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Volume III |
Number 3 |
September 1990 |
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SUMMARIES
| 145 |
THE SURGICAL TREATMENT OF BURNS: SKIN SUBSTITUTES
(Magliacani G. - Italy)
An ample survey is made of the various surgical techniques that may be used in the treatment of bums. The ditlerent types of skin grafts are described, and the causes of success or failure to take are considered. A detailed study is made of the various types of skin substitutes, which may be synthetic (hydrocolloid, polyurethane, polypeptide), biological (fresh and frozen allogenic skin, fresh and frozen amnion, bovine collagen, animal skin, homologous keratinocyte culture) or biosynthetic (combination of collagen and a silicone membrane). The techniques of skin culture are described, thanks to which 2 or 3 CM2 of full-thickness biopsy can be expanded into 2 M2 of autologous epithelium. Cultured keratinocytes are therefore especially useful in patients with extensive bums. A comparison is made of the different surgical strategies to be followed in limited extension burns ( < 25% TBSA) and extensive bums.
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| 160 |
RISK FACTORS IN THE CRITICAL BURN PATIENT
(Santos Heredero F.X., Garcia Torres V., Herruzo R., Fernàndez Delgado J. - Spain)
194 burned patients were studied to find out the influence of three risk factors, previous pathology (PP), inhalation syndrome (IS) and ventilatory support (VS), on their evolution. The mean mortality rate in patients with PP was 58.7%, more than twice the overall rate (25.2%). The higher mortality appeared in neurological (83%) and epileptic (80%) patients. Patients with PP developed twice as many complications as those without pre-existing disease. A history of toxic or hot fumes inhalation (with or without clinical correlation) was recorded in 42.5% of cases. This increased mortality to 50% (7% without IS). In this group of patients, complications were three times as frequent as in IS-free cases [ARDS (95%), sepsis (81%) and respiratory infections (80%)]. A total of 73 patients (37.6%) required VS. This therapy exponentially increased infective complications as long as the mechanical ventilation was maintained. It is concluded that an exhaustive exploration and anamnesis is mandatory to discover previous diseases and inhalation of fumes during the accident. Once the presence of PP or IS is confirmed a number of therapeutic steps should be taken to prevent the expected high number of complications and to reduce the death risk.
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| 166 |
DUODERME IN THE TREATMENT OF DONOR SITES: A REPORT
(Hermans M.H.E. - The Netherlands)
In a prospective study in two burn centres and one rehabilitation centre DuoDERM E, a new hydrocolloid dressing, was tested as a dressing for the treatment of donor sites. The result of these tests prove that DuoDERM E provides fast reepithelialization of the wounds, good cosmetic results and patient comfort.
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| 170 |
AN EPIDEMIOLOGIC STUDY OF BURNS
(Benito Ruiz J., Navarro Monzonis A., Baena Montilla P. - Spain)
We report a retrospective epidemiological study based on 710 charts of patients admitted to our Burn Centre between 1985 and 1988. During this period we assisted 9794 people at our Casualty Centre. The average age of the patients was 24 yrs and 66% were males. Burns were much more frequent in children < 10 yrs, especially due to scalding by hot water. Nearly 47% were children under 15 years old. The two leading causes were scalding and flames. Other significant causes were gunpowder and electricity. Contact burns, fire and chemicals were less frequent. Massive burns were due to flames and gunpowder. The deepest lesions were produced by electricity and contact burns. Regarding the place where the accident happened, burns occurring in the home were due to scalding and fire. Accidents outdoors were produced by improper use of gunpowder and by electricity (high voltage). Work-related accidents occurred mainly to chemists and electricians. Males outnumbered women regarding street and work-related accidents (p <0.000001). The face and neck were most commonly afTected when the cause was flames and chemicals, the trunk and upper limbs in the case of scalds and flames, the lower limbs with flames and hot contact, and the hand and wrists with electrical and gunpowder injuries. Gunpowder and scalds were involved in genitalia burns.
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| 177 |
TISSUE EXPANSION IN THE TREATMENT OF BURN SCARS
(Caleffi E, Bocchi A., Toschi S., Montacchini G., Papadia F. - Italy)
Major post-burn scars are a serious morphological and functional problem and old techniques like skin grafts and distant flaps are not very effective to improve the final result. Expansion of the local skin allows us to obtain very large local flaps and the replacement of the scar tissue with a good skin for colour and texture. We have used the tissue expansion technique in the treatment of burn scars in the head and neck, trunk, upper and lower extremities. In the head and neck, tissue expansion is useful to obtain good results but the complication rate is higher than in the treatment of other pathologies with the same technique. Good results are obtained in the back where very large amounts of scarred tissue can be removed. In the thorax the morphological results are less satisfactory because of the hypertrophic scars resulting after the operation. In the thigh a good cosmetic improvement has very often been achieved; in the leg, on the contrary, we have observed the highest rate of complications: the use of tissue expansion in this area must be very careful and limited to selected cases.
In the last few years tissue expansion has improved thanks to technical refinements in plastic surgery.
In the past, the treatment of bum scars was carried out by the use of skin grafts or the transposition of local flaps. With skin grafts recurrence of contracture, chronic breakdowns and unsatisfactory cosmetic outcomes were observed; local flaps may be insufficient to resurface large defects after debridement or excision of a post-bum scar.
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| 181 |
THERMAL INJURIES FOLLOWING TERRORIST 130MB EXPLOSIONS IN CLOSED SPACES
(Di Leone R., Palmucci G., Mineo L., Mascherini G. - Italy)
Some of the most important documented European terrorist attempts in the last 20 years are analysed. In all the disasters considered, the blast occurred in closed spaces (pubs, stations, etc.). After a short review of the potential wounding processes related to the conventional blast thermic load, skin bums and respiratory injuries are considered, with regard to distribution, severity, and the various injury associations. In conclusion a comparative study is made between the theoretical clinical pictures and the most common injuries seen in this kind of disaster.
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| 184 |
PHYSIOPATHOLOGY OF THE BURN SHOCK: RESUSCITATION
(Gòmez-Cia T., Roa L., Cantero A. - Spain)
We present a comparative analysis of different resuscitation protocols for the burn patient, realized by digital simulation in a simulator of burn patients previously assessed and published by our research group.
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| 193 |
L'ARTICULATION MÉTACARPOPHALANCIENNE DANS LA MAIN BRÛLÉE: ROLE DANS LA FONCTION DE PRÉHENSION ET PROBLÈME DE RÉÉDUCATION
(Gavroy J.A., Thaury M.W, Cauquil C., RougCS D., Griffe D., Teot L., Ster J. & F., De Godebout J. - France)
Il existe dans les brûlures profondes plusieurs facteurs enraidissant les différentes articulations de la main et en particulier l'articulation métacarpophalangienne. Lorsque la métacarpophalangienne est enraidie, même si les articulations interphalangiennes proximales sont mobiles, on ne peut réaliser les deux mouvements indispensables de la préhension: l'ouverture de la main et la réalisation de pinces; par contre des articulations métacarpophalangiennes mobiles tolèrent un certain degré d'atteinte et de raideur des interphalangiennes proximales. Après une étude des bases articulaires de la fonction de la préhension nous analysons les différentes situations comportant une raideur des articulations métacarpophalangiennes se traduisant par un handicap de la préhension. Nous compléterons notre exposé par les techniques de recherche de la mobilité des métacarpophalangiennes en insistant sur l'orthétisation précoce, ses buts, ses méthodes.
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| 196 |
SURGICAL TREATMENT OF POST-BURN LEUK0DERIVIA
(El-Otiefy M.A., EI-Sonbaty M.A. - Egypt)
Post-burn leukoderma is one of the common complications of bums which usually lead to social and psychological disturbances. Its treatment can be difficult. 30 patients with post-burn leukoderma have been studied and surgically treated with excision and skin grafting for the last 3 years in our Plastic Surgery Unit. Modifications of the technique were developed during their treatment. The results were encouraging as regards cosmetic appearance.
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| 200 |
PERSONAL EXPERIENCE IN ESTABLISHING A BURN CARE FACILITY
(Reda Mabrouk AW. - Egypt)
The author describes the three phases of his experience in 25 years of managing burn patients in Military Service and National Health Organization Hospitals, i.e. the early sixties, the late sixties, and the early seventies. In this last period it was decided to build a Military Burns Centre which would also accept civilians and deal with mass casualties. An account is given of the basic criteria followed in the creation of the Centre, as well as a description of its actual functioning.
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| 203 |
CHEMICAL BURNS - OUR EXPERIENCE OVER ELEVEN YEARS
(Sinha S., Sinha J.K., Tripathi F.M., Bhattacharya V. - India)
An eleven-year review is made of chemical burns consisting of 59 cases presenting at the University Hospital, Varanasi. Chemical burns are an uncommon entity which require special considerations in management. In the period studied, they constituted 4.7% of all burn admissions. Most cases were intentionally inflicted with acids, following property disputes. The patients were usually in their second, third or fourth decades. Depth of burn at the initial assessment was often found to be fallacious. Ocular involvement was common (30.5%). Slough separation was delayed compared to thermal bums. Hydrotherapy was the mainstay of first-aid and casualty department care. Early debridement and skin grafting yielded good results especially in chemical burns of the ear and hand.
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| 206 |
BASIC PRINCIPLES RELATIVE TO THE IMPROVEMENT OF BURNS MANAGEMENT
(Reda Mabrouk AW. - Egypt)
The management of burn injuries is still difficult because of a number of as yet unsolved problems. The physician must therefore constantly bear in mind certain basic principles concerning prevention, first aid, early management and reconstruction. These are considered in detail and various practical advice is given.
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