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Volume VII |
Number 4 |
December 1994 |
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SUMMARIES
| 180 |
A RETROSPECTIVE STUDY OF PATIENTS ADMITTED TO OUR BURNS UNIT
(Schembri K, Cacciottolo L, Swain C. - Malta)
Since the creation of a specialized burns unit in our hospital, 348 patients required treatment there during the five-year period 1989-1993. As all burned patients on the island of Malta are treated in this one facility, it is an ideal place to carry out epidemiological studies. Children, especially under five years of age, run the highest risk of burn injuries, Scalds in the patients' own home are the major cause of admission, Firework explosions are another significant cause. This retrospective study pinpoints areas that preventive programmes need to tackle and proposes ways as to how this may be done.
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| 184 |
EPIDEMIOLOGY OF BURNS BY FIREWORKS IN CHILDREN
(Rojas Z.J., Carrasco TR, Cornejo A. E., Cortés P. L. - Chile)
An epidemiological survey performed by COANIQUEM (Burned Children's Help Cooperation) is presented, dealing with children burned by fireworks between 4 December 1993 and 4 January 1994 in Santiago, Chile. In this period there were 44 burned children, with a predominance of boys (64%); the age group most affected in both sexes was 6 to 10 years. Bum accidents occurred with greatest frequency on 25 and 26 December and I January, between 10 p.m. and midnight. Seventy per cent of the children came from low-level socioeconomic districts in Santiago. The most frequent injury-causing agents were firecrackers, sparklers and rockets. The upper limbs, head and neck were the most affected parts of the body. Intermediate burns (AB) presented a frequency of 42%. This kind of survey is not difficult to repeat in view of the high level of cooperation of public and private hospitals. It is suggested that the domestic use of fireworks of any kind should be prohibited and that their use in public firework displays should be strictly regulated.
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| 188 |
EPIDEMIOLOGY, CLINICAL TREATMENT AND THERAPY IN ELECTRICALLY BURNED CHILDREN
(Napoli B., D'Arpa N., Gullo S., Masellis M. - Italy)
This research reviews electrically burned children aged 0-12 years admitted to the Palermo Bums Centre in the period 19751991. As regards the epidemiological aspects, apart from sex and age distribution, particular attention is paid to the lesive agents and mechanisms responsible for the burns and to the voltage of the electric current. From the clinical point of view an account is given of the distribution of the burns according to the most frequently involved sites (hand, mouth, forearm, wrist), followed by a discussion of the influence of the localization of the lesion on the course of the disease and its treatment. The distribution of patients is given on the basis of treatment (either exclusively medical or medical and surgical). For the surgically treated cases the more significant procedures for the functional recovery of the electrocuted upper limb are described.
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| 194 |
THE USE OF ALKALINE HYPERTONIC SALINE SOLUTION FOR RESUSCITATION OF SEVERE THERMALLY INJURED PATIENTS (OUR EXPERIENCE)
(Klein D., Millo Y., Winkler E., Shvurun A., Tzur H. - Israel)
Eleven severely burned patients were resuscitated in our bum intensive care unit last year. They were treated in the first 48 hours post-bum with alkaline hypertonic saline solution. Haemodynamic parameters, electrolytes, arterial blood gases and the general outcome were assessed in the first seven days. Compared to our previous experience with isotonic saline solution we concluded that better results were achieved with hypertonic crystalloids during the resuscitation period. We noticed fewer haemodynamic disturbances as well as an improvement in the prevention of tissue oedema. By using continuous infusion of sodium bicarbonate we managed to prevent the metabolic acidosis usually seen in the first 24 hours. All the patients were successfully resuscitated by this method.
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| 197 |
THE CONSTANT FACTOR FOR FLUID RESUSCITATION IN MAJOR BURNS
(Bang R.L., Ghoneim I.E. - Kuwait)
Thirty patients (17 males, 13 females) with ~~30% T13SA burns admitted to the intensive care unit at Ibn Sina hospital, Kuwait from December 1991 to April 1993 were studied. The mean age was 24 years (range 6 months to 60 years), Twenty-five patients had sustained flame burns and five had suffered scalds. The percentage T13SA burned ranged from 30 to 85% with a mean of 55%. Resuscitation started with the Parkland formula (constant factor 4 ml/kg/%) adjusted to maintain urine output at around 1 ml/kg/hr. The evaluation of the first 24 hours' fluid requirement necessary for successful resuscitation revealed the constant factor of 3.8 ml/kg% (range 2.4 to 6.8). Among children it was constantly above 4 ml/kg/% (mean 4.8), while in adults it was always below 4 ml/kg/% (mean 3.3). The aetiological factor and burn depth did not influence the amount of fluid required for resuscitation, whereas inhalation had some effect. Ringer's lactate solution is recommended for initial resuscitation at a rate of 3 mlIkg1% burn in adults and 5 ml/kg/% in children.
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| 202 |
USE OF AMNIOTIC MEMBRANES AS BIOLOGICAL DRESSINGS IN CONTEMPORARY TREATMENT OF BURNS
(Atanassov W., Mazgalova J., Todorov R., Stereva K., Trencheva W. - Bulgaria)
The positive results of burn treatment with amniotic membranes are described. The indications for the clinical use of amnion are defined. It is used in promoting early epithelial regeneration and it reduces scar hypertrophy.
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| 206 |
CULTURED SKIN CELLS FOR TREATMENT OF BURNS
(Brychta R., Adler J., Rihovd R., Suchdnek V., Komdrkovd J. - Czech Republic)
After considering the history of research into the cultivation in vitro of skin cells, the authors describe their experience at the Brno Burns Centre with this technique in the treatment of burn patients. So far about 10,000 sq cm of cultured epidermal grafts have been applied. The results and costs are described. Keratinocytes cultured in vitro can also be used to test the cytotoxicity of various synthetic bandages. The importance of in vitro cultured skin cells is destined to increase, both on the theoretical level and in clinical practice.
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| 209 |
PRESSURE THERAPY IN THE TREATMENT OF ADVANCED POST-BURN HYPERTROPHIC SCAR: A COMPARATIVE STUDY OF CLINICAL EVALUATION, PHOTOGRAPHY AND ULTRASONOGRAPHY
(Kaya L., Kivang K., Dalay W., AcartOrk S., Atila E. - Turkey)
Eleven bum patients are presented who were treated with pressure garments. The changes in hyper-trophic scar thickness were followed by means of clinical evaluation, photography and high-resolution ultrasonography (USG) in our Bum Unit in 1990-1993. Patients were selected from those who had palpable scars and were late for pressure treatment. The custom-made pressure garments (JuzoHelastic Cotton, Germany) were worn by the patients for about eight weeks after the burn wound had healed. Changes in scar thickness were measured by ultrasonography before treatment and at three-monthly intervals during pressure therapy. We concluded that pressure treatment can control advanced scars that were late for treatment. Changes in scar thickness can be objectively demonstrated better by USG than by clinical evaluation and photography.
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| 214 |
DE L'UTILITE DU LAMBEAU FASCIOCUTANE SUR L'ARTERE RECURRENTE RADIALE DANS LES SEQUELLES DE BRULURES DU COUDE - A PROPOS DE QUATRE CAS
(Chafiki N., Boukind E.A., Terrab S., Alibou F., Bouchta A., Boumzebra D., Bahechar N., Zerouali N.O. - Maroc)
Nous rapportons l'intérêt du lambeau fasciocutané sur l'artère récurrente à travers quatre cas de séquelles de brûlure du coude colligés entre 1991 et 1992. Il s'agit de deux brides rétractiles entravant l'extension du coude et deux greffes tumorales sur des séquelles de brûlures. Ce lambeau a été utilisé comme type A en IC dans deux cas et comme type B modifié dans les deux autres avec des résultats satisfaisants.
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| 218 |
A RARE CASE OF BASAL CELL EPITHELROMA IN A PATIENT WITH BURNS SEQUELAE
(Zermani R., Toschi S., Ricci R. - Italy)
An unusual case is described of basal cell epitheliorna in the pre-sternal area in an elderly man, who had suffered bums in the same area some 65 years previously. The neoformation was excised and a Limberg flap was used to repair substance loss. It is recommended that untreated burn scars should be periodically checked for local signs such as ulceration, bleeding and the presence of pus.
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