|
 |
Volume VIII |
Number 4 |
December 1995 |
|
|
SUMMARIES
| 195 |
ETUDE DE LA MORTALITE PAR BRULURE A PROPOS DE 414 CAS DE DECES
(Boukind L., Chlihi A., Chafiki N., Alibou F., Terrab S., Bouchta A., Bahechare N., Zerouali OX - Maroc)
Nous nous sommes proposés de faire l'analyse causale des facteurs de mortalité par brûlure à travers les données d'une série (IC 414 cas de décès survenus au Service de Brûlés et Chirurgie Plastique du CHU Ibn Rochd de Casablanca sur une période de neuf ans (1985-93). Le taux de mortalité est élevé à 27% par rapport au nombre d'hospitalisation de 1499 patients. Les facteurs pronostiques sont l'âge, la surface corporelle brûlée, le score UBS, et l'atteinte respiratoire. En plus de ces facteurs communs à la plupart des séries, avons relevé des facteurs de mauvais pronostique tributaires de notre contexte de pays en développement, notamment la rréquence élevée des brûlures par gaz butane dues à la défaillance des normes de sécurité et un mauvais usage des bouteilles de gaz 3 kg, la fréquence des brûlures par eau bouillante aux bains maures et enfin la défaillance de la prise en charge des brûlés depuis le ramassage jusqu'à l'hospitalisation qui s'explique par un manque de moyens tant materiel qu'humain ainsi l'énorme disproportion entre les capacités limitées du sel-vice et la population à desservir. Ceci rend compte de l'importance d'insister sur les moyens de prévention afin d'ésperer une réduction (le la mortalité par brûlure.
|
| 198 |
BURNS IN RISK PROFESSIONS
(Hadjiiski 0., Kamburov Z. - Bulgaria)
This paper considers twenty years (1974-93) in the activity of the Pirogov Burns and Plastic Surgery Centre in Bulgaria in relation to burns in professions with particular burn risks. An analysis is made of distribution of burns by occupation, sex, age and sex, body surface area burned, anatomical region affected, seasonal period, and time of day. An analysis is also made of the mortality rate.
|
| 203 |
SENILITY AND BURNS - FOUR YEARS' EXPERIENCE
(lliopoulou E, Lochaitis A, Kalophonou M, Kapositas E, Komninakis E, Poulikakos, L, Daniel-Seferi A. - Greece)
In the four-year period 1990-1994, 185 patients aged over 65 years with mixed full- and partial -thickness burns in a mean total body surface area (TBSA) of 26.8% were admitted to our Bum Unit. In the majority of cases the aetiology was therrial injury (11ame 63%, scalding 19%, contact 10%, friction 5%, chemical burns 3%). Over one~third of the accidents occurred in a closed environment and were domestic. Inhalation injury was present in 23% of the patients (mortality 100%). Overall mortality was 33% (mean age 79.7 years vs. 72.0 years in surviving patients, mean TBSA 40% vs. 23% in surviving patients). The leading causes of death were major cardiopulmonary complications (70%), infection (18%) and hypovolaernic shock (3%). Our results have led us to the conviction that immediate and intensive treatment in combination with very early mobilization will lead to rapid healing and rehabilitation in many of these eleterly patients.
|
| 207 |
CONSIDERATIONS ON INTENSIVE CARE IN ELDERLY BURN PATIENTS
(Masellis M., D'Arpa N., Napoli B. - Italy)
Advanced age is a determinant factor that inay cause death in burn patients, due to progressive involution of the physiological functions of various organs and systems, the onset of chronological pathological conditions, and the organism's reduced capacity to react to therapy. These three main factors are analysed in detail, in relation to the skin and the respiratory, cardiocirculatory, urinary and digestive systems; protein metabolism; and the special problems of the elderly patient when subjected to burns therapy. It is of great importance to establish the patient's general pre-burn condition. The anamnesis should assess the degree of functionality of the main organs and systems in relation to the patient's quality of life, the amount of physical activity usually taken, the type of diet, and the sleeping-waking pattern. The possible chronic pathologies that should be investigated are indicated. The three major aspects of intensive care in the elderly burn patient are considered: the choice of infusion fluids, the rate of administration, and the monitoring of the response.
|
| 214 |
CD36 IS ONE OF THE IMMUNOLOGICAL MARKERS EXPRESSED BY KERATINOCYTES IN ACTIVE HYPERTROPHIC SCARS
(Castagnoli C., Stella M ., Menegatti E, Trombotto C., Calcagni M., Magliacani G ., Teich Alasia S., Alessio M. - Italy)
The pathogenesis of hypertrophic scars is largely unknown, although there is considerable evidence to suggest that many of its features are analogous to inflammatory dermatoses, such as psoriasis, scleroderma and lichen planus. An aberrant expression of HLA Class 11 and ICAM-1 molecules on keratinocytes is reported in these forms of dermatosis. We have already demonstrated in hypertrophic scars that these activation markers are ectopically present in all layers of the epidermis. Here we show that CD36, a membrane glycoprotein normally expressed on platelets, monocytes and endothelial cells, is expressed on epidermal keratinocytes in the stratum granulosurn and stratum spinosum of active hypertrophic scars but not in normotrophic scars or normal skin. These resulis, combined with the local alteration of the biosynthesis of some cytokines in hypertrophic scars and the ectopic expression of HLA 11 and ICAM- I molecules on keratinocytes and fibroblasts in the tissue involved, are consistent with a pivotal role of an altered cellular immune response in this disease.
|
| 220 |
EXPRESSION OF KERATIN IN POST-BURN SCARS AND KELOIDS
(Ramakrishnan M., Prathiba V., Sridhar Rao K., Jayaraman V., Babu M., Gupta P.D. - India)
Keratinocyte migration is one of the initial events of re-epithelialization, and therefore an important phase of wound healing. The aim of this study was to consider the expression of keratin, which is the biochemical marker of re-epithelialization. 50 KDa and 58 KDa keratins, which are markers of proliferation, were found to be overproduced in keloids and post-bum hypertrophic scars compared to normal human skin.
|
| 224 |
SOFT TISSUE RECONSTRUCTION OF THE BURNED HAND
(Atiyeh B.S., Saba M. - Lebanon)
The burned hand represents a real therapeutic challenge because of its particular anatomy and its intricate function. An algorithm for soft tissue reconstruction of acute hand burns and repair of late contractures is presented for each of the three anatomical areas of the hand: the palm, the fingers, and the dorsum. Spontaneous healing of deep bums in these areas can lead to catastrophic results. Adequate skin coverage is critical for function. Early soft tissue coverage of hand burns is emphasized in order to prevent the formation of disabling contractures.
|
| 227 |
LES LAMBEAUX EN ILOT DE L'AVANT-BRAS DANS LE TRAITEMENT DES SEQUELLES DE BRULURE DE LA MAIN
(Boukind H, Terrab S, Alibou F, Chafiki N, Bahechar N, Zerouali 0. N. - Maroc)
Les lambeaux en îlot de l'avant-bras occupent de plus en plus une place privilégiée dans le traitement des pertes de substance de la main. Nous avons utilisé ces lambeaux pour la couverture des pertes de substance engendrées par la libération des rétractions après brûlure de la main chez 20 patients. Ainsi nous avons utilisé le lambeau en îlot sur l'artère radiale dans neuf cas, sur l'artère interosseuse postérieure dans six cas, sur la branche distale de l'artère cubitale dans trois cas, et deux lambeaux sur l'artère cubitale. Les résultats sont très satisfaisants en dehors d'une nécrose totale d'un lambeau interosseux postérieur. Les lambeaux en îlot de l'avant-bras permettent une couverture en un seul temps opératoire et la mobilisation et la kinésithérapie précoces, avec une meilleure résolution de l'oedème et une meilleure vascularisation de la main.
|
| 231 |
THE USE OF FASCIOCUTANEOUS THIGH FLAPS IN THE RECONSTRUCTION OF GROIN AND TROCHANTERIC DEFECTS
(Higazi M, Ayad H, Shalaby H. - Egypt)
Anterolateral and anteromedial fasciocutaneous thigh flaps were used in the treatment of fifteen patients suffering from postburn groin contracture. The anterolateral fasciocutaneous flap was used to cover trochanteric bedsores in five patients. The flaps were found to be large enough to cover extensive defects. The vascular pedicle is long with a wide are of rotation and minimal anatomical variation. The morbidity of the donor site is acceptable.
|
| 236 |
MANAGEMENT PROTOCOL OF BURN PATIENTS DURING AIR EVACUATION
(Santos F.X., Sanchez-Gabriel J., Mayoral E., Hamann C., Fernàndez Delgado J. - Spain)
The evacuation protocol for the airborne transport of critically burned patients is presented. This protocol is based on the repercussion of air evacuation on the physiopathology of bums. Clinical re ercussions are due to acceleration, vibration, noise and, above pall, altitude. Acceleration is important during take~off and landing, and vibration may be important in helicopter evacuation in the presence of craniofacial traumas. Noise, especially in helicopters, can interfere with in-flight diagnostic and therapeutic maneouvres. Altitude alters atmospheric pressure, partial pressure of ox ygen, and water concentration in inhaled air. In the aircraft we use, atmospheric pressure is between 532 and 550 min Hg at normal flight altitudes. This situation determines the expansion of body gases. Hypoxia seriously aggravates any respiratory insufficiency, especially in the presence of smoke inhalation. The decrease of water concentration in inhaled air imposes an increase in fluid perfusion.,Pre-flight and in-flight levels are analysed, especially with regard to smoke inhalation, pneumothorax and parenteral perfusion.
|
|