. Kamolz L.P., Giretzlehner M., Trop M., Parvizi D., Spendel S., Schintler M., Justich I., Wiedner M., Laback C., Lumenta D.B. - Austria)
Split skin grafting is a widely used technique for reconstructing skin defects. Although a vast number of different coverage options for donor sites have become available in daily clinical practice, no optimum dressing material has been found to date. For this reason, we conducted a globally-distributed online survey to poll for the properties of such an "ideal" donor site dressing, possibly leading to an improved clinically-driven direction of future wound dressing developments. A total of 69 respondents from 34 countries took part in the questionnaire, resulting in a response rate of 13.8% (69/500) over a 1-month period. The majority of respondents rated the characteristics of an "ideal" donor site dressing to be either "essential" or "desirable" as follows: lack of adhesion to the wound bed ("essential": 31/69, 44.9%; "desirable": 30/69, 43.5%); pain-free dressing changes ("essential": 38/69, 55.1%; "desirable": 30/69, 43.5%); absorbency ("essential": 27/69, 39.1%; "desirable": 33/69, 47.8%); ease of removal ("essential": 37/69, 53.6%; "desirable": 27/69, 39.13%). With regard to the desired frequency of dressing changes, respondents preferred "no dressing change until the donor site has healed" (51/69, 73.9%) in the majority of cases, followed by "twice weekly" (10/69, 14.5%), "alternate days" (5/69, 7.2%) and "daily" (3/69, 4.3%). With regard to the design of the dressing material, the majority of participants preferred a one-piece (composite) dressing product (44/69, 63.8%). The majority of respondents also denied the current availability of an "ideal" donor site dressing (49/69, 71%). The strength of this study was the remarkable geographic distribution of responses; all parts of the world were included and participated. We believe that this globally conducted online survey has polled for the properties of the "ideal" donor site dressing and possibly will lead to an improved clinically-driven direction of future wound dressing development.
|
| 142 |
ISN'T IT TIME FOR A CADAVER SKIN BANK IN SOUTH AFRICA?
(Rogers A.D., Allorto N.L., Adams S, Adams K.G., Hudson D.A., Rode H. - South Africa)
Improvements in comprehensive burn care, as practiced in dedicated burns units, have reduced mortality and morbidity rates significantly. Strategies deemed most important include the application of fluid resuscitation and nutrition protocols, intensive care and antimicrobial dressings, as well as early excision and grafting. Autografting is limited, however, by availability in very extensive burns, despite the use of expanded (meshed) skin. Alternatives have therefore been required, and deceased donor allograft is considered the gold standard. Fresh allograft use is limited by supply, and legislative and cultural restrictions have significantly influenced availability, despite evidence of its efficacy. This necessitates the establishment of a deceased donor skin bank in South Africa, with a mandate to procure and store allograft for distribution to burns units when required.
|
| 147 |
FUNGAL INFECTIONS IN BURNS: A COMPREHENSIVE REVIEW
(Struck M.F., Gille J. - Germany)
Burn wound infections remain the most important factor limiting survival in burn intensive care units. Large wound surface, impaired immune systems, and broad-spectrum antibiotic therapy contribute to the growth of opportunistic fungal species. Faced with challenging fluid resuscitation, wound excision and cardiopulmonary stabilization, mycosis in burns are likely to be underestimated. Diagnostic performance can sometimes be delayed because clinical signs are unspecific and differentiation between colonization and infection is difficult. Therapeutic measures range from infection prophylaxis over treatment with antifungal agents towards radical amputation of infected limbs. New methods of early and reliable detection of fungal organisms, as well as the use of novel antifungal substances, are promising but require wider establishment to confirm the beneficial effects in burn patients. This review aims to highlight the main important aspects of fungal infections in burns including incidence, infection control, diagnostic and therapeutic approaches, prognosis and outcomes.
|
| 154 |
OPEN BURN WOUND DRESSING: A PRACTICAL OPTION IN RESOURCE CONSTRAINED SETTINGS
(Olawoye O.A., Osinupebi, O.O., Ayoade, B.A. - Nigeria)
Various types of wound care products abound for the treatment of burn injuries. Most of these products are rather expensive and beyond the means of many patients in poorer countries. This poses a challenge to burn care workers in these environments and calls for the adoption of practical solutions with the use of less expensive and readily available alternatives. The aim of this study is to review the outcome of our burn patients managed with topical silver sulphadiazine dressing in terms of time to wound healing and length of hospital stay. Consecutive burn patients admitted over a four year period were included in the study. The patients were resuscitated along standard protocols and their wounds were dressed daily with dermazin. The demographic and clinical characteristics of the patients were retrieved and analyzed using the SPSS version 16. The primary outcome measure for the study was the time to complete re-epithelialization of the wounds and discharge of the patients. 144 patients with a M: F ratio of 2.3: 1 were managed during the period. The age range was 4 months to 81.9 years with a median age of 26 years. The TBSA range was 1 to 99% with a median of 28.5%. The mean duration from time of injury to wound healing was 21.5 days with a median of 17 days. Open burn wound dressing with silver sulphadiazine offers a satisfactory outcome and should be considered for burn dressing in low resource settings.
|
| 158 |
NECROTIZING SOFT TISSUE INFECTIONS FOLLOWING A SCALD BURN OF THE LOWER LIMB: A CASE REPORT
(Alsharari M., Pasquesoone L., Khater R., Guerreschi P., De Broucker V., Martinot-Duquennoy V. - France)
Necrotizing soft tissue infection (NSTI) is a rare but potentially fatal infection. It usually complicates skin traumas, such as lacerations, scratches, insect bites, burns and recent surgeries. Rapid diagnosis is crucial for a favourable prognosis. NSTI is an emergency surgical condition and every delay in the operative treatment has a proven negative effect. Recently, a rare case presented to us with a late diagnosis of NSTI complicating a scald burn of the lower limb. The patient's injury was initially treated as a burn case but unfortunately ended in an above knee amputation. We report our management experience in this case, with a review of the literature.
|
|
