Les brûlures des nouveau-nés ont des caractéristiques qui diffèrent de celles des enfants plus grands : elles sont souvent iatrogènes et par flamme. Les capacités de cicatrisation sont plus importantes mais la finesse de la peau explique que les lésions soient plus graves à exposition identique. Les antiseptiques et les différents pansements utilisables, ainsi que ceux qui sont contre-indiqués chez le nouveau-né, sont décrits. Les antalgiques utilisables ainsi que les règles de remplissage vasculaire sont rappelés. Des techniques chirurgicales de couverture particulières sont souvent utilisées pour pallier le manque de surface cutanée prélevable pour des autogreffes. Malgré leur fragilité, les nouveau-nés montrent des capacités de cicatrisation et de résilience considérables.

La face est une région corporelle où, en cas de séquelles de brûlures, le préjudice esthétique est maximal et le préjudice fonctionnel très important. Nous présentons une étude rétrospective, monocentrique effectuée durant 6 ans dans le service de chirurgie plastique du CHNU de Fann à Dakar, portant sur 93 patients. L’âge moyen était de 14,19 ans. La tranche d’âge la plus exposée était celle comprise entre 0 et 5 ans (33,3%). On notait une prédominance féminine de 53,76%. En termes d’origine géographique, la région de Dakar était la plus représentée (61,29%). La durée d’évolution moyenne était de 24 mois. La majorité des brûlures était d’origine thermique (90,32%). Une origine criminelle a été retrouvée dans 8,6% des cas. La grande majorité (84,95%) des accidents ont eu lieu à domicile. La région la plus atteinte était la joue (47,31%). Parmi les séquelles, les cicatrices pathologiques (47,32%) dominaient. Avec un délai de prise en charge de 2 mois et un recul moyen de 6 mois, 60,21% des patients ont reçu un traitement. La plupart (88%) de nos patients opérés ont été satisfaits du résultat à court terme sur le plan fonctionnel et 47,1% sur le plan esthétique. Nous avons noté 6 complications (10,7% des cas traités): 3 cas d’infections et 3 cas de lyse totale de greffe. Les brûlures de la face affectent considérablement la vie des victimes. Sa prise en charge optimale repose sur la prévention ainsi qu’un traitement initial précoce et efficace.

Pathological scars represent a frequent entity of burns sequelae that affect the aesthetic, functional and psychological status of patients. This study aims to assess the prevalence of pathological scars following burn injuries in the central-eastern and central-western regions of Tunisia and to replicate the factors that affect scar outcome. A retrospective, monocentric study was conducted among 259 subjects. Factors influencing scar outcomes, such as patient demographics and comorbid conditions, were systematically explored alongside injury characteristics and clinical variables. A logistic regression model was performed for factors significantly associated with the development of pathological scars. In our series, the prevalence of pathological scars was recorded at 45.2%, with hypertrophic scars being the most common type. This study identified injury and clinical predictors of hypertrophic scarring after controlling for confounding variables: feminine gender, young age, 3rd degree burns, anatomical location of the burn in the neck, the thorax or the lower limb, skin graft and multiple surgical procedures. As for keloid scars, the predictive factors were: TBSA and location of the burn in the neck. Ulcerated scars post burn are significantly associated with the development of a retractile band and burns located on the lower limb. This study indicates that these scars affect a substantial proportion of burn survivors, taking into account the Tunisian healthcare system and patient demographics. The reported statistics provide practical benefits for clinical-decision making.

Epilepsy is a neurological disease characterized by an enduring predisposition to recurrent seizures. Approximately 1% of the global population is affected by epilepsy, making it the second most common neurological disease after stroke. Individuals with epilepsy are at heightened risk for both seizure-related and unrelated injuries, including soft tissue injuries, head injury, dental and tongue injury, burns and orthopaedic injuries. Several individual studies on epilepsy and burn injuries have been published from various countries. However, there is a paucity of review summaries on epilepsy-related burn injuries, especially in low-resource settings. In this review we highlight an underreported cause of burn injuries in epilepsy patients, particularly in low-resource settings where both epilepsy and burn care remain challenging.

Axillary burn sequelae, particularly scar contractures, present significant functional and aesthetic challenges despite advances in burn care. This retrospective study, conducted at the CHU Habib Bourguiba between 2009 and 2017, investigates the epidemiology, management, and functional outcomes of patients treated for axillary burn contractures. A total of 20 patients were included, with a median age of 23.8 years. The most common burn agent was thermal, and the majority of patients were from rural areas with low socio-economic status. Surgical treatment, including local and loco-regional flaps, was performed after a median delay of 7–24 months, leading to a mean functional gain of 61.3% in shoulder abduction. Post-operative results showed that 81% of patients had good to very good functional outcomes. Early surgical intervention and rehabilitation were crucial for improving shoulder mobility, while aesthetic results were also satisfactory. These findings underscore the importance of timely surgical management and the need for comprehensive rehabilitation to restore function and prevent recurrence of contractures in axillary burn sequelae.

The usage of cadaveric allografts for the early coverage of burn wounds has helped to reduce morbidity and mortality. The main issue faced by skin banks is the paucity of skin donors due to a lack of awareness and misconceptions about skin donation. This study was conducted to assess awareness about skin donation among hospital care personnel and to increase awareness. After ethical committee clearance, all healthcare personnel of Kasturba Hospital and affiliated medical and paramedical institutes were included in the study. The Google Form Link, which included the questionnaire and an information sheet, was emailed to the participants. A total of 1006 participants took part in the study. 74.8% were aware of skin donation, with 51.6% willing to donate skin. 60% of the participants were aware that skin has to be harvested within 6 hours after death. 37.8% of participants were aware that HLA/blood group matching was not required between skin bank donors and recipients, 88.7% knew that cadaveric skin can be used for burns and trauma patients, and 52.1% thought that cadaveric skin is a permanent solution for burn wounds. 76.9% of the study participants knew that malignancy is a contraindication. We observed that most participants were aware of skin donation and skin banking, and about 50% were willing to donate skin. Skin donation and banking as a topic in the undergraduate syllabus of medical, paramedical and nursing courses can increase awareness among health personnel.

Burn injuries in elderly patients within resource-limited settings represent a major therapeutic challenge due to increased vulnerability associated with age-related physiological changes and prevalent comorbidities. This study focuses on intermediate-severity burns and aims to identify clinical predictors of delayed wound healing and burn wound infection in elderly patients in Central Tunisia. We conducted a retrospective study including patients aged 65 years and older who were hospitalized for thermal burns between January 2013 and December 2022. Demographic, clinical and outcome data were analyzed using SPSS v26. Prognostic factors for delayed healing and infection were identified through multivariate logistic regression. Among 414 burn admissions, 31 patients (7.48%) were aged ≥65 years. Flame burns were predominant (77.4%). Key predictors of poor outcomes included: total body surface area burned (TBSA) >10% (OR 3.2; 95% CI 1.4–7.1); full-thickness burns (OR 2.8; 95% CI 1.2–6.5); delayed admission >24 hours (OR 2.1; 95% CI 1.1–4.3). In elderly patients with intermediate-severity burns, early specialized intervention and optimal management of comorbidities are essential to reduce the risk of delayed healing and infection.

This study determined mortality rate and risk factors for death of burn patients suffering septic shock. An observational study was conducted on 38 severe adult burn patients who developed septic shock at the burn intensive care unit, National Burn Hospital, from January 2023 to June 2024. Patients were divided into survivor and non-survivor groups. Results showed that 23 patients died, accounting for 60.53%. Age, gender, admission time post burn, incidence of inhalation injury, required mechanical ventilation on admission as well as onset time of septic shock were not significantly different between groups (p >.05). Compared to the survivor group, burn extent and deep burn area were significantly larger in the non-survivor group (p <.05). Baseline parameters including white blood count, total plasma protein and albumin concentration were significantly lower (p <.01); rate of positive blood cultures (56.52% vs. 20%; p=.03) and plasma IL-6 level (689.46 pg/mL vs. 243.16 pg/mL, p=.02) were significantly higher in the non-survivor group. Meanwhile, plasma level of endotoxin and TNF-α were not remarkably different between the two groups. Multivariate analysis showed that only plasma IL-6 level at the septic shock onset was an independent risk factor for death (p <.05) with AUC at .73, cut-off point at 249.46 pg/mL, sensitivity at 82.61% and specificity at 60%. Further studies should be conducted to confirm the role of IL-6 in the prognosis of burn patients with septic shock complication.

Lightning strikes are a rare cause of multisystem trauma, often leading to complex injuries. This case report highlights the management of a 70-year-old male with bilateral Le Fort II and III craniofacial fractures and burn injuries following a lightning strike. The case emphasizes the need for a multidisciplinary approach in managing such complex trauma. Upon presentation, the patient underwent an immediate stabilization following the Advanced Trauma Life Support (ATLS) protocol, including primary and secondary surveys. A comprehensive trauma assessment was conducted, utilizing imaging studies to determine the full extent of craniofacial and associated injuries. Burn wound assessment showed second-degree burn on the left upper extremity (TBSA 6%). The patient received consultations from multiple specialties, including neurosurgery, otolaryngology, ophthalmology and plastic surgery, to develop a tailored treatment plan. The CT scans revealed bilateral Le Fort II and III-like fractures with intact pterygoid plates, which directed the decision towards non-operative management of the craniofacial injuries. The patient’s burn wound was surgically managed with debridement and the application of a biosynthetic dermal substitute. The patient’s wounds healed successfully within six weeks, with no complications. This case underscores the importance of a multidisciplinary approach in managing lightning strike injuries, particularly when craniofacial fractures are involved. The unique vector of force in this patient spared the pterygoid plates, resulting in minimally displaced Le Fort-like fractures, which were managed conservatively. The use of a biosynthetic dermal substitute facilitated optimal burn healing, demonstrating its effectiveness in managing partial-thickness burns.

Severe burn injuries induce profound physiological and immunological alterations that significantly affect the pharmacokinetics and pharmacodynamics of antimicrobial agents. These changes complicate standard dosing strategies and demand individualized, PK/PD-driven approaches to antimicrobial therapy to prevent treatment failure, resistance and toxicity. This retrospective clinical-analytical study included 154 pediatric and adult patients admitted to the ICU of a tertiary burn center in 2023. Antimicrobial use was quantified using the defined daily dose (DDD) and normalized per 100 patient-days. Logistic regression was applied to identify predictors of antibiotic use. Sepsis occurred in 16.2% of patients, with significantly higher mortality (36%) compared to non-septic patients (3.8%, p<0.0001). Septic patients were older, had larger burn areas, deeper burns, and longer ICU stays. Infections were predominantly caused by Gram-positive bacteria, with MRSA comprising 53% of Staphylococcus aureus isolates. Antibiotic use was significantly greater among septic patients, with 80% receiving ≥3 regimens. Overall, antibiotic consumption was 56.76 DDD/100 patient-days, with metronidazole, ceftriaxone and amikacin being the most used agents. Logistic regression revealed that each 1% increase in burn surface area increased the odds of antibiotic use by 1.6 times, and each additional hospital day by 2.9 times. Septic burn patients experience significantly higher mortality and antibiotic exposure. The high prevalence of resistant organisms such as MRSA underscores the need for local antibiogram-guided therapy. Burn size and length of stay are strong predictors of antibiotic use. Therapeutic drug monitoring and PK/PD-based dosing are essential for optimizing antimicrobial therapy and minimizing resistance in this vulnerable population.

Les brûlures du cuir chevelu sont habituellement de traitement facile, grâce à l’épaisseur du derme et à la grande densité de follicules pileux dans cette région. Malheureusement, dans certains cas de brûlures du troisième degré, la totalité de l’épaisseur des tissus mous est nécrosée, nécessitant le recours à des lambeaux locaux ou libres pour obtenir la cicatrisation. Nous présentons deux cas de patients ayant atteints de brûlures de pleine épaisseur du cuir chevelu. Ils ont nécessité un débridement cutané, suivi dans un cas d’un débridement osseux après réalisation d’un scanner et d’une IRM. La couverture osseuse a été assurée par des lambeaux locaux dans les deux cas. Les zones donneuses des lambeaux ainsi que les zones brûlées au second degré ont été couvertes par des greffes de peau mince. Ce type de brûlure pose plusieurs problèmes. Premièrement, il peut entraîner une thrombose veineuse du sinus longitudinal supérieur, nécessitant une anticoagulation curative susceptible de compliquer les gestes chirurgicaux. Deuxièmement, le choix entre lambeaux locaux et greffes cutanées peut être difficile, en raison de l’évaluation de la profondeur des brûlures et de la surface de peau saine disponible. Ce type de brûlure nécessite une prise en charge dans un centre spécialisé.

Burnout is an increasingly prevalent issue in healthcare, particularly in high-stress hospital units that demand constant emotional, cognitive, and ethical engagement. This qualitative study explores the lived experiences and clinical consequences of burnout among healthcare professionals working in the Emergency, Intensive Care, and Burn Units at the University Hospital Center “Mother Teresa” in Tirana, Albania. Employing a phenomenological approach, the study involved 18 experienced clinicians (9 physicians and 9 nurses), each with a minimum of five years of service. Semi-structured interviews were conducted, and the data were thematically analyzed to examine how prolonged emotional and occupational stress affects empathy, communication, clinical decision-making, and moral sensitivity. The study also investigates how the presence or absence of institutional support shapes these experiences and impacts the quality of patient care. Thematic analysis revealed four central themes: lack of institutional support, moral strain in clinical practice, impaired decision-making, and erosion of empathy, all contributing to compromised care quality. Burnout presents significant risks not only to the mental health of healthcare professionals but also to patient safety, potentially creating a self-reinforcing cycle of emotional disengagement, moral distress, and systemic dysfunction if left unaddressed. As one of the first qualitative investigations of burnout within the Albanian healthcare context, this study offers valuable insights to inform the development of targeted strategies and institutional policies aimed at protecting healthcare workers’ well-being and improving the overall quality of patient care.