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Volume XXVII |
Number 1 |
March 2014 |
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Summaries
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BUILDING A MULTIDISCIPLINARY TEAM FOR BURN TREATMENT - LESSONS LEARNED FROM THE MONTREAL TENDON TRANSFER EXPERIENCE
(Karam E., Lévesque M.C., Jacquemin G., Delure A., Robidoux I., Laramée M.T., Odobescu A., Harris P.G., Danino A.M. - Canada)
Multidisciplinary teams (MDTs) represent a recognized component of care in the treatment of complex conditions such as burns. However, most institutions do not provide adequate support for the formation of these teams. Furthermore, the majority of specialists lack the managerial skills required to create a team and have difficulties finding the proper tools. Our objective is to provide an insight for health care professionals, who wish to form a MDT for burn treatment, on the challenges that are likely to be faced, and to identify key elements that may facilitate the establishment of such a project. The setting for this was a plastic surgery department and rehabilitation center at a national reference center. A qualitative analysis was performed on all correspondences related to our tetraplegia project, from 2006 to 2008. To guide our thematic analysis, we used a form of systems theory known as the complexity theory. The qualitative analysis was performed using the NVivo software (Version 8.0 QSR International Melbourne, Australia). Lastly, the data was organized in chronologic order. Three main themes emerged from the results: knowledge acquisition, project organizational setup and project steps design. These themes represented respectively 24%, 50% and 26% of all correspondences. Project steps design and knowledge acquisition correspondences increased significantly after the introduction of the mentor team to our network. We conclude that an early association with a mentor team is beneficial for the establishment of a MDT.
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DETECTION OF AMBLER CLASS A, B AND D ß-LACTAMASES AMONG PSEUDOMONAS AERUGINOSA AND ACINETOBACTER BAUMANNII CLINICAL ISOLATES FROM BURN PATIENTS
(Hakemi Vala M., Hallajzadeh M., Hashemi A., Goudarzi H., Tarhani M., Sattarzadeh Tabrizi M., Bazmi F. - Iran)
In this study, we evaluated the existence of classes A, B and D ß-lactamases among Pseudomonas aeruginosa (P.aeruginosa) and Acinetobacter baumannii (A.baumannii) strains isolated from burn patients in Tehran during the years 2012 and 2013. From these strains, the frequency of MBL (metallo-beta-lactamase) and ESBL (extended-spectrum beta-lactamase) producers were evaluated using CDDT (Combined Disk Diffusion Tests). The prevalence of some related genes, including blaIMP, blaVIM, blaSPM, blaKPC, blaGIM, blaDIM, blaBIC, blaOXA-48, blaCTX-M-15 and blaNDM genes, was evaluated using PCR and sequencing methods. Of the 75 non-fermenter isolates, 47 P.aeruginosa and 28 A.baumannii were isolated and identified. A high rate of resistance to common antibiotics was detected among A.baumannii isolates in particular, showing 100% resistance to 9 tested antibiotics. CDDT showed that 21 (28%) and 25 (34.25%) of the non-fermenter isolates were ESBL and MBL producers respectively. The prevalence of blaCTX-M-15 and blaIMP genes among the 75 non-fermenter isolates was 7 (9.3%) and 1 (1.3%), respectively. Fortunately, no other genes were detected in either of the non-fermenters. The mortality rate due to MBL-producing isolates was 5 (20%). This study showed specific resistance genes exist among some MBL and ESBL gram-negative non-fermenters which were isolated from burn patients in Tehran.
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IMPROVEMENT OF SURVIVAL IN PATIENTS WITH EXTENSIVE BURNS INVOLVING THE PERINEUM WITH USE OF A FAECAL MANAGEMENT SYSTEM
(Farroha A., Frew Q., Philp B., Dziewulski P. - United Kingdom)
The purpose of this study is to assess the effectiveness of faecal management systems in improving survival of patients with extensive burns involving the perineum. All adults with burns of more than 30% total body surface area (TBSA) who were actively treated in our regional burn service between December 2008 and July 2012 were reviewed and compared to an historical cohort of 18 adult patients with similar injury involving the perineum, treated in our regional burn service between 1999 and 2001. For the last five years, faecal management systems (FMS) have been in use for patients with extensive burns involving the perineum. Sixteen patients with burns greater than 30% TBSA involving the perineal region were admitted during this period and all were managed with FMS. Four of the 16 patients (25%) managed with FMS died compared to 11 of the 18 patients (61%) in the historical cohort. The survival of patients with extensive burns involving the perineal region was improved using FMS. No significant complications were reported in relation to the use of FMS. FMS allows faecal diversion, reduced perineal soiling and improved personal hygiene. We believe this allows easier management of these difficult injuries, may reduce the incidence of sepsis and improves survival.
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INTEGRATM IN BURNS RECONSTRUCTION: OUR EXPERIENCE AND REPORT OF AN UNUSUAL IMMUNOLOGICAL REACTION
(Lohana P., Hassan S., Watson S.B. - United Kingdom)
Limited availability of autologous donor sites poses significant challenges for soft-tissue reconstruction in severe and complex burns. IntegraTM is a bi-layered dermal regeneration template (DRT) which has played a significant role in soft tissue reconstruction since its initial use for full-thickness burn defects. The purpose of this study is to report our institutional experience of IntegraTM in burns management over a 4-year period and highlight an unusual reaction to its second application. Twenty-four cases underwent IntegraTM resurfacing for burn management from September 2007 to August 2011. Data on patient demographics, including co-morbidities, indications, operative data, complications, secondary reconstruction and outcomes were recorded. IntegraTM was used in 24 patients on 37 anatomical sites. One patient died 3 weeks after injury and first stage of IntegraTM application, and was therefore excluded from the study. Split-thickness skin grafting was performed within an average of 23 days (with a range of 7-55 days) and mean graft take was 87% (with a range of 75-100%). Five cases of local infection at the graft site were recorded. The average length of hospital stay was 47 days (with a range of 1-162 days). The mean follow-up time was 17 months (with a range of 9-34 months). Overall, our experience with DRT was mixed, that is to say we found it satisfactory with acute burns resurfacing but very good with secondary reconstruction. The main advantage of IntegraTM is its immediate availability in unlimited quantities for soft-tissue reconstruction in major and complex burns. The main drawbacks are financial implications, twostage procedure, complex wound care and risk of infection. We believe that IntegraTM can be considered as a promising modality in burns management.
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UP-TO-DATE USE OF HONEY FOR BURNS TREATMENT
(Zbuchea A. - Romania)
Made by bees from the nectar of flowers, used since ancient times to treat wounds and burns, honey has lately acquired a growing interest from the international scientific community and has been the subject of many specialized studies and communications. This article highlights the up-to-date knowledge on qualities, properties and mode of appliance of honey in the treatment of wounds of various etiologies, particularly burns, through an extensive retrospective analysis of data from the literature. This article aims to review and provide a synthesis of current issues regarding the complex action of honey on burn wounds, evidenced by in vitro studies, laboratory experiments and clinical trials published in the specialized literature. The present work analyzes extensively the anti-infectious and anti-inflammatory properties of honey, as well as its favorable effect on wound regeneration. Effectiveness of topical administration of honey is evidenced both by a series of experiments on laboratory animals and by clinical trials. This article also draws the attention of both medical staff and patients to the possibility of using this product, and to its acceptability in practice.
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ASSESSMENT OF FAMILY PHYSICIANS' KNOWLEDGE AS AN INDICATOR OF BURN MANAGEMENT KNOWLEDGE AMONG NON-BURN PRACTITIONERS IN ISMIALIA, EGYPT
(Moghazy A.M., Kamel M.H., Farghaly R.M. - Egypt)
The management of burns within the first hours of injury has a significant impact on mortality and morbidity. In case of burns disasters, most patients are managed by non-burn practitioners. The knowledge held by our local family physicians is thought to be representative of that of non-burn practitioners, as they had not partaken in any courses or training on burn management beyond graduation. With regard to emergency burn management, the knowledge required is: assessment of burn extent and depth, associated injuries, indications of escharotomy, fluid therapy and airway management, as well as safe transportation. The aim of this study therefore was to assess the knowledge of family physicians - as an indicator of that of non-burn practitioners - on emergency burn management, and design accordingly an appropriate burn educational program. An interview questionnaire was distributed to all physicians working in Family Medicine Centers in Ismailia, Egypt, who did not possess a post-graduate degree. A total of twenty-four family physicians (100%) participated in this study. The questionnaire findings showed that, out of a possible score of 25 correct answers, the highest result was 12; achieved by 6 physicians (25%). The highest frequency score was 8 correct responses; obtained by 10 physicians (29.2%). This demonstrated a knowledge deficit among Ismailia's family physicians, and subsequently non-burn practitioners, with regard to burns management, due to gaps in undergraduate teaching.
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PHYSICAL REHABILITATION OF PEDIATRIC BURNS
(Atiyeh B., Janom H.H. - Lebanon)
Significant improvements have been made in the acute treatment of pediatric burn injuries over the past 3 decades which have significantly decreased mortality. Each year, more burned children are necessitating serious medical attention during their convalescence. For children with serious consequences resulting from burns that can persist from childhood through adolescence into adulthood, the value of long-term rehabilitation cannot be over stated. Burn injury management should not focus only on the immediate treatment. Long-term functional outcome and the required rehabilitation that burn victims must go through should be given equal if not more attention. The present is a review of the available modalities utilized for the physical rehabilitation of convalescent pediatric burns in order to overcome the catabolic state, improve muscle power and fitness, reduce disfiguring scars and prevent contractures.
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BURN WOUND HEALING WITH INJECTION OF ADIPOSE-DERIVED STEM CELLS: A MOUSE MODEL STUDY
(Karimi H., Soudmand A., Orouji Z., Taghiabadi E., Mousavi S.J. - Iran)
Stem cells have shown promise with regard to the healing process of burn wounds. However, donor sites for these cells are still under investigation. The aim of this study is to review the efficacy of adipose tissue-derived stem cells (ADSCs) in accelerating wound healing of third degree burns in a mouse model. To this end, forty healthy male inbred Balb/c mice were selected and set up as an experimental model for third degree burn wounds. They were randomly divided into 3 equally sized groups: the ADSCs group, the mechanically prepared adipose tissue group, and the control group. The wounds were examined daily until the mice were sacrificed for tissue sampling in the 3rd week. Our results showed that wound surface area and eschar thickness were smaller in the ADSCs group throughout the study period, although there was no significant difference between the groups for decreasing values of wound area characteristics. In terms of wound healing parameters, lymphocyte and macrophage cell counts were larger in the ADSCs group compared to the other groups. Fibroplasia, collagen synthesis and remodeling were more aberrant in this group. However, there was no statistically significant difference in either of these observed differences (p>0.05). Although enzymatically prepared ADSCs seem a potential treatment in wound healing, our study of a mouse model burn wound revealed no significant improvement in using this option.
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