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ANALYSE SIMPLIFIÉE DES TROIS PRINCIPAUX PHÉNOMÈNES THERMIQUES ACCOMPAGNANT LES INCENDIES
(Colonel (e.r.) J.-F. Schmauch, Orvault, France)
La production de fumées, l'embrasement généralisé (flash-over) et l'explosion de fumées (backdraft) sont les 3 principaux phénomènes thermiques observés dans les incendies. Les fumées, produites par tout incendie sont responsables de 90% des décès observés dans ces circonstances. Flash-over et backdraft se produisent lors des incendies en milieu confiné. Très difficilement prévisibles, ils sont responsables de nombreux accidents touchant les sapeurs- pompiers en intervention. Quelques règles simples de construction et de prévention dans les habitations permettraient de limiter le nombre et la gravité de ces incendies.
EPIDEMIOLOGY OF BURN INJURIES: 2 YEARS' EXPERIENCE IN A SPECIALIZED HOSPITAL IN MEXICO CITY
(Garcia-Espinoza J.A., Navarro-Delgadillo C.I., Costa-Dulché A., Flores-Soto D., Barrera-García G., Márquez-Espriela C. - Mexico)
Burn lesions are one of the most devastating forms of trauma. Taking care of this type of lesion generates high costs and may lead to irreversible consequences that limit the daily activities of these patients. This is a two-year descriptive epidemiological study of burned patients treated in a specialized hospital in Mexico City. Data from 38 patients admitted to this hospital were analyzed. Population mean age was 41 years: a higher frequency of men aged 27 to 55 years were affected. The most common mechanism was direct flame, and upper and lower extremities were most frequently affected. Mean affected body surface area was 32.5%. A total of 63% required cutaneous grafting: it was observed that those grafted early (10.5 versus 41.8 days) spent fewer days in the ICU and a lower percentage of them contracted sepsis (62% versus 78%). Patients with Pseudomona aeruginosa had a longer hospital stay and underwent a greater number of surgeries for skin grafting. No difference was observed between graft integration percentages. Early grafting (<7 days) resulted in a shorter stay in the ICU and fewer overall total days in the hospital, as well as a lower rate of sepsis and admission to the ICU. The Pseudomona infection group had a longer hospital stay, greater number of surgical procedures for skin grafting and there was no difference in graft integration percentages.
PROFILE AND OUTCOME OF BURN INJURIES AMONGST PRESCHOOL CHILDREN IN A DEVELOPING COUNTRY
(Nguyen N.L., Ngo M.D. - Vietnam)
The aim of this study was to investigate characteristics, outcomes and risk factors for death from burn in preschool children. A retrospective study was conducted on 3688 preschool burn children admitted to the National Burn Hospital from 1/1/2016 to 31/12/2018. Collected data included patient demographics and burn characteristics. Bivariate and multivariate analysis was conducted to determine independent risk factors for death. Results showed that preschool children accounted for 78.8% of total admitted burn children. The main causal agent was scald. Boys were predominant, and 76.5% patients lived in rural areas. The highest number of burn accidents occurred in winter. In addition, average burn surface area was of 8.8% total body surface area (TBSA) and 43.5% of patients suffered deep burn injury. Overall mortality rate was 0.5% with LA50 of 81.7% and 49.1% for full thickness burn area. A significantly higher mortality rate was seen in patients with inhalation injury. Compared to survivors, patients who died had a significantly larger burn surface area and larger deep burn area. Multivariate logistic analysis for death indicated that presence of inhalation injury and increased burn extent were independent risk factors for death. Inhalation injury resulted in a 3.4 probability unit of death. In conclusion, preschool burn injuries were more common in boys living in the countryside and were mostly caused by scald, with a high proportion of deep injuries. Except for in cases of extensive burn, inhalation injury was not common but was still the main cause of death.
SELF-INFLICTED BURNS IN A NATIONAL SWEDISH BURN CENTRE: AN OVERVIEW
(Pompermaier L., Elmasry M., Steinvall I. - Sweden)
In the Western world, self-inflicted burns are often associated with mental health disorders, and the management, particularly the pain treatment, can often be complicated by the psycho-social background of the patients. The aim wasto describe a group of patients with self-inflicted burns by analysing their in-hospital mortality and the use of sedation during procedures. All patients with self-inflicted burns admitted to the Linköping Burn Centre during 2000-2017 were included. The control group consisted of adults (?17 years) with accidental burns, admitted during the same period. Multivariable logistic and linear regression was used for analysis. Three percent of all patients(47/1601) had self-inflicted burns: most of them were men (60%, 28/47), none was younger than 17 years, and flame was the major cause of injury. Self-inflicted burn patients were younger and had larger burns: mean age (SD) was 42 (16) and 49 (20) years, respectively; mean TBSA (SD) was 29% (26) and 14% (17), respectively. The crude rate of procedures done under sedation was higher (mean (SD) 0.37 (0.23) compared with 0.24 (0.25)) as was crude in-hospital mortality (8/47, 17% compared with 72/1018, 7%). Multivariable analyses showed no difference in the use of sedation for procedures or in-hospital mortality after adjustment for TBSA%, full thickness burns, age and sex. Age and TBSA% were associated with in-hospital mortality, whereas the intentionality of the burn was not. TBSA% and female sex were associated with increased use of sedation for wound care procedures, whereas self-inflicted burns were not.
APPORT DU FACTEUR DE CROISSANCE ÉPIDERMIQUE HUMAIN RECOMBINANT INJECTÉ EN INTRA- LÉSIONNEL DANS LE TRAITEMENT DES PLAIES CHRONIQUES
(Bhihi A., Sahibi M., Elamrani M.D., Benchamkha Y - Maroc)
. L'utilisation du facteur de croissance épidermique humain recombinant (FCEHR) en intra- lésionnel dans les pieds diabétiques a fait l'objet de plusieurs études ayant prouvé son efficacité, allant jusqu'à éviter l'amputation. Son efficacité sur les plaies chroniques est en cours d'étude, avec des résultats pertinents. Nous avons analysé lesrésultatssur une série de 10 patients présentant des plaies chroniques colligés dansle service de chirurgie plastique du centre hospitalier MohammedVI de Marrakech.Ils'agit d'une étude prospective réalisée entre janvier et avril 2019, portant sur dix patients présentant des plaies chroniques suivis dans le service de chirurgie plastique ayant bénéficié d'une infiltration intra- et péri- lésionnelle FCEHR. La moyenne d'âge était de 48,8 ans avec des extrêmes de 17 et 69 ans.Tous nos patients étaient de sexe masculin. Huit patients vivaient dans des conditions défavorables. La durée d'évolution moyenne deslésions était de 8,1 ans avec des extrêmes allant de 6 mois à 37 ans. La taille moyenne de la perte de substance (PDS) était de 10,4 cm2 avec des extrêmes allant de 4 à 18 cm2 . Les étiologies des PDS étaient variables, dominées par les causes traumatiques dans 60% des cas. Quatre patients ont rapporté des douleurs au niveau du site d'injection et 20% des vertiges. L'évolution deslésions a été évaluée régulièrement par un examen clinique et des photographies. Un bourgeonnement permettant une greffe a été obtenu dans 30% des cas, une épidermisation dans 40% des cas et une réduction trèssignificative de la taille de PDS dans 30% cas. L'usage du FCEHR est une avancée thérapeutique encourageante dans la médecine régénérative, qui a prouvé son efficacité dans les plaies chroniques avec un coût global réduit.
EFFECTIVENESS OF TOPICAL ?-TOCOPHEROL ACETATE IN BURN INFECTION TREATMENT
(Di Lonardo A., De Rosa M., Graziano A., Pascone C., Lucattelli E. - Italy)
Infection following burn injury is critical, especially for patients with large total body surface area burns and in skin graft donor sites. Although various aspects of ?-tocopherol acetate (?-TA) beneficial effects on wound healing have been validated, it appearsthat no study hasspecifically addressed its antimicrobial potential. The purpose of this study was to explore the therapeutic efficacy of topical application of ?-TA in terms of bacterial load reduction. Between January 2018 and June 2018, 20 patients with mid-deep and deep burn wounds were included in the present study (average TBSA approximately 42%, range 25-67%). Patient average age was 47.75 years (range 25-72 years), 8 were male. In each patient two clinically similar areas were identified and treated every 24 hours with topical application of ?-TAin the form of Filme Olio® (Group 1) and conventional medication (Group 2). All the patients had positive results for bacterial cultures before treatment. Despite the presence of initial bacterial infection, a quicker reduction of exudates and pain and a progressive and faster bacterial load reduction was observed in Group 1. Negative cultures were obtained after 3 days on average in Group 1 (range 1-6 days) and 8 days in Group 2 (range 5-9 days). This study clearly shows the importance of the therapeutic targeting of infection in the treatment of burns. ?-TA may represent a safe, simple and inexpensive method for improving the healing of difficult wounds with local infection.
UNCOMMON BURN COMPLICATION: SKIN NOCARDIOSIS
(Cases-Perera O., Aguilera-Saez J., Monte A., Rivas-Nicolls D., Andrés-Collado A., Lopez-Masramon B.M., Serracanta J. - Spain)
Skin nocardiosis is an uncommon form of cutaneous infection caused by Nocardia. More than 100 different species have been isolated and they mainly inhabit soil and water. Cutaneous affection can be divided into primary and secondary forms. Cell culture is the most used diagnosis method and trimethoprim-sulfamethoxazole the antibiotic treatment. We present a patient diagnosed with skin nocardiosis whose way of inoculation has not been described in the literature. However in future this kind of infection will probably increase due to the increasing interest in phytotherapy. Physicians should be aware of clinical manifestation, diagnosis and treatment.
MANAGEMENT OF RADIATION-INDUCED ULCERS BY SINGLESTAGE RECONSTRUCTIVE SURGERY: A PROSPECTIVE STUDY
(Hoang T.T., Vu V.Q., Trinh D.T. - Vietnam)
Radiation-induced ulcers are a late-stage skin reaction after radiation therapy for cancer treatment. The present study examined the possibility of using a single-stage reconstructive procedure to manage radiation-related wounds. This prospective study recruited 30 participants who underwent radiation treatment for cancer or hemangioma. The patients ranged in age from 15 to 80 years. They were admitted to the Plastic, Reconstructive, and Regenerative Centre of Viet Nam National Burn Hospital from October 2013 to September 2017. For each patient, the surgeons discussed which reconstructive method would yield the best outcome. Patients' demographic data and information on the radiation-induced ulcer, the reconstructive method used, complications, and length of hospital stay were recorded. The mean age of all participants was 50 ± 36.3 years, and female patients were predominant (83.3%). Eighteen perforator flaps, five random-pattern flaps, three free flaps, three tissue expander flaps, and one full-thickness skin graft were employed, with no instances of recurrence or complications, except for total flap loss in two cases. The median length of stay was 43 days. These data suggest that immediate reconstruction may be a valuable option for managing radiation-induced ulcers.
POST-BURN NECK CONTRACTURE: EFFECTIVELY MANAGED WITH SUPRACLAVICULAR ARTERY FLAP
(Ali H., Pervez M., Khyani I., Sami W., Muneeb D. - Pakistan)
Post-burn neck contracture is one of the most common burn sequels. These contractures affect the patientsignificantly causing both functional limitations and esthetic disfigurements, which lead to cosmetic, functional and social problems. Our objective was to determine the role of supraclavicular artery island (SAI) flap as an option for the reconstruction of soft tissue defect of the neck after release of post-burn contracture. The study was conducted at the Department of Plastic & Reconstructive Surgery, Dow University of Health Sciences & Dr. Ruth KM Pfau Civil Hospital Karachi, Pakistan, from February 2015 to April 2018. Patients of both genders in any age group who required reconstruction of soft tissue defects after release of post-burn neck contracture were included. Patients with neck irradiation, trauma, failure of previoussurgery, bleeding diathesis, orsevere scarring at the supraclavicular region were excluded.Atotal of 31 supraclavicular flaps were performed in 28 cases for reconstruction of soft tissue neck defect. Mean age was 29.8 years. Patients were followed for 3 months postoperatively. Complete flap necrosis was observed in 1 (3.2%), distal necrosis in 2 (6.4%) cases, postoperative hematoma of the neck was found in 1 (3.2%) and wound dehiscence was reported in 2 (6.4%) cases. Donorsite was closed primarily in 25 (81%) cases while the rest were skin grafted. Supraclavicular artery flap is an effective choice with impressive recovery, acceptable skin color match and restoration of anatomic function at the recipient site without any major complications.
CRANIOMAXILLOFACIAL TRAUMA MANAGEMENT IN AUSTERE AND WAR ZONE ENVIRONMENTS - A ROLE FOR COMPOSITE TISSUE ALLOTRANSPLANTATION?
(Ghanem A.M., Borg T-M., Sadigh P., Myers S., Smith D.J., Holmes S. - UK)
Facial composite tissue allotransplantation (CTA) is a powerful reconstructive option in cases of extensive severe facial injury and tissue loss. Despite the risk of allograft rejection and the post-operative need for lifelong immunosuppression, facial CTAcan be used to restore the normalstructural appearance and function of the face. Areas of socioeconomic deprivation and armed conflict zones have a high preponderance of patients with facial burns and othersevere injuries. However, these regions often also suffer from lack of resources, expert surgical care and limited facilities. The purpose of this manuscript is to provide a comprehensive review of key principlesrelevant to facial CTAand their potential applicability in such austere environments.We present a concise literature review ofthe surgical and immunological basis offacialCTAaimed at the plastic surgery readership, as well as issues surrounding organ transplantations in low- and middle- income countries. We then consider the particular challenges posed by austere settings and countries of active armed conflict and discuss how these may impact the suitability of facial CTAfor treating severe facial injuriesin these circumstances. Facial CTAisrecognised as giving huge benefits for patients with severe facial defects with potentially superior results compared with conventional autograft techniques. Its performance in austere settings is limited by scarce resources and increased pre-, intra- and post- operative risks. However, a case can be made for its use even in these more challenging situations when general organ transplantation compliance and expertise input have been addressed.
RÉSUMÉ DES TABLES RONDES DU 39ÈME CONGRÈS DE LA SFB
(Chauvineau V., Pasquesoone L., Le Floch R. - France)
Les trois thèmes choisis pour ce congrès étaient l'inflammation (plutôt axée au séjour en SSR), les incendies et l'inhalation de fumées, les lambeaux en chirurgie des séquelles. Le premier thème est rapporté par Valérie Chauvineau, le 2ème par Ronan Le Floch, le 3ème par Louise Pasquesoone.
FROM ACUTE MANAGEMENT TO ULTIMATE RECONSTRUCTION: A 15-YEARFOLLOW-UPOFAPEDIATRICPATIENTWITHNECROTIZING FASCIITIS SECONDARY TO VARICELLA INFECTION
(Habr N., Chahine F.M., Atiyeh B. - Lebanon)
Necrotizing fasciitis is a rapidly progressive, life-threatening soft tissue infection. The usually aggressive surgical debridement often leaves disfiguring sequelae. We hereby present the case of a 4-yearold boy who presented with post varicella zoster necrotizing fasciitis over his trunk, and follow his journey post reconstruction with split thickness skin grafts and the se- quelae of grafting over the trunk. While the case itself is not unique in its presentation, this is the first report of a long-term follow up, with management of the long-term reconstructive sequelae.
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