Dernier département français, créé en 2011, Mayotte souffre toujours d’un retard dans l’intégrationaux statistiques officielles de santé, rendant difficile l’adaptation de l’offre de soins aux besoins et la planificationde la prévention. Nous avons mené une étude épidémiologique rétrospective incluant tous les patients suivisdans le centre de traitement des brûlés (CTB) de Mayotte entre le 1er février 2022 et le 31 janvier 2023 (339patients). Nous avons d’abord étudié les patients brûlés sur l’île, soit 300 personnes. L’âge moyen est de 10,7ans avec 75% de patients de moins de 12 ans. L’incidence globale est de 100/100.000 habitants, ce qui sembleplus élevé que dans les autres départements, mais de 16/100.000 concernant uniquement les patients hospitalisés,soit un chiffre comparable avec le niveau métropolitain. Les brûlures sont le plus souvent causées par des liquides(82,7%), de surface <10% (91%) et de 2ème degré superficiel (66,7%). Les catégories sociales les plus précairessont sur-représentées dans la population brûlée, en lien avec des conditions de logement très dégradées. L’autregroupe (39 cas) correspond aux patients brûlés aux Comores mais soignés à Mayotte, après un délai moyen de10 jours suivant l’accident. Les brûlures sont significativement plus étendues (SCB 16,6% vs. 4,6%), plusprofondes (3ème degré 66,7% vs. 2,0%) et causées par des flammes (66,7% vs. 10,7%). Ces patients sont plussouvent hospitalisés (71,8% vs. 16,0%), représentant un total de 608 journées d’hospitalisation contre 480journées pour les 300 autres patients. Le CTB de Mayotte doit ainsi prendre en charge à la fois une populationlocale particulièrement précaire, et une population extérieure atteinte de brûlures particulièrement graves.

The burn patient is at high hazard for nosocomial infections (NI) as a result of the nature of theburn damage itself, the immune-compromising impacts of burns, prolonged clinic stays, and intensive diagnosticand therapeutic strategies. The aim of this study is to describe the actual epidemiology of burn wound coloniza-tion and infection in the Intensive Care Unit (ICU) of the Service of Burns and Plastic Surgery at the UniversityHospital Center in Tirana, Albania. The study is retrospective clinical and analytical. Microbiology data, totalbody surface area (TBSA), patient days (LOS) and mortality were collected from a hospital database for all pa-tients admitted to the ICU of the Service of Burns at the UHC in Tirana, Albania in 2020. The burn wound in-fection prevalence rate was greater than in 2010 (17.2 vs. 12 infections per 100 patients), while the burn woundcolonization prevalence rate was reduced by half (20.6 vs. 44 colonized patients for 100 patients). The burnwound infection incidence rate was increased (47 vs. 42.6 infections per 1000 hospitalization days) and also theattack rate was increased (0.7 vs. 0.5 infections for 100 patients in 2010). The main pathogens were gram-positive bacteria (60 strains; 71%), followed by Gram-negative bacteria (22 strains; 26%), and fungi (3 strains;3%). The predominant five bacteria were Staphylococcus aureus (55.0%), Pseudomonas aeruginosa (9%),Acinetobacter baumannii (8%), Staphylococcus coagulase-negative (8%) and Enterococcus faecalis (5%). Me-thicillin-resistant Staphylococcus aureus (MRSA) accounted for 55.3% (31/56) of Staphylococcal isolates. Im-plementation of anti-microbial stewardship programs is necessary to optimize the treatment of sepsis.

Electrical burns are an uncommon type of burn that can cause serious disabilities and mortality.This study aims to provide preventive strategies to investigate high-risk areas of electrical damage in TehranProvince. This is a descriptive cross-sectional study performed on patients with electrical burns referred toShahid Motahari Educational and Medical Center during 2015-2017. Patients’ information was collected ina researcher-made information form. In this study, information of 133 patients with electrical injury wasrecorded. Electrical injuries occurred mainly in the workplace (63.1%). Nearly half of the population wereconstruction workers. The results showed that most of the electrical burn accidents in Tehran province oc-curred in the surrounding counties of the city of Tehran (64%). According to the results, it is suggested thatpreventive strategies first be implemented in high-risk areas of the province of Tehran.

Resuscitation of burns remains a fundamental problem in burn care. Traditional endpoints such asmean arterial pressure and urine output guide fluid therapy for optimal resuscitation, but an ideal marker remainscontroversial. Base deficit and serum lactate are markers of global tissue acidosis and inadequate oxygenation. Theaim of this study was to determine whether serum lactate and base deficit together can be used as prognostic markersin acute burns and their association with sepsis and mortality. A prospective observational study with a sample sizeof 250 was conducted over 18 months, which included patients with 20-60% total body surface area (TBSA) havingthermal burns or scald. Resuscitation was done according to hospital protocol and fluid administration was adaptedaccording to clinical parameters. Serum lactate and base deficit values were analysed at the time of admission, thenon day one, two, three and finally on day seven after admission. The two parameters were compared among sur-vivors and non survivors. Patients were followed up till discharge, death or 30th post burn day. Baseline serumlactate levels are high and base deficit levels low in the patients sustaining burns and the levels normalised overseven days with adequate resuscitation in survivors. Persistently high serum lactate and low base deficit are asso-ciated with sepsis and increased mortality. This study indicates that serum lactate and base deficit are useful pa-rameters to predict mortality and promising predictive tools for assessing resuscitation and development of sepsis.Using these tools to guide fluid resuscitation may help mortality and improve overall outcomes.

The use of new oxygen supports associated to non-invasive respiratory strategies is well-es-tablished in clinical practice, especially after its extensive application in the management of Covid-19 res-piratory failure. The use of high flow nasal cannula (HFNC) in patients undergoing procedural sedation andanalgesia (PSA) is dramatically increasing. Enzymatic debridement in critical burn patients is a painful treat-ment that requires an optimal burn pain control protocol as well as a deep sedation for the entire duration ofthe procedure. Both hypnosis and opioid-analgesia may lead to significant respiratory depression. Fourteenpatients undergoing enzymatic debridement under deep sedation have been included in this case study. Allpatients receiving oxygen through HFNC were evaluated. All patients underwent continuous monitoring ofvital parameters, antithrombotic prophylaxis with low molecular weight heparins and fluid therapy calculatedusing the Parkland formula. Sedation was successful and well tolerated by all patients and physicians wereable to carry out the enzymatic debridement procedure safely. No severe desaturation events were observed.Continuous monitoring of vital signs was carried out. Neither bradycardia events nor hypotensive or hyper-tensive events requiring treatment occurred. Enzymatic debridement procedures did not lead to any seriousadverse events. Based on our experience, the administration of O2 by HFNC at an average concentration of50% was proven safe and efficacious in the management of drug-induced respiratory depression.

L’embrasement des champs de protection durant une intervention chirurgicale constitue un évé-nement rare mais aux lourdes conséquences. Les brûlures iatrogènes occasionnées par cette complicationsont souvent profondes et entraînent des séquelles fonctionnelles et esthétiques. Néanmoins, la connaissancedes mécanismes et des facteurs déclenchants ainsi que l’utilisation adéquate des différents produits tels queles antiseptiques alcooliques et l’oxygène concentré permettent de diminuer l’incidence de cet événementindésirable. Une communication claire entre les différents intervenants en salle d’opération est égalementun outil de prévention essentiel. Dans cet article, nous décrivons le cas d’un patient de 53 ans qui a pris feulors d’une intervention de mise en place d’un site implantable sous anesthésie locale assistée d’une sédation.Les brûlures engendrées représentent 5% de sa surface corporelle au niveau du thorax, du cou, du visage etdu dos. Le but de cet article est de rappeler les précautions d’usage à respecter au bloc opératoire afin deprévenir cet incident dramatique.

Deep intermediate burns of the hand are a challenge for both the functional and aesthetic result. In thisstudy we compare the efficacy of early selective enzymatic escarolysis followed by the application of stromal vascularfraction (SVF) extracted from autologous adipose tissue on a dermal substitute scaffold (DS) versus reconstruction bypartial thickness skin grafts (PTSG). We enrolled all patients admitted to our referral Burn Center from September 2020to January 2022 with deep intermediate burns of the hands: clinical data were collected, then the first group of 4 patientswere treated with PTSG surgical reconstruction, and the second group of 7 patients with DS+SVF. Subsequently, themorpho-functional and aesthetic outcome (with quickDASH and POSAS questionnaires), the healing time and the num-ber of accesses in the operating room were evaluated. A total of 11 patients and 18 hands were treated in the period con-sidered for the study. The mean TBSA was 22.5±15.2% in Group 1, 23.6±13.6% in Group 2; the mean age in Group 1was 47.3±17.6 yo, in Group 2 51.4±16.3 yo. The mean follow up was 10±2.5 months. At six months qDASH andPOSAS in Group 1 were: qDASH 53.4±2.5; OSAS 53.3±5.1; POSAS 51.3±4.3; in Group 2: qDASH 20.8±7.8; OSAS19.7±8.1; POSAS 17.4±7.8. Group 1 had an average healing time of 75±15 days vs 20.4±9.3 days for Group 2, and2.5±0.5vs1 accesses in the operating room. SVF combined with hyaluronic acid-based dermal substitute demonstrateda better morpho-functional and aesthetic outcome, and reduced patient healing time and accesses in the operating roomcompared to surgical partial thickness skin graft reconstruction in the treatment of intermediate-deep burns of the hand.

Hypertrophic burn scars can occur due to imbalances in the healing process and affect quality oflife. They can be assessed with the Patient and Observer Scar Assessment Scale (POSAS). This is an assessmentinstrument with both a patient scale and an observer scale. This study aimed to assess the reliability and validityof the POSAS score to measure the quality of scars in evaluating burns that produce scar tissue. It also aimed todetermine similarities in the assessment of scar tissue using the POSAS score according to observers and patients.This cross-sectional study had a sample of 30 patients, including 19 women (63%). Assessments were performedbefore the initial treatment procedure and 1 and 6 months after. The post-incision scar tissue assessment resultsusing the POSAS instrument were expressed as a score: 5-50 (observer), 6-60 (patient), or 11-110 (both total).The highest degree of burns was superficial–mid-dermal (20 patients; 67%). The POSAS assessment by doctorsand patients tended to be the same and decreased at both months 1 and 6 after the treatment procedure. Themean total score was 51.3 ± 12.1 before treatment, 44.2 ± 9.5 at month 1, and 30.3 ± 5.9 at month 6. This studyshows that in evaluating burns that produce hypertrophic scars, similarities exist in the POSAS score accordingto observers and patients. Precautions at the beginning of the observation will affect the POSAS score.

Le pansement est un élément important de la prise en charge des brûlures. Le but de cette étude était d’évaluerles résultats du pansement en air ambiant et à l’huile d’arachide. Il s’est agi d’une étude rétrospective descriptive menéedu 1er janvier 2014 au 31 décembre 2020 dans le service de chirurgie du centre hospitalier régional de Dédougou. Tous lespatients d’âge inférieur ou égal 15 ans présentant une brûlure grave ont été inclus. Ils ont tous bénéficié d’un protocole depansement en air ambiant et à l’huile d’Arachis hypogaea (arachide). Nous avons colligé les résultats des cas de 81 enfantsd’âge moyen de 4,8 ans. Toutes les brûlures étaient accidentelles et elles étaient thermiques dans 77 cas (95%). Elles étaientsurvenues pendant la période de l’harmattan dans 43 cas (53%). La surface corporelle brûlée moyenne était de 23,2%. Lesbrûlures étaient de 2ème degré profond dans 48 cas (59,3%). Les complications infectieuses étaient au nombre de 16 (19,7%)dont 15 cas (18,5%) de suppuration de la brûlure. Un décès est survenu dans deux cas. Le délai moyen d’épidermisationétait de 26,2 jours et la durée moyenne du séjour hospitalier de 12,5 jours. Des séquelles ont été notées dans 16 cas (20,25%)et étaient majeures dans 15 cas. Les résultats de l’application du protocole de pansement en air ambiant et à l’huiled’arachide sont encourageants. Une étude à plus grande échelle permettra d’apporter des preuves complémentaires sur sonefficacité et son innocuité.

This article presents particular occupational burn injuries resulting in a complex defect of thedigits. Nine patients with exposed bone or tendon wounds on the digits were successfully treated using thepedicle adipofascial turnover flap overlaid with skin grafts. Electrical and high-temperature contact burnsresulted in five and four severe cases, respectively. Flaps were harvested from the adjacent dorsal area ofthe injured digit and the dimension was 2 to 4 mm wider than the defect base on their reliable blood supply.It was suggested that the advantages of adipofascial turnover flaps include a simple, one-stage procedureand minimal donor site deformity.

Topical antibiotic application and occlusive dressings stand as the current standard of care forpartial thickness burn (PTB) treatment. Silver sulfadiazine (SSD) is the most widely used topical antimicrobialagent for acute burn management worldwide. Despite its antimicrobial benefits, there is emerging evidence thatSSD might delay wound reepithelialization. We hypothesized that when compared with a topical antibiotic oint-ment, wound reepithelialization with SSD would be delayed. We created 21 partial thickness burns on the backsof 3 anesthetized female domestic pigs (30kg) using an established vertical progression model. The burns wererandomly assigned to topical treatment with SSD, triple antibiotic ointment, or petrolatum ointment applieddaily for two weeks, followed by twice weekly for another 2 weeks with intermittent dressing changes. The pri-mary outcome was percentage wound reepithelialization at day 21. Our study had 80% power to detect a 25-percentage difference in wound reepithelialization at day 21. All wounds were completely reepithelialized within28 days of burn creation. At day 21 the mean (SD) percentages for wound reepithelialization were 73.6 (38.2),93.2 (16.3), and 65.0 (48.9) in wounds treated with SSD, triple antibiotic, and petrolatum respectively, P=0.049.There was no significant difference among treatment groups in scar depth at day 28. Pseudoeschar formationand erythematous hypersensitivity reactions were common findings on gross analysis with SSD and topical an-tibiotics respectively. We conclude that SSD delayed reepithelialization of partial thickness porcine burns whencompared with triple antibiotic ointment. There were no significant differences in scar depth among the groups.