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Volume XXVII |
Number 4 |
December 2014 |
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Summaries
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Analysis of a retrospective double-centre data-collection for the treatment of burns using biological cover Xe-derma
(Klosová H., Klein L., Bláha J. - Czech Republic)
Xe-Derma® is a new biological acellular temporary wound cover derived from pig dermis in the form of a mesh of collagen and elastic fibers. It is recommended for use in similar indications as classical pig xenografts. A data collection of 2 burns centres in the treatment of burns with Xe-Derma® was obtained from the medical records of 101 patients admitted from January 1, 2010 to December 31, 2011. The primary objectives of the study were to assess efficacy and safety when using Xe-Derma® in burn treatment, and to analyse the course of healing. The secondary objectives were to define the suitable spectrum of indications of Xe-Derma® in terms of burn depth, and to evaluate subsequent scarring using the Vancouver Scar Scale. No undesirable systemic effects or adverse device events were observed. The use of Xe-Derma® was not associated with a higher risk of burn wound infection. On the other hand, the infection was the most common cause of Xe-Derma® dissolution. The majority of patients (81.4%) had no signs of Xe-Derma® dissolution. The mean healing time in the group of patiens under review was close to 12 days and mean hospitalization time was almost 14 days. Using Xe-Derma® proved to be effective as a temporary covering for partial-thickness burns with the capacity of spontaneous healing. It proved to be a well-tolerated wound coverage with minimal complications and low level of pain during dressing changes. Xe-Derma® firmly adhered to the wound bed. There was a lower frequency of wound dressing changes and only a minimal rate of wound infection.
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| 176 |
Electrical burns: The trend and risk factors in the Ghanaian population
(Agbenorku P., Agbenorku E., Akpaloo J., Obeng G., Agbley D. - Ghana)
The usefulness of electricity in daily life offers several advantages which cannot be underestimated. Electricity is needed by industries for manufacturing and also in homes for lighting, cooking, washing, etc. However, electricity can cause severe life-threatening complications. This study investigates the trend and mortality risk factors of electrical burn injuries at the Burns Intensive Care Unit (BICU) of the Komfo Anokye Teaching Hospital (KATH), Ghana. The Burns Registry at KATH BICU containing information on patients who were admitted for electrical burns was used. Data on the sex, age, occupation, cause of injury, Total Body Surface Area burned (TBSA) and outcome of admissions was obtained. GraphPad version 5 was used for the analysis. There were 13 (2.7%) electrical burns, suffered by 11 males (84.6%) and 2 females (15.4%) out of a total 487 BICU admissions over a 4-year period (July 1, 2009 - June 30, 2013); the mean age of the electrical burn victims was 37.8 years (range = 22-56); the TBSA ranged from 5.0% - 98.0%. Mortality risk factors identified were high voltage electrical burns, older age (P=0.0250) and TBSA>20% (P=0.048). Four cases (30.8%) were transferred to the Main Burns Ward (Ward D2C); 6 cases (46.1%) were discharged home; 3 patients (23.1%) died; all deaths were recorded in persons who had high voltage electrical burns. Electrical burns can be severe and can cause death. Even though the current study showed that a small population was affected by electrical burns, society has to be continually conscious of the detrimental effects of electrical energy and take the necessary precautions to minimize this type of accident.
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| 184 |
How important is hydrotherapy? Effects of dynamic action of hot spring water as a rehabilitative treatment for burn patients in Switzerland
(Moufarrij S., Deghayli L., Raffoul W., Hirt-Burri N., Michetti M., de Buys Roessingh A., Norberg M., Applegate L.A. - Switzerland)
Burn rehabilitation using hydrotherapy can have multiple benefits for the burn patient. The therapy uses specific mineral enriched hot spring water and water jets with varied hydro-pressure to combat hypertrophy, inflammatory reaction signs, abnormal pigmentation, and, more specifically, redness and scarring. Standard operating procedures for burn rehabilitation have been developed and integrated into the Standard of Care at the CHUV hospital using localized hydro-mechanical stimulation of burn sites (20 minutes of alternating anatomical sites) followed by constant pressure large-bore and filiform showers targeting specific scarred areas. These therapeutic regimens are repeated daily for 2 to 3 weeks. Patients showed lasting effects from this regimen (up to 3-6 months), the results becoming permanent with more uniform skin structure, color and visco-elasticity in addition to a decrease in pruritus. The specifications of clinical protocols are describedBurn rehabilitation using hydrotherapy can have multiple benefits for the burn patient. The therapy uses specific mineral enriched hot spring water and water jets with varied hydro-pressure to combat hypertrophy, inflammatory reaction signs, abnormal pigmentation, and, more specifically, redness and scarring. Standard operating procedures for burn rehabilitation have been developed and integrated into the Standard of Care at the CHUV hospital using localized hydro-mechanical stimulation of burn sites (20 minutes of alternating anatomical sites) followed by constant pressure large-bore and filiform showers targeting specific scarred areas. These therapeutic regimens are repeated daily for 2 to 3 weeks. Patients showed lasting effects from this regimen (up to 3-6 months), the results becoming permanent with more uniform skin structure, color and visco-elasticity in addition to a decrease in pruritus. The specifications of clinical protocols are described herein along with the virtues of hot spring hydro-pressure therapy for burn rehabilitation. The use of hydrotherapy, which has been a controversial topic among burn units across the world, is also discussed. In North America, hydrotherapy is defined only within the scope of in-patient wound cleansing and is thought to lead to microbial auto-contamination and bacterial resistance. In Switzerland and France the emphasis of hydrotherapy is on rehabilitation after the wound has closed. herein along with the virtues of hot spring hydro-pressure therapy for burn rehabilitation. The use of hydrotherapy, which has been a controversial topic among burn units across the world, is also discussed. In North America, hydrotherapy is defined only within the scope of in-patient wound cleansing and is thought to lead to microbial auto-contamination and bacterial resistance. In Switzerland and France the emphasis of hydrotherapy is on rehabilitation after the wound has closed.
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| 192 |
Effect of immune-enhancing diets on the outcomes of patients after major burns
(Mahmoud W.H., Mostafa W., Abdel-Khalek A.H., Shalaby H. - Egypt)
The use of immune-enhancing diets (IEDs) has been shown to be beneficial in some categories of critically ill patients. This study aimed to evaluate the effect of early enteral feeding supplemented with glutamine and omega-3 fatty acids, as immune-enhancing diets, on the outcomes of patients after major burns. Forty thermally injured adult patients with 30-50% total body surface area (TBSA) burns, including deep areas ranging from 5-20%, were randomized into a prospective, double-blind, controlled clinical trial. They were placed into two equal groups: group A (IED group), in which patients received early enteral feeding supplemented with glutamine and omega-3 fatty acids as immune-enhancing diets; and group B (control group), in which patients received early enteral feeding not supplemented with immune-enhancing diets. Laboratory assessment of serum albumin, serum C-reactive protein, total lymphocytic count and serum immunoglobulins (IgA, IgG and IgM) was performed at admission, and on days 4, 7 and 14. Finally, outcomes were assessed by monitoring the survival rate, the length of hospital stay and the incidence of infection. There were no significant differences between the IED and control group regarding age (28.7±5.32 versus 29.85±5.94), sex, weight, %TBSA (37.75±4.4 versus 38.3±4.84) and %burn depth (11.7±2.36 versus 10.7±2.036). The incidence of infection (2 versus 8) and the length of hospital stay (16.3±0.92 days versus 17.95±2.96 days) were decreased significantly in the IED group versus the control group. There was no significant difference between the survival rates in both groups as there was only one death in the control group. Thanks to IEDs, patient outcome was improved and infectious morbidity and length of hospital stay were reduced, but there was no effect on the survival rates following major burns.
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| 197 |
Semi-permanent skin staining associated with silver-coated wound dressing Acticoat
(Zweiker D., Horn S., Hoell A., Seitz S., Walter D., Trop M. - Austria)
A 17-year-old male with burns to 8% of his total body surface area was treated for 10 days with Acticoat®, a nanocrystalline silver dressing. The burns, which were on his back and shoulder, healed without infection. However, a skin discoloration in the wound area and the adjacent uninjured skin appeared in the first days of treatment. The staining remained visible even after the treatment had ended and disappeared approximately three years later. Despite the outstanding antimicrobial properties, possible side effects of silver nanocrystalline dressings should be kept in mind.
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| 201 |
La greffe de peau totale dans le traitement des séquelles de brûlures de la main et des doigts: A propos de 84 cas
(Boukind S., Droussi H., Elatiqi O.K., Dlimi M., Dhaidah O., Ejjiyar M., Quaboul M., Dehhaze A., Fkhar S., Elamrani D., Benchamkha Y., Ettalbi S. - Maroc)
Nous avons mené une étude rétrospective s'étendant de septembre 2004 à septembre 2012 sur les données de à propos de 84 patients présentant des séquelles de brûlure majeures de la main. Ces patients étaient traités chirurgicalement par une greffe de peau totale. Le but de cette étude est, donc, d'insister sur la simplicité de cette technique et surtout son efficacité et sa fiabilité. L'âge moyen de la survenue de la brûlure était de 4 ans. L'âge moyen de nos patients était de 18,3 ans (2-62 ans), avec prédominance masculine dans 60% des cas. L'agent causal le plus fréquent était un agent thermique - le plus souvent un liquide chaud (56%). Le délai moyen entre la fin de la cicatrisation et la prise en charge des séquelles était de 36 mois (2 mois - 16 ans). Dans 69 cas (82.5%), les lésions étaient localisées au niveau de la face palmaire de la main. Les séquelles ont été dominées par les rétractions digitales (65%) dont le déficit fonctionnel est évident. Une greffe de peau totale a été réalisée chez tous nos patients après libération des brides et excision des placards cicatriciels. Les rétractions commissurales ont été traitées par des plasties en Z. Dans 95% des cas, le prélèvement de peau totale était réalisé au niveau du pli inguinal. Le recul moyen était de 5,5 ans (1-8 ans). 11 patients ont été perdus de vu. Les résultats après cicatrisation complète et rééducation ont été jugés satisfaisants (bons) dans 62 cas (85%), et assez bons dans 11 cas (15%). Un traitement initial bien conduit et effectué dans les meilleures conditions permet non seulement de réduire le nombre de séquelles des brûlures mais encore de les rendre moins sévères.
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| 209 |
Free thin anterolateral thigh flap for post-burn neck contractures - a functional and aesthetic solution
(Sarkar A., Raghavendra S., Jeelani Naiyer M.G., Bhattacharya D., Dutta G., Bain J., Asha J. - India)
Neck contractures after burn injuries produce restrictions in motion and unacceptable aesthetic outcomes. Although different methods of reconstruction have been used in the treatment of this ailment, a limited and unsatisfactory outcome often results. Free thin anterolateral flaps have been found to be a good single stage option for reconstruction of post-burn contractures of the neck. In our study, 11 patients with post flame burn contractures of the neck underwent surgical release and coverage by a free thin anterolateral thigh flap. Patients were followed up for an average of five years and various aspects of functional and aesthetic rehabilitation were assessed. Our findings revealed that the free thin anterolateral flaps covered the defects over anterior and lateral aspects of the neck with good colour match and contour. Furthermore, none of the flaps had any significant early or delayed complications. Two cases had to be reoperated for partial loss of flaps and all patients were satisfied with functional and aesthetic outcomes. We therefore consider free thin anterolateral thigh flaps to provide a good single stage reconstruction for post-burn cervical contractures with good functional and aesthetic outcomes.
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| 215 |
Burns from ECG leads in an MRI scanner: Case series and discussion of mechanisms
(Abdel-Rehim S., Bagirathan S., Al-Benna S., O'Boyle C. - UK)
Iatrogenic burns are rare and preventable. The authors present two cases of burns from ECG leads, sustained during magnetic resonance imaging (MRI). Common features included a long duration spinal MR scan (120 and 60 minutes) and high patient body mass index (BMI >30). Both patients were discharged within 24 hours of admission, but required a period of outpatient burn care. The causation of these injuries remains unclear but there are several possible mechanisms including: electromagnetic induction heating, antenna effects and closed-loop current induction. The authors provide a description of the injuries, discuss possible mechanisms that may lead to burn injury in the MRI environment and suggest ways to reduce the risks of such injuries.
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