|Ann. Medit. Burns Club - vol. 6 - n. 4 - December 1993
IMPROVEMENT OF HUMAN KERATINOCYTE ISOLATION AND CULTURE USING THERMOLYSIN
A modified method for epiderinic cell isolation is described. This is an improvement on the conventional keratinocyte isolation procedure because it offers better purity, colony-forming efficiency and growth capacity of the isolated epidermal cell population. Thermolysin, which selectively digests the dermoepidermal junction, was used. After separation from the dermis, the epidermis was digested with trypsin to obtain a single cell suspension. This method of isolation was quicker than the conventional method and had four other advantages: 1) cells displayed a higher colony-forming efficiency'l 2) cells reached confluence 1-3 days earlier; 3) cells were not contaminated by fibroblasts; and 4) the cell population contained all the basal layer keratinocytes. Considering the fact that when extensively burned patients are treated with cultivated epidermal sheets the time required for their production is always problematic, the absence of fibroblast overgrowth of the keratinocyte cultures, together with the reduced time to obtain confluent cultures and epidermal sheets, means that the new method proposed has important implications in the treatment of large burn wounds.
Germain L., Rouabhia M_ Guignard R.,
Carrier L_ Bouvard V., Auger F.A.
BURN VICTIMS AFTER A MAJOR DISASTER: REACTIONS OF PATIENTS AND THEIR CARE. GIVERS
The Piper Alpha oil-rig in the North Sea 130 miles from Aberdeen exploded one evening, killing 164 out of the 226 men on the installation. Many of the survivors suffered bum trauma, and 21 men were detained as in-patients in the Burns Unit at Aberdeen Royal Infirmary. This paper identifies the complex psychological and emotional reactions in the men involved, and also considers the stresses to which the medical and nursing staff were exposed. It is recommended that more should be done, by means of careful debriefing, to cater for the needs of the staff after critical incidents.
Alexander D.A. Bums, 19:105-9,1993.
A RECOMBINED SKIN COMPOSED OF HUMAN KERATINOCYTES CULTURED ON CELL-FREE PEG DERMIS
In the treatment of full skin thickness bums both the dermal and the epidermal components of the skin have to be replaced. A method is described for preparing recombined human/pig skin (RHPS) by cultivating human keratinocytes on dried cell-free pig dermis (CFPD). When CFPD is dried on a tissue culture dish it forms a thin collagen film which acts as a firm substrate for cell cultures. Human keratinocytes were grown on the epidermal side of the CFPD using lethally irradiated 3T3 cells as feeders. When human keratinocytes have reached confluency, it is possible to culture human fibroblasts on the dermal side of RHPS. About 500 cm' of RHPS can be obtained from I cml of human split-skin graft in 3 weeks. RHPS, which is easy to handle and similar in structural, mechanical and adhesive properties to normal skin, could be useful for permanent covering of major bum wounds.
Matouskova E, Vogtova D., Konigova R. Bums, 19: 118-23, 1993.
MANAGEMENT OF PARTIAL THICKNESS BURNS WITH GRANUFLEX 'E' DRESSINGS
Bactigras is a paraffin gauze impregnated with 0.5% chlorhexidine acetate. Granuflex is a hydrocolloid dressing (marketed as DuoDenn in the USA); Granuflex 'E' has a modified hydrocolloid matrix which results in increased ability to manage and control wound exudate, allowing longer wearing time and so reducing the number of dressing changes. A prospective trial, involving 98 victims of partial-thickness burns treated on an out-patient basis, was conducted in order to compare the safety, efficiency and performance characteristics of the two dressings (Bactigras and Granuflex 'E'). The patients were divided equally into two groups. The overall rating of the dressings expressed by investigators and patients showed a significant preference for Granuflex 'E'. The quality of healing was rated as 'excellent' in 58% of patients treated with Granuflex 'E' compared to 11% of patients treated with Bactigras. Granuflex 'E' is safe, effective and flexible and is recommended as a first-choice dressing in the management of partial skin thickness burns.
Wright A., MacKechnie D.W.M., Paskins J.R. Bums, 19: 128-30,1993.
EXPANDING ORAL PLASTIC SPLINT FOR BURN PATIENTS
It is important to prevent microstomia after deep facial burns, and this can be done by appropriate splint therapy. This is particularly indicated in patients in whom early surgery is not possible. An expanding oral plastic splint is described which can be made quickly and applied without difficulty. The splint adjusts to fit the affected oral angles without the need for taking any impression before it is made. It is suitable for use in severely injured patients in the period shortly after the trauma, even if they are intubated. The expansion forces can be controlled easily according to the degree of contracture.
Yotsuyanagi T., Sawada Y. Bums, 19: 131-3, 1993.
THE ESTIMATION OF BLOOD LOSS DURING BURNS SURGERY
It is extremely difficult to estimate blood loss and transfusion requirements during burns surgery. This clinical study compares the accuracy of estimates made by bums surgeons and anaesthetists in relation to calculated blood losses. Regression analysis shows good correlation between these estimates, although there is a tendency to under- estimate transfusion requirements. The mean blood loss for 1% of burn excised or split-skin donor site harvested was 117 mI in adults. Gravimetric analysis of soiled swabs gives a 50% underestimate of blood loss.
Budny P.G., Regan P.J., Roberts A.H.N. Bums, 19: 134-7, 1993.
CHRONICALLY EXPOSED CALVARIUM FOLLOWING ELECTRICAL BURNS
Electrical bums of the scalp and the underlying calvarium usually cause necrosis of the parts, with sequestered bone being retained in situ by flimsy adhesions of underlying granulation tissue and overhanging edges of the scalp caused by secondary wound contraction. Fourteen case histories are described. The reasons for the chronic state are explained and the subsequent clinical management is described.
Srivastava J.L., Biswas G., Narayan R.P., Goel A. Bum 19:138-41,1993.
WIDELY EXPANDED POSTAGE STAMP SKIN GRAFTS USING A MODIFIED MEEK TECHNIQUE IN COMBINATION WITH AN ALLOGRAFT OVERLAY
The Meek technique for obtaining widely expanded postage stamp autografts, described in 1963, was largely superseded by the introduction of mesh skin grafts. The method is re-proposed because of its usefulness in patients with extensive burn injuries with a lack of autograft donor sites. The Meek technique gives an expansion ratio of 1:9, by the use of special prefolded gauzes, combined with an overlay of glycerol-preserved allografts applied one week after grafting. In a series of 16 consecutive skin grafts performed on 10 extensively burned patients, the mean epithelialization rate was 90% (range 70-100%) within 5 weeks. Cosmetic results were as good as those achieved with widely expanded mesh grafts.
Kreis R.W., Mackie D.P., Vloemans
A.W.F.P., Hermans R.P., Hoekstra M.J.
ESTIMATION OF THE CALORIE REQUIREMENTS OF BURNED CHINESE ADULTS
A formula was calculated for the optimal nutritional regimen in bum patients: the daily caloric input should be 1000 x in' (surface area) + 25 x % TBSA. Glucose should provide 55-60% of the calories, fat 20-30% and protein 15-20%. The calorie/nitrogen ratio should be between 150 and 170 to 1. Comparisons are made with other standard formulae (Curreri, Pasulka and Wachel, Wilmore, Nolan et al.). Clinical observations showed that the calories supplied to severely burned patients, following the formula described, resulted in a significant improvement in their nutrition.
Xie W. -G., Li A.(N), Wang S. -L. Bums, 19: 156-9, 1993.
BURNS COMPLICATED WITH GASTROINTESTINAL HAEMORRHAGE - AN ANALYSES OF 70 CASES
Bums complicated by gastrointestinal haemorrhage may occur at any age, especially in extensive full skin thickness burns. It usually occurs within two weeks of the burn. Seventy burn patients who developed gastrointestinal haemorrhage are described, with clinical data concerning age, burn surface area and depth, burn shock, time and location of the haemorrhage, amount of blood lost and prognosis. Morbidity, diagnosis, treatment and prevention are discussed.
Zhou Y. -P., Zhou Z. -H., Xue J. -Z. Bums, 19:150-2,1993.
SERUM CALCITONIN MAY BE A MARKER FOR INHALATION INJURY IN BURNS
The presence or absence of inhalation injury is a stronger determinant of mortality than the size and severity of bums. The effects of inhalation injury are often delayed, and may occur from 24 hours to several days after exposure to fire. In view of the fact that there is often little indication that a patient has substained inhalation injury, this study was undertaken to determine whether serum levels of calcitonin can be a clinically useful marker for inhalation injury in burn patients. A prospective study of serum immunoreactive calcitonin (iCT) was carried out in 41 burn patients. Mean serum iCT values were four times normal value at the time of admission and reached 31 times by 24 hours after injury. These levels were not specifically related to burn size. Serum iCT had a strong positive correlation with mortality, the need for mechanical ventilation, and the amount of pulmonary shunting. Other factors also play a role in hyperealcitonaemia, but serum iCT may be an important marker as a prognostic indicator.
O'Neill W.J., Jordan M.H., Lewis M.S.,
Snider R.H., Moore C.F., Becker K.L.
DIAGNOSES OF LOCAL INFECTION OF A BURN BY SEMI QUANTITATIVE CULTURE OF THE ESCHAR SURFACE
The aim of this research was to establish if semiquantitative surface cultures of bum eschar are as reliable and useful as the conventional standard invasive biopsy culture method. Eschar cultures from burn patients were made in an in vitro system. Lyophilized pigskin was utilized as the medium for the growth of micro-organisms. This method was simple and showed a high degree of sensitivity compared to quantitative biopsy culture. It is concluded that semiquantitative burn wound surface cultures are useful for surveillance and are equivalent to qualitative biopsy cultures as regards prediction of invasive wound infection.
Herruzo-Cabrera R., Vizcaino-Alcaide M.J.,
PinedoCastillo C., Rey-Calero J.
A PRESSURE PREVENTION DEVICE FOR BURNED EARS
The application of pressure to maturing facial sears is a key component in minimizing disfigurement. This is not true, however, in the case of car burns, where pressure is contraindicated at all phases of recovery because of the risk of pressure necrosis and chondritis. This article describes a particular form of headgear designed to prevent pressure on the ear during the acute-care phase. The headgear can also be fitted to patients who are intubated. Fabrication time is one hour and the cost is 25 dollars. The device is recommended as a simple method for preventing a complex cosmetic deformity in patients with ear bums.
Jordan M.H., Gallagher J.M., Allely R.R., Leman C.L. J. Bum Care Rehabil., 13: 673-7, 1992.
EVALUATION OF A BURN PREVENTION PROGRAM IN A PUBLIC SCHOOL SYSTEM
Accidental injuries are the leading cause of death and disability in children and young adults, and every attempt to reduce their number must be promoted. Bum injuries in particular can be reduced by properly conducted prevention campaigns. The "Learn not to Burn" programme is a burn prevention programme followed in North Carolina. Its goal is to reduce burn-related deaths and injuries through burn prevention education by making the "Learn not to Burn" curriculum available to primary school children at no cost to local schools. The techniques of the programme are described.
Grant E., Turney E., Bartlett M., Winbon
C., Peterson H.D.
PSYCHIATRIC REFERRAL PATTERN IN A BURN CENTER
Over two-thirds of patients with severe burns exhibit emotional responses that are serious enough to be labelled as psychiatric complications, ranging from fear, anger and depression to more alarming and life-threatening symptoms such as regression and psychosis. Little research has been done on specific patterns of psychiatric referral in burn units. This article considers the in-patient treatment of 28 bum patients over a period of one year. The various demographics and characteristics of the patients are discussed and the nature of their injuries and experiences while in the hospital are examined. It is concluded that all members of the burn care team should be aware of the ways in which psychological problems may manifest themselves in bum patients, so that prompt psychiatric care may be provided.
Boman Bastani J., Baskin M.A., Wiebelhaus P. J. Bum Care Rehabil., 13: 709-12, 1992.