|Annals ofBurns and Fire Disasters - vol. IX -
n. 3 - September 1996
USE OF THE FIRST
PORSOMETACARPAL ARTERY FLAP TO COVER ELECTRICAL BURNS OF THE FIRST FINGER IN CHILDREN
Two cases are described of electrical
burns in the first finger in children (aged respectively 22 and 24 months) repaired by
using a first dorsometacarpal flap, known as the "kite flap", as first developed
by Foucher. A description is given of the anatomical characteristics of the flap, which
offers a number of advantages: good skin coverage, sensitivity of the reconstructed finger
tip, minimal damage in the donor area, possibility of one-stage surgical repair,
sinidlarity of donor skin to original skin, and minimal hospital stay. This technique is
recommended as an alternative approach in certain hand defects.
Fonseca Valero R., Martinez Ibern6n
D., Gaos Font L., Alvarado
EFFECT OF BURN BLISTER FLUID ON THE VIABILITY OF HUMAN CULTURED FIBROBLASTS
With a view to making some contribution to the still undecided question of the optimal therapeutic care of burn blisters, this study considered the effect of bum blister fluid on the viability of human cultured fibroblasts. Blister fluid was obtained from burn patients within 24 h post-burn. Normal human fibroblasts were cultured in the fluid for 3 h. Cell viability was determined by MTT assay (3-[4.5-dimethylthiazol-2-yl]-2.5- diphenyltetrazoleum bron-dde) spectrophotometric measures. There was a reduction in cell viability as the concentration of bum blister fluid increased in the culture medium. At a concentration of 100%, fibroblast viability ranged in the various patients from 5 to 66%. It is concluded on the basis of these results that in the majority of cases burn blisters should be debrided.
Caneira M., Mota-Filipe H., Castro
M., Pinto R., Condinho-Matos
HUMAN KERATINOCYTE CULTURE USING PORCINE PITUITARY EXTRACT IN SERUM-FREE MEDIUM
The permanent closure of extensive burn wounds is a challenge to the surgeon because of the shortage of skin graft donor sites. These wounds can be covered successfully by using sheet grafts of cultured keratinocytes or by overlaying a glycosaminoglycan substrate, allodermis or xenodermis. Boyce and Ham's serum-free medium has been found to facilitate the preparation of keratinocyte cultures, with prompt cell growth. In this study one of the supplements in the Boyce and Ham medium, bovine pituitary extract (BPE) at a concentration of 140 Pg/ml, was replaced by different concentrations of fresh frozen porcine pituitary extract (PPE). It was found that PPE is a good supplement for in vitro growth of keratinocytes, and that the concentration of 350 pg/ml induces significant keratinocyte growth by day 9 as compared to the standard concentration of BPE and other concentrations of PPE.
Wang H.J., Chen T.M., Cheng L.F.,
Cheng TY, Tung Y.M.
RELATIONS BETWEEN COPPER, ZINC AND SELENIUM INTAKES AND MALONDIALDEHYDE EXCRETION AFTER MAJOR BURNS
Trace elements are directly involved in free radical scavenging - copper and zinc mainly as part of ceruloplasmin and CuZii superoxide dismutase, and selenium as part of glutathione peroxidase. However, as these elements also have site-specific antioxidant action, they are potentially important in burns. The trace element status is altered after major burns, with severely decreased scrum levels, especially in the first week. The serum levels can be restored to near normal values by large trace element supplements, and this may reduce hospital stay. The purpose of this study was to determine whether nutritional factors, and especially trace element supplements, could have any influence on lipid peroxidation, by studying the relationship between intravenous trace element intakes, serum trace element levels and urinary malondialdehyde excretion. It was concluded that the malondialdehyde decrease observed after day 3 was not clearly attributable to the trace element supplements. The negative trend observed between Zii and Se supplements and decreased malondialdehyde excretion requires further study.
Berger M.M., Chiol6ro R.
BURN VARIABLES INFLUENCING SURVIVAL: A STUDY OF 144 PATIENTS
This review consists of an epidemiological analysis of burn variables observed in the Bums Unit at King Abdulaziz - MOH - Hospital in Jeddah, Saudi Arabia. One hundred and forty-four patients were considered over a 2-year period. The overall mortality rate was 9.7%, with a mortality risk 16 and 86 times higher respectively in patients with 30-50% and 50-80% TBSA burns than in patients with 30% TBSA burns. The mortality risk increased fivefold in cases of full skin thickness bums or when arrival was delayed 2-5 hours. Increases in burn size, burn depth and arrival delay all significantly raised the mortality rate. When the burn size was over 30% TBSA the effects of these other two variables on survival were augmented. Patient age below 5 years increased the risk of death fivefold but did not significantly raise its rate.
EI Danaf A.
INFLUENCE OF A CHANGED CARE ENVIRONMENT ON BACTERIAL COLONIZATION OF BURN WOUNDS
The influence was investigated of a conditioned care environment per se on the bacterial colonization of burn wounds. In successive years (1992 and 1993) two cohorts of burn patients were treated in different environments: the first group was treated in a permanent purposedesigned unit, and the second in wards of traditional open design, during renovation of the unit. The number of patients treated were respectively 224 and 231, and the general medical features were similar. The princi~ ples and practice of burn care remained unchanged in the two years. No significant difference in wound colonization was found between the two groups. It is conclu-ded that although purpose-designed units present many advantages for the care of burn patients a conditioned care environment does not per se influence the bacterial colonization rate of burn wounds.
Adeniran A., Shakespeare P., Patrick
S., Fletcher A.J., Rossi L.A.F.
OUTCOME OF AMPUTATIONS IN PATIENTS WITH MAJOR BURNS
The purpose of this study was to review the hospital records of patients who underwent amputation in the University of LouisAlle Burn Unit, USA, in the period 1984-1993. Criteria for entry into the study were irrespective of the size or type of bum that involved subsequent amputation as part of the treatment. The results of these. patients were compared with those of a similarly injured control group (elevated total body surface areas involved, Apache 11 scores, and percent of inhalation injuries). The survival rate was 60% in both groups. Unlike other reports, the amputations were performed late (mean, 15 days) in the hospital course and after attempts at limb salvage (mean, two procedures). The elimination of either non-viable or infected tissue served to achieve a respectable survival rate in these severely injured patients, comparing favourably with the control group.
Viscardi P.J., Polk H.C., Jr
MICROBIAL COLONIZATION OF LARGE WOUNDS
It has been estimated that as many as 75% of all deaths following bum injuries are related to infection. Bearing in mind this consideration, it was decided to determine the nature of microbial wound colonization in a cohort of 28 extensively burned patients in the Haukeland University Hospital Burn Centre (Bergen, Norvay), with the major objectives of establishing which micro-organisms were prevalent and how the wound flora of the patients changed during hospital stay. Altogether, 748 swabs were taken in 141 sampling procedures. A total of 414 microbial isolates were detected, and their resistance patterns to various systemic antimicrobial agents were determined. The isolates most frequently detected were Staphylococcus aureus (14%), Enterococcus species (11.3%), Speudomonas aeruginosa (10.9%), and Candida species (9.7%). Nearly half the enterococci and just over a third of the coagulase -negative staphylococci were resistant to the aminoglycosides routinely given in conjunction with surgery in the ward. Only four of the 89 strains of coagulase-negative staphylococci were insensitive to methicillin, and no Staphylococcus aureus were methicillin-resistant. On admission and during the first week staphylococci and (x-haemolytic streptococci were dominant, while during the following weeks these bacteria were superseded by enterococci, gram-negative opportunists (in particular Pseudomonas aeruginosa, Acinetobacter calcoaceticus, and Escherichia coli), and Candida species. It is concluded that the initial treatment of patients with large bums should be guided by the results of systematic sampling and evaluation of the microbiological flora present in a given ward, as empirical selection of suboptimal or wrong antibiotics will result in higher mortality.
Vindenes Il., Bjerknes R.
THE EPIDEMIOLOGY AND PREVENTION OF BURN INJURIES TO FIREFIGHTERS
Burn injury will always be an occupational hazard of firefighters; however, careful categorization of these injuries can identify anatomic areas that require improved protection, which may result in a decrease in both the severity and the number of such injuries. This study considers the 289 firefighters admitted forbums over a ten-yearperiod (1981-1991) to New York Hospital-Comell Bum Center. The anatomic areas mainly involved were the hands and the lower extremities. Following an educational programme, urging proper use of protective gear, a reduction was observed in the number of hand bums, but not in bums to the lower extremities. It was found that firefighters working as nozzle operators were particularly subject to lower extremity burns, owing to inadequate protection. The incidence of such injuries could be reduced by the use of better protective means, e.g. bunker pants, with less physical harm and substantial economic saving.
Madden M.R., Mathwick M., Valentino L., Finkelstein J.L.,
PROSPECTIVE, RANDOMIZED STUDY OF THE EFFICACY OF
PRESSURE GARMENT THERAPY IN PATIENTS WITH BURNS
USE OF A HELIUM-OXYGEN MIXTURE IN THE TREATMENT OF POSTEXTUBATION STRIDOR IN PEDIATRIC PATIENTS WITH BURNS
A helium/oxygen mixture ("heliox") is less dense than normal air, and this property allows the gas to flow with less turbulence past airway narrowings, thus decreasing airway resistance and increasing the volume of gas exchange. Stridor due to airway obstruction has been found to occur in 92% of patients requiring reintubation. Eight paediatric burn patients with post-extubation stridor or retractions unresponsive to racemic epinephrine were treated with heliox for 28 t 5 hr with an initial helium concentration of 50-70%. Only two of the patients who received heliox suffered respiratory distress and required reintubation. Both these patients had stridor for a longer time before initiation of heliox therapy than patients who did not require reintubation. Heliox therapy significantly decreased respiratory distress scores. Heliox thus relieved persistent stridor and helped prevent respiratory distress and reintubation.
Rodeberg D.A., Easter A.J., Washam
M.A., Housinger T.A.,
SERUM COPPER AND ZINC CONCENTRATIONS IN PATIENTS WITH BURNS IN RELATION TO BURN SURFACE AREA
Serum copper and zinc concentrations are reduced after bum injury, but although these elements play essential metabolic roles clinical evidence of functional deficiency is limited. The purpose of this study was to evaluate serum zinc and copper concentrations in a wide range of thermal injuries and to attempt to define a policy for patient monitoring and supplementation. The concentrations were measured by flame atomic absorption spectroscopy in 34 patients between one and three weeks post-bum. Serum copper concentration was inversely correlated with bum surface area, whereas serum zinc concentration showed no such association. In the first week post-bum hypocupraernia was found in 48% of the patients and hypozincaemia in 62%. Serum copper concentrations in patients with less than 15% bums remained within normal limits, whereas hypozincaemia was found in patients regardless of bum extent. Post-burn hypozincaemia was very variable and not associated either with serum albumin concentration or with periods of clinical sepsis. As major bum injuries are associated with hypocupraernia, serial monitoring is recommended with appropriate copper supplementation.Gosling P., Rothe H.M., Sheehan T.M.T., Hubbard L.D.
J. Bum Care Rehabil., 16: 481-6, 1995.