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Volume VIII |
Number 3 |
September 1995 |
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SUMMARIES
| 132 |
EDITORIAL NOTE |
| 133 |
LES BRULURES CRIMINELLES (DOUZE CAS)
(Boukind EA, Boumzebra D., Bahechar W Chafiki W Zerouali N. - Maroc)
Les br?lures criminelles sont particuli?res par les circonstances de survenue et par la gravit? des l?sions. Cependant leur ?pid?miologie reste mal connue. Cette ?tude r?trospective porte sur douze cas de br?lures criminelles collig?s dans notre formation entre janvier 1992 ? mai 1994. Pendant la m?me p?riode 9000 cas d'agression ont ?t? soign?s dans le service des urgences. Les douze malades, huit hommes et quatre femmes, ?taient de bas niveau socio-?conomique et culturel. Leur ?ge moyen ?tait de 28 ans. Ils repr?sentaient 3,5% des br?l?s suivis au service et 1,2% de l'ensemble des agressions. Les circonstances de survenue ont ?t? diverses. Il s'agissait d'une br?lure dont l'?tendue variait de 8% ? 60% avec une moyenne de 28%. L'agent le plus fr?quemment en cause ?tait l'essence (36%). Des l?sions par armes blanches ont ?t? associ?es chez trois malades. Trois malades sont d?c?d?s et neuf sont gu?ris, dont quatre ont n?cessit? une greffe cutan?e. La dur?e moyenne d'hospitalisation ?tait de trois semaines.
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| 135 |
ETUDE DES BRULURES CHEZ LES ENFANTS ADMIS AU CENTRE DES BRULES A SOFIA SUR UNE PERIODE DE SIX ANS (1988-1993)
(Diakov R, Hadjiiski 0, Atanassov N, Argirova M. - Bulgarie)
Sur une période de six ans, au Centre des Brûlés et de Chirurgie Plastique à Sofia ont été traités 1491 enfants brûlés âgés de 0 à 15 ans, dont 42,98% de 0 à 3 ans. Prédominent les brûlures par des liquides chaudes (75,47%), en deuxième position sont les brûlures par flamme (l 1,35%), et en troisième les brûlures électriques (6,56%) et par d'autres agents (6,62%). Les premiers soins ont été apportés au Centre à 53,70% des enfants, dans un autre établissement de médecine à 43,20%, et à domicile rien qu'à 2,90%. L'accident est survenu à domicile dans 82,45% des cas. La tranche horaire la plus concernée est le matin - 35,15% des cas. Les brûlures ont été les plus nombreuses pendant le week-end (le samedi 23,11% et le dimanche 19,33%). Le taux de la mortalité est de 3,22%.
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| 140 |
RANITIDINE-INDUCED THROMBOCYTOPENIA IN SEVERE BURN PATIENTS. A PROPOS OF ONE CASE
(P?rez del Caz M.D., Terr?n J., De la Rubia J., Cod?na J., Safont J., Mirabet V. - Spain)
We present a case of thromboeytopenia induced by H2 antagonists (ranitidine) in a 55% TBSA burned patient. This is a relatively rare cause of thromboeytopenia and we were unable to find other cases among burn patients in the literature. We describe the cli nical evolution and how discontinuation of ranitidine improved the platelet disease.
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| 142 |
A BIOSYNTHETIC SKIN SUBSTITUTE (BIOBRANE) IN THE MANAGEMENT OF BURNS
(Terròn J., Codina J., P6rez del Caz M.D., Safont J., Mirabet V. - Spain)
This study concerns our use of a temporary skin substitute (Biobrane) in the management of excised burn wounds (deep bums). We also use Biobrane to cover meshed autograft. It is demonstrated that this skin substitute diminishes the healing and closing time of the mesh and improves graft take. The use of Biobrane in autograft donor sites is also discussed.
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| 146 |
REDUCTION OF BLOOD LOSS DURING PRIMARY TANGENTIAL EXCISION WITH EPINEPHRINE INFILTRATION
(Br& A. - Republic of Slovenia)
One of the problems in primary tangential excision of bum wounds is bleeding. To reduce bleeding epinephrine solution (2 mg epinephrine active substance in 1000 ml normal saline) has been used to infiltrate the excision area, also using a tourniquet on the extremities. As the amount of blood loss during the operation is not known precisely the amount of blood transfused was recorded in order to maintain haemoglobin at 10- 12 g%. In this study I I children and 24 adults with deep dermal and full-thickness bums covering 10-60% body surface were randomly included. In the children the total amount of blood given was 57.4 rut per 1% excision (one half during and one half after the operation). In the adults the value was 142.4 ml (80.2 rut during and 62.2 after the operation). Compared to a previous study carried out by the author, and despite the considerable differences between patients, the results were satisfactory, especially in the children. The main advantages of this method are the reduction of blood loss, the prevention of uncontrollable profuse bleeding and the slowing-down of the transfusion rate during the operation.
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| 150 |
DECORTICATION OSSEUSE DES OS LONGS DANS LE TRAITEMENT DES BRULURES PROFONDES
(Roug6 D., Bodnar M., Micheau Ph., Gavroy J.P., Grolleau J.L., Chavoin J.P., Costagliola M. - France)
La décortication osseuse des os longs dans le traitement des brûlures profondes est une technique utile chez les grands brûlés longtemps hospitalisés au Centre de Rééducation et chez le sujet âgé. Les modalités techniques sont variables mais une surveillance médicale est nécessaire. Douze cas ont été réalisés entre 1987 et 1992. Les avantages et les inconvénients sont précisés. Les indications qui en découlent sont détaillées.
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| 154 |
ISLAND PARASCAPULAR FLAP FOR THE TREATMENT OF DIFFUSE AXILLARY BURN SCAR CONTRACTURE
(Shalaby H.A. - Egypt)
Fifteen parascapular flaps based on the oblique branch of the circumflex scapular artery were used to correct post-burn axillary contractures in 12 patients. The contractures were of the diffuse type (type IV), in which scarring involves all the anterior and posterior axillary folds, usually in association with the hair-bearing area. All the flaps remained totally viable and were successfully used to release the contractures. The donor area was either closed primarily or covered by split-skin graft.
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| 159 |
PREVENTION OF THERMAL AND CHEMICAL INJURIES
(Puls M., K?nigov? R., Bohm T., Ml?dek D. - Czech Republic)
Burn injuries lead to permanent changes in the medical condition and lifestyle of many patients. This article reminds us of the fundamental differences in the causes of these injuries in the two major groups of patients, defined by NovA (1986) as children and adults. Based on the evidence and the conditions of 421 hospitalized patients subdivided into three age groups (0-3 years, 3-15 years, adults), concrete statistic information is provided on the percentage frequency of the injuries, and the cause of each injury is defined. It is concluded that in children these injuries are due to their varied interests, after-school activities, inexperience, recklessness and the lack of parental (or other) supervision. The degree of the bums becomes more severe, leading to the fatal outcome that could have been prevented.
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| 164 |
COST/BENEFIT VALUE OF A BURN UNIT AT THE AMERICAN UNIVERSITY OF BEIRUT MEDICAL CENTER
(Atiyeh B.S., Saba M. - Lebanon)
In order to assess the value of establishing a burn unit at the American University of Beirut Medical Center, a retrospective study was conducted on all burn patients admitted to the Centre between 1975 and 1993. All patients were entered into the hospital computer system following the ninth Revision of the International Classification of diseases. A total of 787 patients were computed, with an overall mortality rate of 13.98%. An average of 40 to 45 burn patients were admitted to the hospital each year, constituting about 0.25% of all hospital admissions and 1% of all surgical admissions. Distribution of the burns by age, sex, involvement of specific anatomic sites and extent was evaluated. Despite the fact that these patients were treated in a regular surgical ward, the final outcome was not worse than that reported from major burns centres. This raised the question of the wisdom of establishing a small burn unit in a private institution with tight budgetary restrictions. It may be economically much wiser in small countries like Lebanon to establish one central burn unit with the assistance of the governmental authorities instead of creating highly expensive small units. Nevertheless, the necessity of having a burn centre in a teaching institution should not be overlooked. The academic value of such a centre by far justifies the cost.
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| 169 |
CHEMICAL SPILLAGE - A PREVENTABLE DISASTER?
(Rosenberg L., Shabshin U. - Israel)
This paper considers accidents caused by the spillage of dangerous chemicals and how they could be prevented, in the light of direct experience gained in Israel and of the findings of researchers in other parts of the world, as reported in the literature. The procedure followed in Israel in the event of such accidents is described and general guidelines are suggested for the stockpiling and transport of these potentially lethal substances. It is important to be prepared and there must be specific protocols for all possible forms of chemical poisoning. Hospitals must be well equipped and medical and paramedical staff properly trained. These accidents can happen anywhere at any time, and it is stressed that the best protection is prevention.
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