Ann. Medit. Burns Club - voL VII - n. 2 - June 1994

INTERNATIONAL ABSTRACTS

PREHOSPITAL CARE OF BURNS: AN ANALY. SIS OF 3 YEARS' USE OF THE EMERGENCY PHYSICIAN SYSTEM (EPS) COLOGNE

In order to dispose of more information about the vital parameters of burns victims shortly after the trauma, a prospective study and an analysis were made of all cases of burns and electrical and caustic injuries presenting to the Emergency Physician System in Cologne (Germany) over a 3-year period (1987-89). Patients admitted were classified at the site of the accident according to their vital signs, using the Trauma Score (TS) of Champion et al. (Crit. Care Med., 9: 672, 1981). This classification provides 16 classes according to the vital situation - 16 points corresponding to normal vital parameters and 1 point to no vital signs. It was found that immediately after the accident, in spite of even a major burn injury, the vital signs were not impaired, or only slightly so. Subsequent measurements by the emergency physician at the scene increased with decreasing initial TS. At TS 14, half the patients were intubated, and below 14 nearly all the patients were. Fluid administration also increased with decreased TS. It is concluded for resuscitation purposes.

Lechleuthner A., Schmidt-Barbo A., Bouillon B., Perbix W., Holzki L, Spilker G.
Burns, 19: 153-7, 1993.

The treatment of the burned pregnant woman presents special difficulties since the clinician has to consider the condition of both mother and foetus, each with different medical needs. It is however emphasized that with proper care the prognosis in such cases is encouraging and comparable to that of any other routine burn patient. A report is presented concerning 25 pregnant women sustaining burns who were treated in an Indian hospital over a 6-year period (burn range: 15-100% TBSA). Sixteen of the patients (64%) had full-term normal healthy babies, and nine patients aborted, most commonly in the first trimester of pregnancy, as a result of septicaemia. Five patients died, all having sustained more than 50% TBSA burns.

Jain M.L., Garg A.K. Burns, 19: 166-7, 1993.

The superficial cervical artery (SCA) skin flap can be designed as two types, the cervicodorsal flap and the cervicoscapular flap. This report describes the versatility of the free or pedicled SCA flap for reconstructing head and neck burns in extensively and deeply burned patients. The surgical technique is described, together with its application in five patients. The free SCA flap is very useful because the pedicle vessels are long enough, and their diameter wide enough, for microvascular anastomoses. It can therefore be used for the reconstruction of extremities, especially when other useful donor sites for flee flaps cannot be used.

Hyakusoku H., Takizawa Y., Murakami M., Gao J.-H., Takekoshi A., Fumiiri M. Burns, 19: 168-73, 1993.

Patients with burns are immunocompromised and are frequently at risk from fungal infections, in particular from Candida albicans. However, this is the first case reported, as far as is known, of Candida albicans of the spine in a patient who had previously sustained extensive burns and candida septicaemia. The patient was involved in an ultralight plane crash and suffered a 59% BSA burn, mostly full-thickness skin loss. He also sustained a fracture of the first lumbar vertebra. During the acute phase candida septicaemia was diagnosed and treated. After a long period of hospitalization (110 days), the patient was discharged. He began to suffer from low-grade back pain, and after a fall down a flight of stairs he was readmitted for spinal radiography, which revealed osteomyelitis at the level of the eighth and ninth vertebrae with an intervertebral abscess. Following evacuation of the disc space during surgery, the organism was identified as Candida albicans. Treatment was by amphotericin B, followed by flucanazole, and the patient's recovery was uneventful. The infection was probably of haemotogenous origin.

Mullins R.F., Still J.M. Jr, Savage J., Davis J.B., Law E.J. Burns, 19: 174-6, 1993.

One of the most characteristic signs of the response of the human metabolism to burn injury is increased body temperature. This increase is proportional to burn wound size and may represent fever and/or hyperthermia. As there was no description in the literature of this phenomenon in a nonseptic animal model, it was decided to test the hypothesis that extensive burn wounds in rats would produce increased body temperature. The rectal, skin and body temperatures were sequentially measured and calculated in rats in a control group and in rats subjected to bun injuries covering 26 to 63% BSA (dividedinto 3 groups: 26-35%, 36-45% and 46-63%). The group with the most extensive burns had significantly higher rectal temperatures than at least one other group on post-burn days 7, 9, 11, 13, 18 and 20. This increase was significantly higher than that of all burn and control groups on post-burn days 7 and 11. There was no overt sign of wound infection. Although these findings do not establish a cause for the increase in body temperature after burn injury they suggest that a reproducible animal model may be possible for research into the causes of the increase.

Caldwell F.T. Jr, Graves D.B., Wallace B.H. J. Burn Care Rehabil., 14: 420-6, 1993.

The purpose of this study was to investigate the thermoregulatory response to exercise in paediatric patients with burns and to study changes in body temperature during cardiopulmonary exercise stress testing, in consideration of the hypothesis that the extensive destruction of the skin and appendages after thermal injury might impair the thermoregulatory control mechanism in conditions of physical stress. Cardiopulmonary stress tests were carried out in 32 children with a mean post-burn period of 2.3 ± 1.5 years and a mean burn size of 44 ± 23% TBSA. The exercise variables included expired volume, tidal volume, respiratory rate, tidal/dead space rate, heart rate and work stage achieved. Temperature monitoring included external auditory canal temperature, bum scar, and normal skin auditory canal temperature, burn scar, and normal skin temperature. Values were measured at baseline during exercise and at maximum levels. All the patients reached the same endurance level regardless of the TI3SA bum. It was also found that in a temperature-controlled environment adequate heat dissipation in children with burns can be maintained during exercise testing without an excessive rise in body temperature.

Mlcak R.P., Desai M.H., Robinson E., McCauley R.L., Robson M.C., Herndon D.N.
J. Burn Care Rehabil., 14: 427-30, 1993.

A principle that should always be borne in mind by the plastic surgeon is that nothing should be discarded unless one is absolutely sure that it is expendable. It is thus logical that during damaged upper lip revision the burn scars should not be discarded but instead be salvaged for simultaneous correction of any nasal deformities. This article presents two case histories in which this principle was applied, with one patient receiving columella lengthening and the other alar rim augmentation. Thus the twin goals of maximal aesthetic improvement and functional restoration were both achieved.

Hallock G.G. J. Burn Care Rehabil., 14: 431-4, 1993.