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Volume XXXIII

Number 3

September 2020
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Summaries

177 AVAILABILITY OF COVID-19 INFORMATION FROM NATIONAL AND INTERNATIONAL BURN SOCIETY WEBSITES
(Al-Benna S., Gohritz A. - South Africa)
National and international burn society websites are an important source of information for patients and burn care professionals. The current COVID-19 pandemic represents an unprecedented global health crisis. The aim of this study was to assess the information available on national and international burns society websites on the current pandemic of COVID-19. National and international burns society websites were assessed with regard to COVID-19 information. Five percent of nations had a burn care society website. Forty percent of these national society websites mentioned COVID-19. None provided their state's guidelines, nor advised to provide only urgent or emergent care. None recommended following WHO guidelines. One-third (33%) of the international societies documented the decision to postpone its congress and provided links to two articles describing burn care during the COVID-19 pandemic. The availability of COVID-19 clinical guidelines and information on national and international burn care society websites is lacking. Burn care society websites must develop relevant COVID-19 information to support burn care professionals on the frontline of care.
182 PROTECTIVE MEASURES FOR BURN CARE PROFESSIONALS DURING THE CORONAVIRUS DISEASE 2019 PANDEMIC: SYSTEMATIC REVIEW
(Al-Benna S. - South Africa)
The emergence of a novel human ? coronavirus, severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), has developed into a global pandemic and public health emergency. The management of patients with burns must be adapted to this context. The aim of this systematic review is to identify the optimal protection measures during the COVID-19 pandemic and provide guidance of protective measures for burn surgeons. A systematic search of PubMed was performed for articles about COVID-19. "Burn units", "burns", "COVID-19", "health personnel", "protective devices", "severe acute respiratory syndrome coronavirus 2", "surgeons" and "telemedicine" were reviewed during the entire diagnosis and management process of burn patients. Eight articles were included, and five articles emphasized that burn care professionals should pay attention to prevent cross-infection. Only three articles reported in detail how burn care professionals should be protected during surgery in the operating room. These experiences and strategies can help burn care professionals work safely and effectively, and prevent both nosocomial infections and burn care professional infections during the global pandemic of COVID-19.
191 A PROSPECTIVE, MULTICENTER, PILOT TRIAL OF A NOVEL HOMOLOGOUS SKIN CONSTRUCT ON DEEP PARTIAL-THICKNESS AND FULL-THICKNESS BURNS
(Feldman M.J., McLawhorn M.M., Han J., Marcu A.C., Burkey S.E., Travis T.E., Johnson L.S. - USA)
Split-thicknessskin grafting (STSG) isthe standard of care for treating deep burns. They often contract, have unpredictable cosmetic outcomes, lack dermal appendages, and result in painful, conspicuous donor sites. An autologous homologous skin construct (AHSC) has been shown to produce full-thicknessskin architecture. Thisstudy examined the safety profile, engraftment, and quality of healing of a pilot group ofAHSC-treated burn wounds. Following IRBapproval and informed consent, patients with deep-partial/full-thickness burns requiring grafting underwent side-by-side treatment with AHSC and STSG. A 2 cm2 fullthickness harvest was processed into AHSC at an FDA-registered facility, returned within 48 hours, and applied to a 4 cm2 area alongside a STSG.AHSC donorsite was closed primarily. Wounds were evaluated for healing with digital photography and investigator assessments for 90 days. All adverse events (AEs) were recorded. Eight patients with average 13.3% TBSA [range 2-58%] burn wounds were treated: 5 Caucasian and 3 African American with an average body mass index (BMI) of 26.8. Injury was due to predominantly flame burn, with additional injury from grease, scald, contact, friction and flash. Mean time between injury and AHSC treatment was 11 days[range 5-35 days].All patients had adequate engraftment and complete epithelialization by the end of the study. Patients required one application of AHSC and no other additional surgical procedures at the application sites. The most common AEs for STSG-treated wounds included hypertrophic scarring and pruritus. One non-infected AHSC harvest site experienced a dehiscence. There were no other AEs related to AHSC treatment. AHSC treatment is feasible in deep partial and fullthickness burn wounds warranting additional investigation.
198 CHARACTERISTICS AND GENDER INFLUENCE ON OUTCOMES OF BURNS IN ADOLESCENTS
(Lam N.N., Duc N.M., Hung T.D. - Vietnam)
The aim of this study was to investigate the characteristics and influence of gender difference on the outcome of adolescent burns. A retrospective study was conducted on 641 burn patients (10 - 19 years old) admitted to the Viet Nam National Burn Hospital over a three-year period (2016 - 2018). Demographic data, burn features and outcome including complications, length of hospital stay and mortality of male and female groups were compared. The results indicated that adolescents accounted for 6.5% of total admitted burn patients, with a predominance of males (69.3%). Higher proportions of burn due to dry heat (flame or hot surface contact) and electricity were seen in the male group (p < .001). No significant differences were seen between male and female groups in terms of age, admission time, season of burn and burn severity. Compared to females, males experienced more surgical interventions and stayed longer in hospital with higher LA50 (71.2% vs. 56.5% TBSA). It is necessary to conduct prevention and intervention to improve the outcome of adolescent burns, especially for female patients.
203 BRÛLURES CHIMIQUES : ÉTUDE RÉTROSPECTIVE SUR UN AN DANS LE CENTRE DE TRAUMATOLOGIE ET DES BRÛLÉS DE BEN AROUS À TUNIS. À PROPOS DE 123 CAS
(Kassous F.N., Mokline A., Messadi A.A. - Tunisie)
Les brûlures chimiques, bien que rares, présentent des aspects cliniques et évolutifs particuliers, variables selon l'agent en cause. Cette étude rétrospective, conduite dans le CTB de Tunis, présente les caractéristiques des 123 patients hospitalisés pour cette raison durant l'année 2018. Les brûlures chimiques touchent majoritairement des hommes (69%) jeunes (36,4 ans) et actifs, plus d'une fois sur 2 (51%) dans le cadre du travail. Seuls 57 patients avaient procédé à un lavage immédiat de la zone touchée. Le premier examen est souvent tardif (délai de 3,7 j). On constatait des atteintes peu étendues, souvent au niveau des mains. La grande majorité (121/123) des patients ont bénéficié d'un traitement non chirurgical, d'une durée moyenne de 20 j. Toutefois, des séquelles esthétiques et fonctionnelles ont été observées dans 46,3% des cas. Il semble que les mesures préventives et l'information soient insuffisantes tant au niveau de la population générale que dans les sites de travail. C'est le meilleur moyen de réduire l'incidence des brûlures chimique, dont les coûts individuel et collectif sont élevés. Si elle survient, une brûlure chimique doit immédiatement conduire à un lavage abondant et à une consultation auprès d'un brûlologue.
209 BASE DEFICIT, SERUM ALBUMIN LEVEL AND BLOOD HAEMOGLOBIN CONCENTRATION CAN BE USED AS PREDICTOR FACTORS FOR MORTALITY IN MAJOR BURN PATIENTS
(Megahed M.A., El-Helbawy R.H., Gad S.S., Mansour M.M., Elkandary K.A. - Egypt)
Hypoalbuminemia asseen in major burn injury resultsin widespread endothelial dysfunction. Base deficit provides the best estimate for degree of tissue anoxia. Acute blood loss describes anemia present in burn patients. Controversy focuses on the administration of protein-based colloids: whether to provide them, which solutions to use, and when to begin? The aim of this study was to determine whether alteration of gas exchange, excess base deficit, hypoalbuminemia and anemia could predict mortality in major burn patients, whether to provide protein-based colloids, and when to begin fluid resuscitation. The prospective study included 42 major burn patients.All the patients were admitted to the burn intensive care unit at Menoufia University Hospital. Serum albumin level, hemoglobin concentration, arterial blood gases and base deficit were measured at admission, third day and after one week. Average serum albumin on admission was 3.33 ± 0.44, after 3 days 2.85 ± 0.54 and after 1 week 2.46 ± 0.67 gm./dL, while hemoglobin concentration was 14.79 ± 2.13, 12.25 ± 1.99, and 10.24 ± 2.47 gm./dl respectively. However, base deficit was 5.75 ± 2.40, 5.24 ± 2.05 and 5.45 ± 2.76 respectively, with significant statistical difference (p<0.001) between the death and survivor groups. Binary logistic regression analysis for independent predictors of mortality declared that base deficit, albumin and hemoglobin serum levels were independent predictors for mortality with an odds ratio of 2.23, 95% CI, 1.66-16.75 for base deficit, 3.56, 95% CI, 1.88-12.59 for albumin and 2.21, 95% CI, 1.56-13.54 for hemoglobin. Hypoalbuminemia, anemia and excess base deficit can be used as prognostic factors for mortality in major burn patients.
216 AN ADJUSTED IDEAL BODY WEIGHT INDEX FORMULA WITH FRESH FROZEN PLASMA (FFP) RESCUE DECREASES FLUID CREEP DURING BURN RESUSCITATION
(Lindsey L., Purvis M.V., Miles D., Lintner A., Scott V., McGinn K., Bright A., Kahn S.A. - USA)
Severe burn injury requires significant volume resuscitation, but over-resuscitation can be deadly. Accurate resuscitation of obese patients is challenging due to the decreased vascularity of adipose tissue. This study compares an adjusted ideal body weight index formula with fresh frozen plasma rescue to historical controls resuscitated with Parkland-based resuscitation. A retrospective review was conducted of adult patients admitted to our regional burn center with ? 20% total body surface area (TBSA) burns from 2010 to 2017 who survived more than 48 hours. Historical controls were resuscitated with Parkland-based resuscitation with occasional albumin. The adjusted ideal body weight (AIBW) patients were resuscitated with 2-4 mL/kg/%TBSAusing an adjusted ideal body weight with fresh frozen plasma (FFP) rescue. Outcomes were compared with nonparametric statistics.Atotal of 161 patients met inclusion criteria: 40 patients receivedAIBW resuscitation and 121 patients were included as controls. The AIBW group received less fluid (3.30 vs. 4.15 mL/kg/%TBSA, p<0.001). A significant reduction in acute kidney injury requiring dialysis in the AIBW group was appreciated (5% vs. 19%, p=0.03) with improved mortality in AIBW patients as well (5% vs. 20%, p=0.03). Using an adjusted ideal body weight with FFP rescue to resuscitate patients with severe burn injury leads to a significant reduction in fluid administration without increase in acute kidney injury requiring dialysis and with improved mortality.
224 PERINEAL DIAGNOSTIC MICROBIAL SWABS AS A PREDICTIVE PARAMETER IN PEDIATRIC BURN INJURY
(Bohr S., Mammadli T. - Germany)
The aim is to evaluate the predictive usefulness of perineal diagnostic microbial swabs (PDMS) which will identify an enteric reservoir as possible source of concomitant wound infection following scald burn injury in infants. Perineal swabs were taken on admission of infants presenting with scald burn injury along with a standardized protocol ofinitialsterile surgicalfield cleansing and dressing.Complicated (CC) and uncomplicated (UC) clinical cases were discriminated based on parameters ofsignificant microbial burn wound colonization,such as onset of fever, white blood cell count (WCC), C-reactive protein (CRP) and a concomitant need for surgical wound revision with/without guided antibiotic therapy. Relative risks (RR) / odds ratios (OR) based on microbial swab results were calculated related to anticipated wound infection.We found PDMS to be an independent predictive parameter for clinically relevant microbial wound colonization in pediatric patients (n=274; age 2.81±2.69). Most importantly, we show that in patients with initial total burn surface area (TBSA) >5%, clinically relevant burn wound infection requiring intervention can be predicted from initial perinealswab results with ORs ~10fold. Infants presenting with scald burn injury are exposed to a relevantrisk of wound infection emanating from a unique microbial enteric reservoir, even with initial surgical decontamination and sterile dressing protocols, warranting further hospitalization. Based on our findings we suggest PDMS as a useful additional predictive parameter to (i) characterize the relevant enteric microbialreservoir and (ii) directfurthertherapeutic measures with the aim of preventing complicated wound infections, including preemptive aseptic wound dressings, guided antibiotic therapy and surgical wound revision.
233 MANAGEMENT OF SUPERFICIAL PARTIAL THICKNESS BURN WITH COLLAGEN SHEET DRESSING COMPARED WITH PARAFFIN GAUZE AND SILVER SULFADIAZINE
(Singh A., Bhatnagar A. - India)
Burn injury is a global problem that equally concerns under-developed and developing countries.An ideal dressing material has to maintain a moist environment, act as a bacterial barrier and as a medium for free exchange of gases, while providing a barrier against toxic contaminants. Sixty-eight consecutive patients with fresh acute superficial partial thickness burns ? 15% BSA, registered in two tertiary care teaching hospitalsin North India between January 2015 to December 2019, were divided into two groups: a collagen dressing group (group A) and a paraffin gauze (PG) plus silver sulfadiazine (SSD) group (group B). Forty-four patients received collagen dressing and 24 patients received conventional paraffin gauze (PG) plus silver sulfadiazine (SSD) dressing. Patients were followed up for clinical outcome until burn wounds healed. We observed complete healing in 5-7 days for 26 cases (59%) in group A, in 8-12 days for 16 cases (66.66%) in group B. A total of 95.5% of group A patients required analgesia only for ? 2days, while 90.90% of group B patients required analgesia for ? 6 days. Ninety percent of group A patients required none or a single dressing change with shorter hospital stay. In group B, 22 cases required 3-5 dressing changes. Collagen dressing has proved to be highly advantageous for acute small areas of partial thickness burns (< 15% BSA). It confers better pain relief, and minimal or no dressing change with better rate of wound healing. Pediatric patients preferred collagen sheet dressing. Conventional dressings tend to adhere to the wound surface, and their need for frequent changes traumatises newly epithelialized surfaces and may delay healing.
239 DOES ENZYMATIC DEBRIDEMENT ALLOW US TO PERFORM CONSERVATIVE TREATMENT ON CLINICALLY DEEP HAND BURNS? A RETROSPECTIVE REVIEW
(Rivas-Nicolls D., Aguilera-Sáez J., Gallardo-Calero I., Serracanta J., Gomez P., Palao R., Barret J.P. - Spain)
The hands are one of the main locations of burns. In deep second-degree and third-degree burns, the gold standard of treatment is surgical debridement and subsequent coverage, which can result in suboptimal aesthetic and functional results. The aim of our study is to assess whether treatment by initial enzymatic debridement (NexoBrid®) of deep second-degree and third-degree burns prevents the need for surgery. We carried out a retrospective study of 53 hands with deep burns treated in our centre from May 2015 to December 2016. Two experts evaluated the initial photographs of the burns and classified them as surgical or nonsurgical (interobserver kappa index = 0.83). These assessments were compared with the actual need for surgery on each hand. Sixteen of the 32 (50%) hands that the experts considered surgical spontaneously epithelialized. Four of the 17 hands (23.5%) that were not considered surgical required a split-thickness skin graft for healing. Enzymatic debridement helps to preserve viable tissue, which reduces the number and extension of surgical interventions, thus favouring better results.
245 THE USE OF DERMAL REGENERATION TEMPLATES FOR PRIMARY BURNS SURGERY IN A UK REGIONAL BURNS CENTRE
(Phillips G.S.A., Nizamoglu M., Wakure A., Barnes D., El-Muttardi N., Dziewulski P. - United Kingdom)
The gold standard of treatment for major burns is early burn excision and autografting. In major burns this is complicated by a lack of donor site availability. Another challenge after burn injury is achieving optimal cosmetic and functional outcomes. Dermal regeneration templates (DRT) are biomatrices that help to address these problems. Within our centre the most commonly used are two-stage Integra® and single-stage Matriderm®. We review the use and outcomes of DRT in primary burns reconstruction within our regional burns centre.All patients undergoing primary burn reconstruction using Integra® (n=59) or Matriderm® (n=35) over a 13-year period were included. Integra® was used in patients with significantly larger burns(20.4% TBSA vs 1.7% TBSA). Comparable levels of graft take were seen in both groups. Major infections were significantly higher in the Integra® group (11/35 compared to 3/59). There was no significant difference in haematoma development, hypertrophic scarring or the need forsecondary reconstructive surgery. Burn contractures developed in 15 patients treated with Matriderm® and 21 with Integra®. DRT have been used safely and effectively and have played an increasingly important role in our service over the last 13 years. Integra® is used primarily in large burns with limited donor sites and Matriderm® in smaller burns in cosmetically sensitive areas.
253 MYTHS AND MISCONCEPTIONS ABOUT DISASTERS: DO STUDENTS IN THE FIELD KNOW BETTER?
(Papp B. - Hungary)
Disaster myths pose a great challenge in disaster risk management all over the world. These misconceptions mean barriers to disaster higher education as well. This research is designed to examine these beliefs among disaster management students at the National University of Public Service, Hungary, as well as in a control group compiled from students from three other Hungarian universities. Based on the methodology of research published by David Alexander, a questionnaire was edited with 19 false statements about disaster events. Respondents had to evaluate them on a Likert scale from 1 to 5, where 1 means "completely disagree" and 5 means "completely agree". Strong agreement was expressed for some of the misconceptions regarding disasters (e.g. unburied bodies constitute a serious health hazard), and to a lesser degree for others (e.g. disasters cannot be managed systematically). The results of the control group reached similar values to those of the test groups, however in some cases the former tend to be more skeptical about the statements. Although Hungarian students shared the same beliefs as US and Italian students, the Hungarians seem to be less critical of the statements. These disaster myths create a serious problem in disaster higher education and have a great impact on future disaster managers in the field.
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