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A prospective study of time to healing and hypertrophic scarring in paediatric burns:every day counts

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burns & Trauma 2017年第1期5卷 44-49页

作者： Elizabeth Chipp Lisa Charles Clare Thomas Kate Whiting Naiem Moiemen Yvonne Wilson burns Centre Birmingham Children’s HospitalSteelhouse LaneBirminghamUK

Background: It is commonly accepted that burns taking longer than 3 weeks to heal have a much higher rate of hypertrophic scarring than those which heal more quickly. However, some of our patients develop hypertrophic scars despite healing within this 3-week period. Methods: We performed a prospective study of 383 paediatric burns treated non-operatively at a regional burns centre over a 2-year period from May 2011 to April 2013. Scar assessment was performed by a senior burns therapist using the Vancouver Scar Scale. Results: Overall rates of hypertrophic scarring were 17.2%. Time to healing was the strongest predictor of developing hypertrophic scarring, and the earliest hypertrophic scar developed in a patient who was healed after 8 days. The risk of hypertrophic scarring was multiplied by 1.138 for every additional day taken for the burn wound to heal. There was a trend towards higher rates of hypertrophic scarring in non-white skin types but this did not reach statistical significance. Conclusions: The risk of hypertrophic scarring increases with every day and, therefore, every effort should be made to get the wound healed as quickly as possible, even within the traditional 3-week period usually allowed for healing. We believe that the traditional dogma of aiming for healing within 3 weeks is overly simplistic and should be abandoned: in paediatric burns, every day counts.

关键词： Scar Hypertrophic Burn Time to healing Paediatric Skin type

A rare case of failed healing in previously burned skin after a secondary burns

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burns & Trauma 2017年第4期5卷 268-271页

作者： Stephen J. Goldie Shaun Parsons Hana Menezes Andrew Ives Heather Cleland Victorian Adult burns Service Alfred Hospital Melbourne Australia Department of Surgery Monash University Melbourne Australia Victorian Adult burns Service Alfred Hospital Melbourne Australia

Background:Patients presenting with large surface area burns are common in our practice;however, patients with a secondary large burn on pre-existing burn scars and grafts are rare and not reported. Case presentation:We report on an unusual case of a patient sustaining a secondary large burn to areas previously injured by a burn from a different mechanism. We discuss the potential implications when managing a case like this and suggest potential biological reasons why the skin may behave differently. Our patient was a 33-year-old man who presented with a 5%TBSA burn on skin scarred by a previous 40%total body surface area (TBSA) burn and skin grafts. Initially assessed as superficial partial thickness in depth, the wounds were treated conservatively with dressings;however, they failed to heal and became infected requiring surgical management. Conclusions:burns sustained in areas of previous burn scars and grafts may behave differently to normal patterns of healing, requiring more aggressive management and surgical intervention at an early stage.

关键词： Previous burns Burn scar Non-healing

Foot burns and diabetes: a retrospective study

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burns & Trauma 2015年第3期3卷 151-154页

作者： E.Lawrence F.Li Concord Hospital burns Unit RhodesAustralia

Background: Diabetes in conjunction with a foot burn can compound the challenges in wound healing;however, the impact of diabetes on outcomes of patients with foot burns has not been examined. Methods: A retrospective notes audit was conducted at the Concord Hospital burns Unit for patients with foot burns who were admitted from 1st January 2012 to 31st December 2013. Data were collected for 15 subjects with foot burns and diabetes and 18 subjects with foot burns and no diabetes as a control group. Subjects were matched for percentage total body surface area of burns. Results: The mean inpatient and total lengths of stay for the diabetic group were 21.27 days and 64.80 days, which were significantly longer (P = 0.090 and P = 0.054) than the 9.61 days and 30.56 days in the control, based on a significance level of 0.10. The diabetic group was significantly older (P = 0.001), at 56.60 years versus 39.44 years in the control. Significantly (P = 0.033) more patients with diabetes were not working (n = 12/15 or 80.00 % versus n = 7/18 or 38.89 %) compared to the control. The diabetic group had higher rates of regrafting (n = 3/15 or 20.00 % versus n = 1/18 or 5.55 %) than the control and significantly (P = 0.013) more amputations (n = 5/15 or 33.33 % versus n = 0 or 0.00 %) compared to the control. Fewer patients with diabetes were prescribed pressure garments (n = 2/15 or 13.33 % versus n = 9/18 or 50.00 %), which was significant (P = 0.034). The increased age of patients in the diabetic group correlates with results from other studies. Healing time may be reflected by total length of stay, which was more than double for patients with diabetes, increasing demand and cost of inpatient and outpatient services. Conclusion: This study highlights the importance of recognizing the potential for poorer outcomes for patients with diabetes and indicates the need for more burn prevention education and promotion in this 'at risk' patient group.

关键词： Diabetes Foot burns Age Regrafting Wound healing

Epidemiology of pediatric burns and future prevention strategies—a study of 475 patients from a high-volume burn center in North India

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burns & Trauma 2017年第1期5卷 50-57页

作者： Amol Dhopte V.K.Tiwari Pankaj Patel Rahul Bamal Department of burns Plastic&Maxillofacial SurgeryVMMC&Safdarjung HospitalNew DelhiIndia Present Address:Department of burns&Plastic Surgery PGIMER&RML HospitalNew DelhiIndia

Background: Pediatric burns have a long-term social impact. This is more apparent in a developing country such as India, where their incidence and morbidity are high. The aim of this study was to provide recent prospective epidemiological data on pediatric burns in India and to suggest future preventive strategies. Methods: Children up to 18 years old admitted to the Department of burns, Plastic&Maxillofacial Surgery, VMMC&Safdarjung Hospital, New Delhi, between January and December 2014 were included in the study. Data regarding age, sex, etiology, total body surface area (TBSA), circumstances of injury, and clinical assessment were collected. The Mann-Whitney test or Kruskal-Wallis test or ANOVA was used to compare involved TBSA among various cohort groups accordingly. Univariate and multivariate linear regression analyses were used to determine the predictors of TBSA. Results: There were a total of 475 patients involved in the study, including seven suicidal burns, all of whom were females with a mean age greater than the cohort average. Age, type of burns, mode of injury, presence or absence of inhalation injury, gender, and time of year (quarter) for admission were found to independently affect the TBSA involved. Electrical burns also formed an important number of presenting burn patients, mainly involving teenagers. Several societal issues have come forth, e.g., child marriage, child labor, and likely psychological problems among female children as suggested by a high incidence of suicidal burns. Conclusions: This study also highlights several issues such as overcrowding, lack of awareness, dangerous cooking practices, and improper use of kerosene oil. There is an emergent need to recognize the problems, formulate strategies, spread awareness, and ban or replace hazardous substances responsible for most burn accidents.

关键词： Epidemiology Pediatric burns India Suicidal burns Burn prevention

Long-term medical treatment of patients with severe burns at exposed sites

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World Journal of Clinical Cases 2020年第16期8卷 3515-3526页

作者： Yong Du Guo-Zhong Lv Shun Yu Dan Wang Qian Tan Department of burns and Plastic Surgery Affiliated Hospital of Jiangnan UniversityWuxi 214000Jiangsu ProvinceChina Department of burns and Plastic Surgery The Drum Tower Clinical College of Nanjing Medical UniversityNanjing 210008Jiangsu ProvinceChina

BACKGROUND Body parts such as the face and hands are highly exposed during daily life and burns may accumulate in these *** addition,residual wounds,scar hyperplasia and contracture often exist in the late stage of a deep burn in these areas,which may affect patients’appearance,movements,and mental ***,inadequate attention has been paid to this issue which can result in problems,such as difficulty in healing,possibility of carcinoma,chronic pain and a heavy mental *** To investigate the long-term medical treatment of patients with severe burns at exposed sites following a mass burn casualty *** A retrospective analysis of 13 patients with severe burns at exposed sites was performed to determine their respective long-term medical treatment.A combined wound dressing scheme consisting of traditional Chinese and Western medicine was introduced to repair residual *** and passive functional exercises with massage,Chinese herbal baths and compression fixation were proposed to ameliorate the condition of the hands.A combination of physical,chemical and photoelectrical measures was adopted for anti-scar treatment.A psychological intervention and recovery guide was provided which corresponded to the patients’psychological *** Compared to patients who did not simultaneously receive the same treatment,patients who underwent systematic treatment recovered with a lower woundinfection rate(P<0.05),a shorter healing time(13.6±3.2 d)compared with(19.1±3.5 d)and more bearable pain during wound dressing at three days,one week and two weeks after a Chinese herbal bath(P<0.05).Satisfactory results were achieved with regard to restored function of patients’joints and blood supply to nerve endings,closure of the eyelids and the size of mouth opening tended to be normal,and only 7.1%of patients were diagnosed with severe scar hyperplasia and contracture deformity compared with 30.7%in the control *** addition,the color,thickness,va

关键词： Exposed sites Severely burned patients Mass burn casualty Medical treatment

Observation of viable alloskin vs xenoskin grafted onto subcutaneous tissue wounds after tangential excision in massive burns

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burns & Trauma 2016年第2期4卷 134-143页

作者： Haibin Zuo Guodong Song Wen Shi Jun Jia Yonghu Zhang Department of burns Jinan Central Hospital Affiliated to Shandong University105 Jiefang RoadJinanShandong 250013PR China

Background:Staged excision and grafting with viable cryopreserved alloskin or fresh pigskin at an early stage is a main strategy for wound management in massive *** is the gold standard of a biological temporary skin substitute,and the main drawback to its wider use is the limited number of *** this paper,we compare the use of fresh pigskins to cryopreserved alloskins as temporary skin substitutes on subcutaneous tissue wounds after tangential excision by observing the clinical performances of these grafts in cases of a massive ***:We selected six adult massive burn patients undergoing tangential excision and skin grafting on subcutaneous tissue wounds(TESGSTW)at our burn center from January 1,2003 to December 31,*** general clinical data and survival percentage of skins at postoperative weeks(POWs)1,2,and 3 were *** our clinical practice,we also observed the phenomenon that several viable cryopreserved alloskin or fresh pigskin grafts used as temporary coverage on subcutaneous tissue wounds had long-term survival after repeated *** macroscopic and histological results of one typical case were also ***:In this study,the first three TESGSTW operations were performed at 2–3,5–8,and 11–16 days *** operation areas were 30.3±7.9%total body surface area(TBSA),19.0±6.0%TBSA,and 12.0±1.7%TBSA,*** survival percentage of the cryopreserved alloskins or fresh pigskins at POWs 1,2,and 3 were 80.0±10.0%vs 75.7±5.3%(t=1.01,P=0.16),71.2±10.6%vs 66.4±6.2%(t=1.09,P=0.30),and 48.7±2.5%vs 35.0±7.0%(t=3.83,P=0.03),*** microscopic observation of the survival of alloskins or pigskins in one typical case showed rete ridges and a basilar membrane at the joint of the epidermis and dermis at an early stage;these structures disappeared with extended time ***:From the clinical observations,fresh pigskin and cryopreserved alloskins could be used with equal effectiveness a

关键词： Burn Skin grafting Alloskin Xenoskin Subcutaneous tissue

Epidemiology of isolated foot burns in children presenting to a Queensland paediatric burns centre—a two-year study in warmer climate

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burns & Trauma 2017年第1期5卷 58-63页

作者： Florence Ngu Bhaveshkumar Patel Craig McBride Pegg Leditschke Children’s burns Centre Department of Paediatric SurgeryLady Cilento Children’s Hospital501 Stanley StreetSouth Brisbane QLD 4101Australia Centre for Children’s burns and Trauma Research Queensland Children’s Medical Research InstituteUniversity of QueenslandQueenslandAustralia

Background: European studies of paediatric foot burns report scalds as the leading cause. Mechanisms of injury are different in warmer climates. We sought to characterize the mechanisms and outcomes of isolated foot burns in our population. Methods: Retrospective review of a prospectively collected database of all children aged 0–15 years presenting to a Queensland paediatric burns centre over a 26-month period. Non-parametric analyses such as the Mann-Whitney U and Pearson Chi-square were used. Results: There were 218 children with foot burns treated over a period of 2 years and 2 months of which 214 had complete records. There were significantly more boys than girls (n=134, 62.6% cf. n=80, 37.4%, pburns were a minority but were significantly deeper (p=0.03) and significantly more likely to require grafting (p=0.04) and scar management (pburns. Conclusions: In our population, contact burns are the most common mechanism of injury causing burns to the feet. The leading aetiology is campfire burns, which account for one-third of all burns to the feet. Prevention campaigns targeted at this population could significantly reduce the burden of morbidity from these burns. Friction, flame and chemical burns constitute a minority of patients but are deeper and more likely to require skin grafting and scar management.

关键词： Epidemiology Foot burns Paediatric Scald Australia Campfire

Successful treatment of invasive burn wound infection with sepsis in patients with major burns

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Chinese Medical Journal 2000年第12期000卷 86-90页

作者：柴家科盛志勇杨红明刁力李立根 burns Institute 304th HospitalBeijing 100037China

To investigate the clinical characteristics of invasive burn wound infection with sepsis in patients with major burns and to summarize the successful experiences in the treatment of such patients Methods Eight patients with major burns, complicated by invasive burn wound infection and sepsis were consecutively admitted to our hospital from September 1997 to October 1998 Among them, 6 patients developed multiple organ dysfunction syndrome (MODS) and 2 developed septic shock The plasma concentrations of IL 6, IL 8, TNFα and lypopolysaccharide (LPS) were assayed before and after surgical intervention, as well as when the patient's vital signs became stable Results The patients' conditions usually deteriorated abruptly when extensive invasive burn wound infection emerged While multi microbial infection was usually found, Pseudomonas aeruginosa was the predominant bacteria isolated from the subeschar tissue The plasma concentrations of IL 6, IL 8, TNFα and LPS before surgical intervention were significantly higher than those after surgical intervention ( P <0 05) The lowest levels of the inflammatory mediators were observed when the patients' conditions became stable, and the values were significantly lower than those before surgical intervention ( P <0 001) Conclusion Since the main cause of burn wound sepsis is the presence of a large area of infected burn wound, they should be excised and covered as early as possible LPS and pro inflammatory mediators play an important role in the pathogenesis of burn sepsis Although favorable results should be attributed to comprehensive treatment, we believe that early, aggressive and thorough surgical excision of infected burn wounds, followed by sound and complete coverage of the area, play a crucial role

关键词： burns · burn wound sepsis · treatment?

Decreasing incidence of cutaneous chemical burns in a resource limited burn centre: is this a positive effect of modernization?

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burns & Trauma 2017年第1期5卷 64-67页

作者： R.E.E.Nnabuko C.P.Okoye I.S.Ogbonnaya Egi Isiwele burns and Plastic Department National Orthopaedic HospitalPMB 01294 EnuguNigeria Department of Surgery University of Calabar Teaching HospitalCalabarNigeria

Background: burns present a devastating injury to patients. burns caused by chemical agents, present a worse scenario. In a resource limited country like Nigeria, readily available sources of these corrosive agents are mainly from lead-acid battery vendors and to some extent local small scale soap manufacturers who use caustic soda. We hypothesized that with the reduction in small scale soap manufacturing and increasing trend towards modernization in the use of dry cell batteries, chemical burns may be on the decline, and we sought to investigate this. Methods: The records of all acute burn patients seen at the burns and Plastic Department of the National Orthopaedic Hospital Enugu Nigeria between January 2011 and December 2014 were retrospectively reviewed. The results were compared to similar studies carried out at the same centre. A questionnaire was administered to corrosive chemical (sulphuric and caustic soda) vendors to assess the trends in product sales and use in recent times. Results: A total of 624 acute burn cases were treated during the period;among which, 12 cases (1.9%) were chemical burns. When compared with previous studies at the centre, Chemical burn cases were recorded as the lowest rate. The median age of patients was 24 years. There were eight males and four females. Interpersonal assault was the commonest mechanism of injury with sulphuric acid suspected to be the commonest agent in 83.3% of the cases, while 16.7% of the cases were from accidental use of caustic soda. The head and neck as well as the upper limbs were the most affected (30%). Twenty-six questionnaires to lead-acid vendors were analyzed and revealed that all respondents noticed a marked downward trend in the sale of either sulphuric acid or caustic soda, and they attributed this to the ready availability of imported alternatives to locally manufactured soap or wet lead-acid batteries. Ease of use, durability and convenience of the dry cell batteries were cited as principal reaso

关键词： Chemical burns Interpersonal assault Lead-acid battery vendors Resource-limited country Modernization