The Euro-Mediterranean Council for Burns and Fire Disasters

About MBC

Mission, board, constitution, and activities of the Euro-Mediterranean Council for Burns and Fire Disasters

WHO Collaborating Centre

Since 1995 MBC has been an official WHO Collaborating Centre

NGO in Consultative Status of UN

MBC is NGO in Special Consultative Status with ECoSoC

International scientific participation

Meetings, conferences and symposia

Invitation for membership

Subscription and membership welcome

For further information about the Council

Links

Sites of interest for Council
activities

	> editor	> National correspondents	> Subscription
	> Information to authors	> Advertising	> Search



Volume XXXIV	Number 1	March 2021

Summaries

3	INFLAMMATORY AND COAGULATIVE PATHOPHYSIOLOGY FOR THE MANAGEMENT OF BURN PATIENTS WITH COVID-19: SYSTEMATIC REVIEW OF THE EVIDENCE (Al-Benna S. - South Africa) The pathogenesis of coronavirus disease 2019 (COVID-19) involves a prominent innate immune response to SARS-CoV-2 infection, including inflammatory cytokines, chemokines, the complement system and acute phase proteins. This hyperinflammatory response predisposes patients to thromboembolic disease, acute lung injury, acute respiratory distress syndrome and multiple organ dysfunction syndrome. In burn injuries, damaged tissues induce a local and systemic inflammatory response through pathways associated to COVID-19. As such, a COVID-19 positive patient sustaining burn injuries may have an amplified response to the burn insult due to their baseline hyperinflammatory and hypercoagulable states. Burn patients may have compromised physiological reserve to withstand the insult of surgical intervention before reaching clinical instability. The concurrent pathogenesis of COVID-19 and the inflammatory response in burn injury have serious implications on the management of burn patients.
10	BACTÉRIÉMIES NOSOCOMIALES: ÉPIDÉMIOLOGIE CLINIQUE ET BACTÉRIOLOGIQUE CHEZ LES BRÛLÉS (Frigui S., Bourbiaa Y., Mokline A., Naija H., Messadi A.A., Thabet L. - Tunisie) Les bactériémies nosocomiales (BN) constituent une des infections les plus sévères chez les brûlés en réanimation. Leur pronostic est aggravé par l'émergence et la dissémination des bactéries multirésistantes (BMR). Notre étude rétrospective avait pour objectif de déterminer les caractéristiques clinico-bactériologiques des BN survenues chez les patients hospitalisés dans le service de réanimation des brûlés du Centre de Traumatologie et des Grands Brûlés en Tunisie, durant une période de 3 ans (2016-2018). Nous avons relevé 261 bactériémies chez 216 patients, soit une prévalence de 25,7% et une densité d'incidence de 13,4? journées d'hospitalisation. La grande majorité (88,9%) des BN survenaient pendant les 2 premières semaines d'hospitalisation. Le taux de BN liées au cathéter était de 11,1%. P. æruginosa (20,2%) et A. baumannii (16,8%) étaient les 2 espèces les plus fréquemment isolées quand S. aureus ne représentait que 7,5% des bactéries en causes. Les taux de résistances étaient élevés avec 71% des P. æruginosa résistant à la ceftazidime, 64% des S. aureus étant des SARM, 69,5% de résistance aux C3G parmi les entérobactéries. La colimycine restait le seul antibiotique régulièrement actif (98%) sur A. baumannii. Le taux global de BMR était de 44%, représentées essentiellement par A. baumannii, E-BLSE et P. æruginosa. La mortalité attribuable aux BN était de 25%, avec un taux de BMR nettement plus élevé dans les BN fatales comparativement à celui dans les BN avec évolution favorable (p= 0,000019).
18	"OFF-LABEL" MEDICINE USE IN BURNED CHILDREN: THREE-YEAR RETROSPECTIVE STUDY (Saputro I.D., Putra O.N., Hardiyono, Mufidah E. - Indonesia) Burn patients, especially children, experience many problems during their hospitalization. Because of their unique physiologic and altered pharmacokinetic profile, children receive more off-label prescribing than adults. The aim of this study was to analyze the incidence of off-label prescribing in burned children. This was a retrospective observational study conducted in the Dr. Soetomo General Hospital from December 2019 to March 2020. Data were collected from the medical records of burned children hospitalized over a 3-year period, from January 2017 to December 2019. Burn patients under 18 years old who received at least one prescribing medication were enrolled in this study. Twenty-six burned children met the inclusion criteria. A total of 215 medications were prescribed during this study and 35% of them were classified as off-label. The term off-label for age range was the highest among the off-label prescribing medicines, as much as 53%, with 30% classified for an unapproved indication, 15% for an unapproved dosage, and 2% for an unapproved dosage form. The prevalence of off-label prescribing was higher in children from 2 to 12 years old than in adolescents. Analgesics were the therapeutic classes most often prescribed as off-label in burned children. Most burned children are administered off-label medication with uncertain evidence. Further research is needed in this population to focus on several medications with high risk potential.
26	INFLUENCE OF PRE-EXISTING NEUROLOGICAL ILLNESSES ON THE OUTCOME OF SEVERE BURN INJURIES (Daniels M., Becker M., Lefering R., Fuchs P.C., Demir E., Schulz A., Perbix W., Grigutsch D., Schiefer J.L. - Germany) It is known that patients suffering from neurological illnesses have an increased risk of burn injuries. These burns are often very severe and lead to poor outcomes. To date, only a few studies have evaluated the impact of pre-existing neurological illnesses on the outcome of burn injuries. None of them performed a regression analysis regarding specific influence on mortality. Between 1996 and 2016, 1475 patients were admitted to the BICU of a specialized German burn center: 26 had less than 1% TBSA burned and were excluded; 177 had pre-existing neurological disorders (group N). 87 patients with psychological disorders were excluded. 1185 patients without neurological or psychological disorders formed the control group. Length of hospital stay, TBSA and number of operations were analyzed using the chi-squared test and Mann-Whitney U-test. Additionally, mortality was evaluated using the logistic regression analysis adjusted for known outcome predictors. Mean age of the patients in the control group was 41.53 years with a BICU stay of 18 days, TBSA of 18.25% and mortality rate of 12.4%; 23.7% had inhalation injuries. Patients in group N had a mean age of 54.63 years, a BICU stay of 27 days, mean TBSA of 20.97%; 31.1% had inhalation injuries and mortality was 20.3%. Patients with neurological disorders were older and showed higher affected TBSA, higher rates of inhalation injury, mortality and affected TBSA, and a longer stay in the BICU compared to the control group. Nevertheless, pre-existing neurological disorders alone had no significant influence on mortality.
33	ÉTAT DES LIEUX DE L'UTILISATION DU PRP DANS LE TRAITEMENT DE LA BRÛLURE (Hanriat C., Barani C., Mojallal A., Braye F., Brosset S. - France) Le plasma riche en plaquettes (PRP) possède des fonctions trophiques du fait d'une concentration importante en facteurs de croissance et cytokines. Ces propriétés peuvent avoir un intérêt thérapeutique dans la prise en charge des lésions de brûlures. En préparation d'une étude clinique au centre de traitement des brûlés de Lyon sur le PRP comme inducteur de la cicatrisation chez le brûlé, nous avons réalisé une revue de la littérature s'intéressant aux résultats de l'utilisation de cette thérapeutique. Elle a été réalisée en interrogeant la base de données PUBMED à l'aide des mots clés [platelet rich plasma] AND [burns]. Les études contrôlées, cliniques ou pré-cliniques, en langue anglaise ou française, ont été incluses. Onze articles ont été inclus, dont huit études pré- cliniques sur modèle animal et trois études cliniques. Les effets du PRP sur la cicatrisation des zones brûlées, qu'elles soient greffées ou non, sur l'amélioration des douleurs neuropathiques, sur la trophicité cutanée à distance y sont traitées. Les résultats des études pré- cliniques récentes montrent des durées d'épithélialisation plus courtes grâce au PRP. Chez l'homme, une étude d'effectif significatif (201 patients) valide son utilisation en association avec des greffes de peaux minces et une autre montre des bénéfices sur la trophicité cutanée à distance. En conclusion, l'utilisation de PRP en application topique ou en injection sous cutanée présente un intérêt potentiel dans la prise en charge en aigu des brûlures. Une série de grande ampleur valide son utilisation en pratique clinique.
42	DOES PLATELET-RICH FIBRIN ENHANCE HEALING OF BURN WOUNDS? OUR FIRST EXPERIENCES AND MAIN PITFALLS (Schulz A., Schiefer J.L., Fuchs P.C., Kanho C.H., Nourah N., Heitzmann W. - Germany) Recent research found that enzymatic debridement clearly improves long-term scarring in burns. By reducing the spontaneous wound-healing period, scarring might be optimized. The latest publications show that wound healing can be accelerated by the application of platelet-rich fibrin (PRF). However to date no study that evaluates PRF treatment in burn wounds following enzymatic debridement has been published. We conducted a single-center prospective observational trial treating ten patients with partial thickness to deep dermal burns after enzymatic debridement with PRF. After wound treatment, the dressing remained untouched for five days. For wound healing, we compared different dressings and treatment options. Minimum pain and no signs of infection were observed during any of the treatments. Physicians were able to learn the manufacture of PRF quickly. For two early treatments, skin grafting was required. In one case, the dressing was removed too early. In a second case, the wait for spontaneous wound healing was not long enough. After a standardized treatment procedure was set, we found that results were clearly improving. Mean healing time of seven wounds treated with Suprathel® dressing was 18 days (min 9 days, max 21 days). PRF application might be useful to reduce healing time in partial thickness to deep dermal burn wounds that heal spontaneously after enzymatic debridement. Thus, scarring can be improved.
53	NON-HEALING BURN WOUND TREATMENT WITH A STERILE SILICONE GEL (Lucattelli E., Cipriani F., Pascone C., Di Lonardo A. - Italy) Treatment of burn wounds can be complicated due to fluid and electrolyte loss and the increased chance of infectious complications. Silicone-based products have become increasingly used for non-healing wound treatment, but no study has specifically addressed its potential on burn patients. The purpose of this study was to compare the use of sterile silicone gel with conventional medication in improving the healing of burn wounds. Between November 2019 and March 2020, 12 patients with mid-deep and deep burn wounds were included in the present study (average TBSA approximately 29%, range 13-51%). Patient average age was 49 years (range 29-67 years), 7 were male. In each patient two clinically similar areas were identified and treated every 48 hours with topical application of silicone gel in the form of Stratamed® (Group 1) and conventional medication (Group 2). All the cases healed without requiring skin grafting. No secondary wound infection nor allergic reactions were found. The mean days from commencing the treatment to 95% re-epithelialization in Groups 1 and 2 were 5.4 and 12.5, respectively. Culture samples were negative for common pathogens. Silicone gel has shown to be particularly effective in speeding up the re-epithelialization process. The protective film formed by the silicone helps to reduce possible infectious complications. Finally, silicone gel is easy to apply and associated with greater pain control during medication.
58	OUR INITIAL EXPERIENCE IN THE CUSTOMIZED TREATMENT OF DONOR SITE AND BURN WOUNDS WITH A NEW NANOFIBROUS TEMPORARY EPIDERMAL LAYER (Schulz A., Fuchs P.C., Heitzmann W., Kanho C.H., Schiefer J.L. - Germany) Recently, electrospinning technology has gained increasing attention for wound care. SpinCareT electrospun polymer nanofibrous temporary epidermal layer is one of the latest developments in the market. Our objective was to explore the potential use of the new SpinCareT system for treating burns and wounds. We conducted a single-center prospective observational trial, treating 10 patients with superficial to partial thickness wounds including burn wounds with a nanofibrous dressing. Treatment was evaluated, including procedures, place of injury, treatment times, ease of use etc. Ten superficial to deep dermal wounds were treated successfully. Inexperienced users learned the handling of the device quickly. Covering difficult-to-access wound surfaces was challenging. One leading problem is that the product is nearly opaque once applied on the moist wound. We introduced a standardized 3-day treatment protocol. After application, wounds were covered with a silicon layer for 2 days. The nanofibrous dressing appeared to be suitable following enzymatic debridement in burn wounds. Because there is a risk of wounds drying out under the dressing, the application should probably be limited to superficial and partial thickness wounds if not combined with other treatment options. The electrospun polymer nanofibrous temporary epidermal layer shows promising results in the treatment of superficial to partial thickness wounds including burns. However, minor improvements might help to optimize its usage and thus take full advantage of all existing treatment options.
67	THE IMPACT OF HUMAN SKIN ALLOGRAFT AS A TEMPORARY SUBSTITUTE FOR EARLY COVERAGE OF MAJOR BURN WOUNDS ON CLINICAL OUTCOMES AND MORTALITY (Megahed M.A., Elkashity S.M., Talaab A.A., AboShaban M.S. - Egypt) The aim of the study was to evaluate the application of different types of skin allograft as a skin substitute for coverage of major deep burn wounds, and their effect on the clinical outcomes and mortality of burned patients. This prospective study was conducted on 36 patients admitted to the Burn Unit from August 2016 to November 2019. The number and percentage of patients that needed auto-grafting after surgical intervention was 9 (100%) in Group I (allograft coverage not available), 13 (86.66%) in Group II (allograft source was from unrelated patients) and 8 (66.7%) in Group III (allograft from a first-degree relative). Patient survival was 55.6% in Group I, 86.7% in Group II and 91.7% in Group III. There was significant difference between the groups regarding time to complete healing, with P1 = 0.034* and P2 < 0.0001*. Human skin allograft harvested from living first-degree relatives is freshly donated at maximum viability and does not require complex preparation or preservation. It shows prolongation of graft survival that helps to improve general condition, decrease microbial wound contamination, improve vascularization and prepare the wound bed with healthy granulation tissue. This promotes wound healing and subsequent autograft take, and decreases mortality rate among burned patients.
75	SINGLE-STAGE COMPOSITE RECONSTRUCTION OF COMPLEX ELECTRICAL BURN DEFECTS BY MICROVASCULAR TECHNIQUES - A PROSPECTIVE STUDY (Monga K., Goil P. - India) Electrical burn constitutes a major proportion of patients admitted to the burn ward with life- as well as limb-threatening complications. Due to the severity of an electric current passing through the body, local tissues are greatly damaged. These patients require multiple debridements and surgeries to cover the composite defect resulting from a high voltage electrical contact burn. In our study, we intend to evaluate the application of microvascular reconstruction by doing a free tissue transfer on an electrical burn defect, and determine how doing a composite reconstruction of a complex defect in a single stage helps in decreasing morbidity.

This site has been realized and maintained by Informed Italia s.r.l.