|
 |
Volume XXX |
Number 1 |
March 2017 |
|
|
Summaries
| 5 |
THE TREATMENT OF PALMAR CONTACT BURNS IN CHILDREN: A FIVE-YEAR REVIEW
(Grossova I., Zajicek R., Kubok R., Smula M.C. - Czech Republic)
Pediatric palmar contact burns are becoming a common trauma, especially in young children. Treatment of this kind of burn is challenging as well as controversial, regarding the choice between split-thickness or full-thickness skin graft to close the defect. The aim of this review was to evaluate the treatment algorithm at our clinic. We conducted a retrospective study including all patients 0 - 5 years of age admitted to our department from 2008 to 2012 with isolated superficial or deep partial-thickness palmar burns. The mean age was 16.1 months. In 27 cases (52.9%) we were able to close the wound conservatively. Average healing time in this group was 13.3 days. Two of these 27 patients developed flexion contractures, but none of them required additional operation. Twenty-four patients were treated using split-thickness skin graft. The average time period from the day of injury to the day of surgery was 14.2 days. Contractures occurred in 5 (20.8%) of the patients who underwent grafting, Secondary reconstruction using full-thickness skin graft was performed in all 5 of them, which represents 9.8% of all patients. We consider split-thickness grafting quick, easy and effective, with minimal to no donor site morbidity and insignificant inflammation complications. Due to reduced healing time after the actual grafting, rehabilitation can commence earlier.
|
| 9 |
COST-UTILITY OF BURNS MANAGEMENT IN NIGERIA: A CASE STUDY OF THE NATIONAL ORTHOPAEDIC HOSPITAL, ENUGU
(Okafor C.E., Onunka O., Idoko L.N. - Nigeria)
A major problem of burns is the high cost of management, as well as the discrimination and disability they can cause to patients. Maximising resource utilisation is of key importance for lower-middle-income countries (LMICs) like Nigeria. There is a need to know if Nigerian patients who were victims of burns get the best value for money. This study aimed to evaluate the average cost of managing burns in Nigeria, and determine if the treatment approach is cost-effective. The study was a cost-utility analysis from the perspective of health service providers in Nigeria, a case study of the National Orthopaedic Hospital Enugu (NOHE) using 2013 Microsoft excel. Data on the cost of burn management were obtained from a retrospective study conducted in NOHE in 2012 on 285 patients. Costs were adjusted to reflect the future (2015) value using a real interest rate of 3%. These costs were presented in 2015 US dollars, and a discount rate of 3% was used for both cost and outcome. Health outcome was presented in disability adjusted life years (DALYs). Based on a cost-effectiveness threshold of $2,758.4 (i.e. representing Nigerian GDP/capita), burn management is cost-effective in Nigeria ($526.68/DALY averted). The result also showed that the cost of managing burns in Nigeria is $7,123.28 per patient, which is more than the average income. Burn management in Nigeria is cost-effective but too expensive for most Nigerians to afford.
|
| 13 |
COMPARISON OF SIX OUTCOME PREDICTION MODELS IN AN ADULT BURN POPULATION IN A DEVELOPING COUNTRY
(Salehi S.H., As'adi K., Abbaszadeh-Kasbi A., Isfeedvajani M.S., Khodaei N. - Iran)
There are two types of prognostic model - burn-specific and general - to predict mortality risk in burn patients. Most prediction models were devised in developed countries. The aim of this study was to compare the performance of six outcome models in a developing country. In a retrospective cohort study, data of all thermal burned adult patients (age ? 18 years) admitted to the Burn Intensive Care Unit (BICU) were collected and then the following six prediction models were used to assess each patient: Acute Physiology and Chronic Health Evaluation (APACHE II), Abbreviated Burn Severity Index (ABSI), Belgian Outcome in Burn Injury (BOBI), the Ryan model, revised Baux and FLAMES model. Discriminative ability and goodness-of-fit of the prediction models were determined by receiver operating characteristic curve analysis and Hosmer-Lemeshow tests. We included 238 patients (mean age: 38.3 ± 18.39 years, average TBSA: 58.27% ± 24.55) in our study; 172 (72.3%) of them were diagnosed with inhalation injury and 178 (72.4%) were intubated. Mortality rate was 69.7%. Deceased patients had significantly higher mean age, %TBSA and number of inhalation injury. The area under the curve of the models was between 64.5 (APACHE II) and 85.9 (ABSI). The best estimation of predicted mortality was obtained with the ABSI model (67.2%).
|
| 18 |
LE CIMENT BRÛLE TOUJOURS
(Lebreton T., Fontaine M., Le Floch R. - France)
Les brûlures chimiques par ciment représentent une cause fréquente de corrosion cutanée en France. Elles nécessitent fréquemment un traitement chirurgical. Notre étude rétrospective concerne tous les patients admis pour une brûlure par ciment dans le service entre 2004 et 2016. Quarante-neuf patients âgés de 21 à 71 ans ont été pris en charge dans le centre des brûlés du Centre Hospitalier Saint Joseph Saint Luc à Lyon entre 2004 et 2016. La population concernée était majoritairement masculine, relativement jeune (44 ans en moyenne) et professionnellement active. Les brûlures survenaient principalement dans le cadre d'accidents domestiques (78%). Elles étaient profondes et atteignaient majoritairement les membres inférieurs, de façon bilatérale. La surface brûlée représentait 3% de la surface cutanée totale. Presque tous les patients (98%) ont nécessité une prise en charge chirurgicale pour excision et autogreffe de peau mince. Un seul patient a bénéficié d'une cicatrisation dirigée. Le délai moyen entre la brûlure et la chirurgie était de 13 jours et la durée moyenne d'hospitalisation de 8 jours. Sept patients ont nécessité une prise en charge en centre de rééducation à leur sortie du service. Cette étude confirme la sévérité des brûlures chimiques par ciment. Elle met également en avant l'impact que peut avoir ce type de brûlure en terme de retentissement socio-économique dans une population de patients majoritairement jeune et active. Elle insiste sur le fait que des mesures doivent être prises afin d'informer cette population rarement professionnelle sur les risques encourus lors du mésusage du ciment. La réglementation actuelle, classant le ciment comme irritant, ne prend pas en compte son caractère corrosif et devrait être amendée.
|
| 24 |
THE AIRWAY IN INHALATIONAL INJURY: DIAGNOSIS AND MANAGEMENT
(Sabri A., Dabbous H., Dowli A., Barazi R. - Lebanon)
It is estimated that 13.000 to 22.000 individuals suffer from inhalational burns each year in the United States alone. Despite these high numbers, inhalational burns remain a major challenge to otolaryngologists. In this paper, a review of literature is presented in order to provide otolaryngologists with a systematic approach to patients with inhalational burns to optimize treatment, cost, morbidity and, most importantly, mortality. For this purpose, a broad PubMed search was conducted. The available literature was found to highlight the importance of airway management in terms of the timing of intubation, method of intubation, trachea-esophageal (TE) fistula formation and TE rupture. It also emphasizes the importance of carbon monoxide intoxication and prompt correction. Drugs such as heparin sulfate, N-acetylcysteine and albuterol have been proven to help in the treatment of patients with inhalational burns, and more research is currently underway with the purpose of developing chelating drugs that scavenge the toxic substances in the smoke before they can damage the airway.
|
| 30 |
BURN-RELATED FACTORS AFFECTING ANXIETY, DEPRESSION AND SELF-ESTEEM IN BURN PATIENTS: AN EXPLORATORY STUDY
(Jain M., Khadilkar N., De Sousa A. - India)
Burns are physically, psychologically and economically challenging injuries, and the factors leading to them are many and under-studied. The aim of the current study was to assess level of anxiety, depression and self-esteem in burn patients, and look at various burn-related variables that affect them. This cross-sectional study included 100 patients with burn injuries admitted to a tertiary care private hospital in an urban metropolis in India. The patients were assessed for anxiety, depression and self-esteem using the Hamilton anxiety rating scale, Hamilton depression rating scale and Rosenberg self-esteem scale respectively. Assessment was carried out within 2-8 weeks of injury following medical stabilization. The data was tabulated and statistically analyzed. The study sample was predominantly male (54%), married (69%), with a mean age of 34.1 ± 10.8 years. Accidental burns (94%) were the most common modality of injury. The majority (46%) suffered burns involving 20-59% total body surface area (TBSA), and facial burns were present (57%). No significant association was found between TBSA and anxiety, depression or self-esteem, and the same was true for facial burns. Deep burns, however, were significantly associated with anxiety (p=0.03) and depression (p=0.0002). High rates of anxiety and depression are associated with burn injuries and related to burn depth. Adjustment and recovery in these patients depends on various other factors like the patient's psychological status, nature/extent of the injury and ensuing medical care. Further research is warranted to reveal the magnitude and predictors of psychological problems in burn patients.
|
| 35 |
LACTATE: PROGNOSTIC BIOMARKER IN SEVERELY BURNED PATIENTS
(Mokline A., Abdenneji A., Rahmani I., Gharsallah L., Tlaili S., Harzallah I., Gasri B., Hamouda R., Messadi A.A. - Tunisia)
Plasma lactate (PL) has been used as a marker of cellular hypoxia and shock. The correlation between PL and clinical outcome has been well accepted in hemorrhagic and septic shock. In contrast to the existing evidence, there are no or almost no data dealing with lactate and burn-related outcome. We attempted to assess whether early plasma lactate (PL) is a useful parameter to predict outcome in burned patients. A prospective study was conducted in a 20-bed adult burn ICU at a university-affiliated teaching hospital in Tunis. Patients admitted within the first 24h post burn with greater than 10% total body surface area (TBSA) burned were enrolled in the study. There were 60 males and 20 females. Mean age was 40.7 ± 19.5 years old, and average TBSA was 32 ± 21%. At admission, 86.7% patients had an initial lactate value of more than 2 mmol/L. In our study, an initial lactate value of 4 mmol/L provided the best sensitivity and specificity: 88% and 79% respectively for predicting sepsis, with an area under the ROC curve of 0,82. Furthermore, plasma lactate cut-off value for mortality prediction was 4.46 mmol/l with a good sensitivity (86%) and specificity (92%). Mortality rate was 36.25%. Plasma lactate appears to be a powerful predictor biomarker of sepsis and mortality in burn patients
|
| 39 |
PREVALENCE OF BIOFILM PRODUCING AEROBIC BACTERIAL ISOLATES IN BURN WOUND INFECTIONS AT A TERTIARY CARE HOSPITAL IN NORTHERN INDIA
(Asati S., Chaudhary U. - India)
Burn wounds frequently get infected due to a break in skin integrity and prolonged hospitalization. Microbial flora originating from the patient's own flora colonize and infect the burn wounds. Bacterial biofilms in particular are postulated as the culprit for the development of non-healing burn wounds by inducing chronic inflammation in these patients. In the present study, 190 wound isolates obtained from patients admitted to the burn ward at the Pt. B.D. Sharma PGIMS, Rohtak, were evaluated for biofilm formation along with Antimicrobial Susceptibility Testing (AST). Biofilm detection was done by modified Tissue Culture Plate method and AST was done by Kirby-Bauer disc diffusion method. A total of 190 isolates were studied, which included Staphylococcus aureus, Coagulase negative Staphylococcus, Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella spp., Proteus spp., Citrobacter spp., Escherichia coli and Enterobacter spp. Of these, 68.9% isolates showed biofilm formation. Biofilm formation was more common in Pseudomonas aeruginosa followed by Klebsiella spp. and Staphylococcus aureus. Biofilm producing isolates showed greater multidrug resistance than non-biofilm producers. In our study, a high rate of biofilm formation and antimicrobial drug resistance was seen.
|
| 43 |
NEW DRESSING COMBINATION FOR THE TREATMENT OF PARTIAL THICKNESS BURN INJURIES IN CHILDREN
(G., Tóth E., Juhász Zs. - Hungary)
Burns are among the most common causes of injury in children. Several wound dressings are available to conservatively treat second-degree burns. Seventy-three children were treated with Aquacel Ag foam and Zn-hyaluronon gel to determine their effectiveness on partial thickness burns. We applied silver nitrate solution on 25% of patients for 24 hrs, then checked burn depth. If the burn was superficial second degree, we applied the dressing under study. All dressings were removed 6-7 days later. In the remaining children we used Aquacel Ag foam dressing with Zn-hyaluronon gel at first intervention. The dressing was checked on the second day, and removed on the sixth or seventh day (unless it had spontaneously separated). Hot water scalds were the main cause of injury. Other causes included hot oil, flame and contact, among others. Wound size was on average 5% total body surface area. Burns were seen on all body parts, and in 38 cases on more than one area. None of the 73 children treated with this dressing were diagnosed with wound infection. We observed the epithelialization of the burned areas on the 6th or 7th day after primary treatment. These dressings efficiently promote epithelialization, and a further advantage of Zn-hyaluronon gel is that it enhances cell regeneration and inhibits dressing fixation into the wound. Based on our experience, with this dressing combination we can achieve gentle, child-friendly and cost-effective treatment, excellent wound healing and favourable cosmetic results.
|
| 47 |
SURGERY ON BURNS SEQUELAE IN DEVELOPING COUNTRIES
(El Ezzi O., Dolci M., Dufour C., Bossou R., de Buys Roessingh A. - Switzerland)
The purpose of this study is to analyze the effectiveness of surgery and follow-up of children operated on for burn sequelae. For many years, we have organized two missions per year to Benin and Togo, one for surgery and one for follow-up. We analyzed the files of children born in Africa and victims of burns from the years 2002 to 2011. Children were referred through a non-governmental organization (NGO) and assessed in Africa by local paediatricians before and after surgery. Treatment consisted in operating on burn sequelae such as contractures, hypertrophic scars and hard cords. Impaired mobility was our only indication for the operation. We kept a database on all patients. Sixty files were reviewed, of which fifty were deemed suitable for analysis. The most common methods of surgery were skin grafting and Z-plasty. There were no complications, such as infection or graft/flap necrosis after immediate surgery. Long-term follow-up revealed a recurrence of hypertrophic scarring (47%), retractions (24%) and hard cords (2%) due to a lack of occupational therapy and physiotherapy treatment. Partnership with an NGO and a local team allows us to treat children with burn injury sequelae in Western Africa. A continued and often long-lasting follow-up by occupational therapists and physiotherapists is highly mandatory in order to guarantee good long-term results. In 2010, we initiated local rehabilitation therapy.
|
| 52 |
GRAFTING BOTH ACUTE WOUND SITE AND ADJACENT DONOR SITE WITH THE SAME GRAFT: AN EASY AND SAFE PROCEDURE TO IMPROVE HEALING AND MINIMIZE PAIN IN ELDERLY AND BEDRIDDEN PATIENTS
(Keilani C., Agard D., Duhoux A., Lakhel A., Giraud O., Brachet M., Duhamel P., Bey E. - France)
In harvesting skin to cover the defect caused by a burn, a second wound is created, the donor site wound. We propose an alternative method to manage the donor site: taking a split-thickness skin graft (STSG) from a donor site adjacent to the burn wound to be treated, and meshing at a 3:1 ratio to cover both sites at once. The main objective of this study is to evaluate the effectiveness of covering both burn wound and adjacent donor site with the same STSG in elderly and bedridden patients. We retrospectively reviewed the medical records of 6 patients over 60 years old or/and bedridden presenting with a small burn wound who underwent STSG of both burn wound and adjacent donor site between April 2016 and November 2016 in the Department of Plastic Surgery and Burn Treatment at Percy Military Hospital (France). Their data were compared with data of five patients who had undergone the usual STSG procedure during the same period. There was a statistically significant difference between patients who underwent adjacent STSG procedure and those who underwent usual STSG procedure in healing time (days) mean (SD) (7,33 ± 1,03 vs. 16,2 ± 0,83; p = 0,007) and Numeric Rating Scale pain mean (SD) at day 2 (0,33 ± 0,33 vs. 2,4 ± 1,35; p = 0,04). Grafting both acute burn wound and adjacent donor site with the same graft seems to be an easy method to improve healing and minimize pain in the STSG donor site in elderly and bedridden patients.
|
| 57 |
THE PEDICLED GROIN FLAP IN RESURFACING HAND BURN SCAR RELEASE AND OTHER INJURIES: A FIVE-CASE SERIES REPORT AND REVIEW OF THE LITERATURE
(Amouzou K.S., Berny N., El Harti A., Diouri M., Chlihi A., Ezzoubi M. - Morocco)
In many settings, microsurgery is not yet common practice for hand injuries. In settings where it is current practice, the patient's health condition can sometimes be a contraindication. In this case, the pedicled groin flap may be a reliable option for hand surgeons. Information was retrieved from the medical charts of five patients treated with a pedicled groin flap at our National Centre for Burn, Plastic and Reconstructive Surgery between 1st January 2013 and 1st July 2015. We documented socio-demographic features, defect characteristics (aetiology, size), post-operative complications, outcome, and patient satisfaction with cosmetic appearance and donor site scar. There were two cases of burn scar release, two cases of traumatic hand injury, and one case of squamous cell carcinoma excision. There was one distal ischemia of the flap and one flap requiring secondary thinning. All the patients were very satisfied with the donor site scar, which was easily hidden in underwear. Four patients were very satisfied with the reconstructed hand. Despite the current trend towards free tissue transfer, the pedicled groin flap continues to be regarded as a safe, easy and reliable option for the reconstruction of soft tissue defects, and remains widely used.
|
| 62 |
THERMAL BURN IN A 30-MINUTE-OLD NEWBORN: REPORT ON THE YOUNGEST PATIENT WITH IATROGENIC BURN INJURY
(Abboud L., Ghanimeh G. - Lebanon)
Burns in infants are rare. The majority of neonatal burns occur in the hospital setting. The immaturity of their immune system, their fragile and thin skin, difficulties in resuscitation, engraftment paucity limited by donor sites, and long-term complications make taking care of burned newborns extremely difficult. We present the case of a newborn burned 30 minutes after his birth over a total body surface of 35%, when the hot water bottle used in the hospital accidentally burst. This is the earliest iatrogenic burn in a newborn reported to date. The newborn was discharged home after 30 days in hospital for resuscitation, dressings and skin grafting. He is now under regular observation.
|
| 65 |
LETTER TO THE EDITOR: ASHURA: A FESTIVAL OF CHARITY ASSOCIATED WITH A SERIOUS AND DISABLING EYE INJURY (REPORT OF 12 CASES)
(Moustaine M.O., Allali B., Fetouh I., Elmaaloum L., Elkettani A., Zaghloul K. - Morocco)
In North African tradition, the 10th day of Muharram or 'Ashura' is a religious festival and traditionally a day of sharing and charity, when children receive gifts and toys from their parents and relatives. Over time, this festival has turned into a period of selling dangerous toys and products (firecrackers, fireworks), which are increasingly used by children and adolescents. They are sometimes responsible for serious and disabling eye lesions.
|
|