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Volume IX |
Number 3 |
September 1996 |
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SUMMARIES
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ANALYSE EPIDEMIOLOGIQUE DE 2000 BRULES HOSPITALISES A BORDEAUX ENTRE 1987 ET 1994
(Perro G., Bourdarias B., Cutillas M., Castède J-C., Sanchez R. - France)
Les données épidémiologiques de 2000 patients brûlés hospitalisés entre 1987 et 1994 sont étudiées. 54% des accidents sont des brûlures par flammes, 24% des ébouillamments, 8% des lésions électriques, 7% des lésions par contact, 5% des lésions chimiques. La répartition de la population est la suivante: de 0 à 5 ans, 10%; de 6 à 15 ans, 9%; de 16 à 64 ans, 67%; 65 ans et plus, 13%. La part des accidents domestiques est de 80%. Le sex-ratio est de deux hommes pour une femme. 64% des brûlures de l'enfant jusqu'à 5 ans sont provoquées par des liquides chauds (nourriture 2/3, eau chaude sanitaire 1/3). Chez l'adulte, il s'agit le plus souvent de brûlure par flamme (58%) avec manipulation de liquides inflammables dans 40% des cas; les bassines de friture sont responsables de la majorité des accidents domestiques chez la femme. Chez le sujet de plus de 65 ans, une chute par trouble de la conscience est à l'origine de 25% des accidents. Certains agents vulnérants entraînent des lésions de topographie spécifique (mains et visage pour les flammes, oeil pour les brûlures chimiques, membres inférieurs et périnée pour les ébouillantements). Alcoolisme (12%), maladie psychiatrique (7%) et bas niveau socio-culturel (24%) sont les facteurs de risque les plus souvent associés. La surface brûlée moyenne des patients est de 15%. La mortalité totale est de 9%, avec 50% de survie à 80% de surface corporelle brûlée entre 0 et 40 ans.
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| 139 |
PROTOCOLE DE MAITRISE DES INFECTIONS CHEZ LES GRANDS BRULES
(Verrienti R, Mavilio D, De Sanctis R, Savoia A. - Italie)
La cause la plus fréquente de morbidité et de mortalité du patient brûlé est de nos jours, sans doute, l'infection. Le déficit relatif à l'immunité qui vient se créer rend le patient particulièrement sensible aux infections systémiques qui sont causées par l'invasion des bactéries provoquée par la blessure, par le contage extérieur, et par la translocation de la flore bactérique Gram négatif de l'intestin. Dans le Centre des Grands Brûlés de Brindisi on est en train d'effectuer une étude nationale sur l'usage de la péfloxacync, de la teicoplanine et de la nétilmicine pour le contrôle des infections. Cependant, selon l'opinion des Auteurs, le contrôle ne concerne pas seulement l'usage des antibiotiques mais aussi une série de méthodologies (préventives, diagnostiques et chirurgicales) pour atteindre ce but.
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| 142 |
CENTRAL EMBOLIZATION BY A GUIDEWIRE IN A BURN PATIENT
(Valero J., Barreiro J., S6ez E., Vèzquez Gonzalez, Lòpez-Suso E., Martelo F. - Spain)
Few risks are involved in the replacement of central venous catheters when guidewires are used, but repeated practice, critical situations, and inexperience increase the possibilities of error. A case is described in which a burn patient suffered embolization of a guidewire during replacement of a central catheter. The situation was normalized percutaneously using radiographic control without affecting the patient's later evolution.
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| 145 |
HYDROELECTROLYTIC DISTURBANCES IN BURN PATIENTS DURING THE EMERGENCY PERIOD AND THEIR TREATMENT
(Dauti L, Andrea A., Osman X.H. - Albania)
This paper considers the nature of burn shock, which is the main cause of mortality unless local and systemic treatment is correctly administered. The primary and secondary manifestations are described. The effects of burn shock are described in relation to 75 burn patients. Sodium plasma concentrations were significantly reduced, while potassium plasma levels rose considerably in 29 patients. An increase in glycaemia was seen in 28 cases; 29 cases presented haemoglobinuria and bilirubinuria due to haernolysis. Serious complications were prevented by fluid replacement and the treatment of hydroelectrolytic and metabolic disturbances. All the patients who died were suffering from critical burns and were admitted to the Burns Department after a considerable delay.
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| 147 |
A NEW TECHNIQUE FOR WOUND DEBRIDEMENT
(Midon Miguez, Valero Gasalla J., Pousa Real F, Martelo Villar F.J. - Spain)
A new technique is presented for wound debridement, based on the use of metallic swabs. The technique's simplicity and rapidity and the limited damage caused to healthy tissue surrounding the wound make it particularly useful in the debridement of partialthickness wounds.
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| 149 |
SEVERE COMPLICATIONS IN ELECTRICAL BURNS (INCLUDING VISCERAL COMPLICATIONS)
(Haberal M., UQar K., Bayraktar O., Oner R - Turkey, Ankara)
Over a period of 13 years (1979-92), 1065 patients were admitted to the Bum Unit at the Hacettepe University Hospital, Ankara. Of these, 219 (20.1%) suffered from electrical injury. The patients were treated according to a routine protocol. The most important early complications were acute renal failure, sepsis, and associated skeletal and central nervous system injuries. The late complications were total or partial extremity amputation, scars and contractures, cataract, and epilepsy. The mortality rate was 21.5% (47 patients, of whom 26 died of multiple organ failure, 13 of sepsis, and 8 of severe cerebral trauma). The high overall incidence and rate of severe cornplications in electrical burns compared with those found in other reports show that electrical injury still constitutes a life-threatening problem in our country. The victims often suffer the physical and psychological consequences of late complications, such as amputation. To prevent these undesired effects, preventive measures are urgently required through a massive education campaign, together with the realization and maintenance of high industrial safety standards.
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| 153 |
THE TREATMENT OF ELECTRICAL BURNS IN THE VOLAR PART OF THE ADIOCARPAL REGION
(Beiba GA. - Albania)
In electrical bums in the volar part of the radiocarpal region, with damage to the u1nar and radial arteries, it is of great importance to preserve the posterior interosseous artery. It is this artery, together with the dorsal carpal arch and other anastomoses, that ensures vascularization of the hand. A regional anatomical description is given in relation to different stages of the surgical protocol. An evaluation is made of early necrectomy, decompression of the muscle compartment, ligation of damaged vasal stumps, surgical re-exploration, and the closure of wounds with skin grafts. The treatment of electrical trauma in this region of the body is debated on the basis of the description of a number of cases.
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| 156 |
BURNS SEQUELAE IN CENTRAL AFRICA: REPORT ON THE TREATMENT OF ELEVEN CASES
(Gandini D. - Italy)
The results are presented of 11 cases of burn sequelae, mainly in children, treated by an Italian team in the Zambian-Italian Hospital in Lusaka (central Africa). From a technical point of view the surgical procedures do not present particular problems, but in the social context of central Africa they assume great value because they not only improve the quality of life of the unfortunate children but may become a sine qua non for their survival. In Zambia, as in all central Africa, burns are not treated in any specific way. The few surviving patients suffer from extremely severe scar contractures, with tragic consequences. This paper describes the cases treated and the results obtained.
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| 163 |
USE OF CULTURED HOMOLOGOUS KERATINOCYTES IN THE LOCAL TREATMENT OF LVELUS SYNDROME
(Napoli B., D'Arpa N., Masellis M., D'Amelio L., Genovese M. - Italy)
The authors describe two cases of toxic epidermal necrolysis (Lyell's syndrome). The first case did not have a clear pharmacological aetiology, occurring in a patient with a lymphoproliferative condition (non-Hodgkin's lymphoma). The second patient had taken a number of drugs and the aetiology was probably attributable to anticonvulsants (phenobarbital, phenytoin and carbarnazepinc). The cases did not present any complications and were treated with vitamins, gastroprotective and rehydrating therapy, appropriate nutritional support, without the use of steroids, and with local application of cryopreserved cultured homologous keratinocytes which promoted extremely rapid re-epithelialization of the lesions (48 h). The specific literature regarding both Lyell's syndrome and the problerns involved in the cultivation of human epithelium are reviewed and the Authors find confirmation of the biological foundations and the validity of the local treatment which they applied.
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| 168 |
SOME OBSERVATIONS ON MAST CELL NUMBERS IN STEROID-TREATED KELOIDS
(Popchristova E, Mazgalova J. - Sofia)
This study focuses on mast cells in steroid-treated keloids. Ten cases of untreated and steroid-treated keloids were assessed for the number of mast cells. The use of light microscopy morphometric analysis made it possible to establish a decreased number of mast cells in steroid-treated keloids in comparison with that of mast cells in untreated skin lesions. The reduction in the number of mast cells can be considered evidence for the participation of these cells in the stages of keloid healing. The probable ways in which mast cells and other connective tissue cells participate in the processes of steroid keloidal treatment are discussed.
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| 172 |
BANQUE DE LA PEAU DE PRAGUE - LE PASSE, LE PRESENT ET LE FUTUR
(Bucek S, Voghtova D. - Czech Republic)
La banque de la peau de Prague, maintenant dans la troisi?me d?cennie de son existence, depuis sa fondation est surtout orient?e au pr?l?vement de x?notransplants qui constituent une partie importante de notre identit? nationale dans la th?rapie des br?lures. Une question urgente est de savoir s'il faut ?larger son activit? ?galement au pr?l?vement des allotransplants qui pour la plupart ?taient pr?lev?s seulement comme des allotransplants frais (surtout des donneurs-membres de famille) pour les enfants br?l?s graves. Les Auteurs discutent la question des allotransplants cadav?riques frais, cryopr?serv?s et glyc?rol?s.
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