The impact of the use of silicone dressings on reducing the extent of surgical intervention in the treatment of second- and thirddegree burns

Introduction Burn injuries pose a significant healthcare burden, with a substantial number of patients requiring hospital or emergency room treatment each year. Janzekovic generated renewed interest in early excision in 1970 when she reintroduced the concept of tangential excision of the necrotic tissue and immediate resurfacing with split-thickness skin grafts. Timely excision and grafting are now the standard surgical management of deep burns. However, existing studies lack comprehensive verification and fail to specify optimal operative periods for patients with third-degree burns. To address this gap, our objective was to determine the optimal skin graft operative days for burn surgery in patients suffering from third-degree burns. Methods In this retrospective analysis, we isolated a group of burn patients who met the criteria for surgical burn repair, including burns injuries greater than 20% total body surface area (18-64 years old) or greater than 15% total body surface area (65-89 years old). The patients were categorized based on the percentage of third-degree burns, and an area under the curve (AUC) analysis was performed to evaluate the correlation between earlier surgical intervention and survival outcomes (AUC>0.5 with a p< 0.05 were considered significant. Results A total of 163 patients fitting the criteria were included in the ten-year period 2012-2022. Our results demonstrated that earlier operative days were a significant predictor of mortality for patients with third-degree burn percentages within the ranges of 0.0-9.9% TBSA (n=58, AUC=0.5740, p=0.0002), 10-19.9% TBSA (n=38, AUC=0.5572, p=0.0043), and 30-39.9% TBSA (n=12, AUC=0.7272, p=0.0106). Interestingly, the operative day for patients with 20-29.9% TBSA burns did not significantly predict mortality (n=34, AUC=0.275, p=0.0112). Due to the limited number of patients with greater than 40% TBSA third-degree burns (n=21), further research with a larger sample size is required for accurate data analysis for that category. Conclusions In summary, our retrospective analysis highlights the crucial role of operative timing in treating third-degree burns. We found a significant association between earlier surgical intervention and better survival outcomes for patients with burns covering less than 40% TBSA. While further research is needed for patients with greater than 40% TBSA burns, our findings provide valuable insights into optimizing surgical timing to enhance patient care and reduce mortality in burn management. Applicability of Research to Practice Our research findings offer practical implications for healthcare practitioners. We emphasize the importance of timely surgical intervention for patients with third-degree burns covering less than 40% total body surface area (TBSA). Specifically, our study recommends performing skin graft surgery within three days of admission, when feasible for improved patient outcomes and reduced mortality rates in burn management.

Introduction Thermal injury due to contact with engine exhaust systems represents a distinct subgroup of acute contact burns. Temperatures generated by motor vehicle, radiator, and lawn mower engines can exceed 250℃, at which point relatively deep tissue loss occurs with less than 0.06 seconds of cutaneous exposure. While prior studies have helped elucidate the demographic characteristics of exhaust pipe contact burns, our analysis was aimed at both demographics and burn severity, as indicated by rate of full-thickness injury and requirement for tangential excision and skin grafting. Methods Data were obtained from a retrospective review of admissions at a regional burn center between 1 July 2012 and 30 August 2016. Patients of all ages with muffler, exhaust, motorcycle, lawn mower, and radiator burn injuries were included. Extensive demographic information, percent total body surface area burned (TBSA), burn etiology and location, third-degree and fourth-degree burn percentage, and subsequent operative information were analyzed for patients who sustained exhaust pipe contact burns. These data were then compared with all contact burn injuries from the same time period, matched for %TBSA range, using Fisher exact and unpaired t-tests. Results A total of 110 patients suffered exhaust pipe contact burns during the study period; 65 (59%) were males, and mean age was 30. Nearly two thirds of the muffler burns were sustained from motorcycles with TBSA ranging from 0.05% to 3.14%; at least 61% had some third-degree burn. The average number of operating room visits per patient was 0.54, though this varied significantly, with 38 patients (35%) requiring 59 total surgeries (range 1–6). Muffler burn patients were older than the matched control group. The most common location of burn injury was the lower leg with no difference between adults and children. Pediatric patients understandably had smaller burn surface area but similar TBSA compared to adults. The majority of injuries occurred in May, June, and July. Conclusions Exhaust pipe contact burns comprise a specific subset of low %TBSA contact burns with relatively high morbidity, evidenced by a significantly higher proportion of full-thickness tissue loss and eventual need for skin grafting when compared with nonexhaust burn controls. Awareness of the increased severity of exhaust pipe contact burns may lead to more expedient surgical intervention as well as further education regarding preventative measures.

Burn injuries represent a significant clinical challenge due to the complexity of accurately assessing burn depth, which directly influences the course of treatment and patient outcomes. Traditional diagnostic methods primarily rely on visual inspection by experienced burn surgeons. Studies report diagnostic accuracies of around 76% for experts, dropping to nearly 50% for less experienced clinicians. Such inaccuracies can result in suboptimal clinical decisions-delaying vital surgical interventions in severe cases or initiating unnecessary treatments for superficial burns. This diagnostic variability not only compromises patient care but also strains health care resources and increases the likelihood of adverse outcomes. Hence, a more consistent and precise approach to burn classification is urgently needed. The objective is to determine whether a multimodal integrated artificial intelligence (AI) system for accurate classification of burn depth can preserve diagnostic accuracy and provide an important resource when used as part of the electronic medical record (EMR). This study used a novel multimodal AI system, integrating digital photographs and ultrasound tissue Doppler imaging (TDI) data to accurately assess burn depth. These imaging modalities were accessed and processed through an EMR system, enabling real-time data retrieval and AI-assisted evaluation. TDI was instrumental in evaluating the biomechanical properties of subcutaneous tissues, using color-coded images to identify burn-induced changes in tissue stiffness and elasticity. The collected imaging data were uploaded to the EMR system (DrChrono), where they were processed by a vision-language model built on GPT-4 architecture. This model received expert-formulated prompts describing how to interpret both digital and TDI images, guiding the AI in making explainable classifications. This study evaluated whether a multimodal AI classifier, designed to identify first-, second-, and third-degree burns, could be effectively applied to imaging data stored within an EMR system. The classifier achieved an overall accuracy of 84.38%, significantly surpassing human performance benchmarks typically cited in the literature. This highlights the potential of the AI model to serve as a robust clinical decision support tool, especially in settings lacking highly specialized expertise. In addition to accuracy, the classifier demonstrated strong performance across multiple evaluation metrics. The classifier's ability to distinguish between burn severities was further validated by the area under the receiver operating characteristic: 0.97 for first-degree, 0.96 for second-degree, and a perfect 1.00 for third-degree burns, each with narrow 95% CIs. The storage of multimodal imaging data within the EMR, along with the ability for post hoc analysis by AI algorithms, offers significant advancements in burn care, enabling real-time burn depth prediction on currently available data. Using digital photos for superficial burns, easily diagnosed through physical examinations, reduces reliance on TDI, while TDI helps distinguish deep second- and third-degree burns, enhancing diagnostic efficiency.

Genital Burns in the National Burn Repository: Incidence, Etiology, and Impact on Morbidity and Mortality

Backgroundand objectives: Burn patients represent a challenging cohort because the injuries entail a vulnerability to colonisation by microorganisms. The ensuing infections can lead to serious complications and, in many cases, to the death of the burn patient. Surgical intervention and wound dressings, as well as antibiotic treatment, are crucial for optimising the treatment of the patient. Material and Methods: In this retrospective analysis, we analysed the treatment course, antibiotic therapy, and general complications of 252 burn patients with second- or third-degree burns over a time span of 7 years. Results: Patients who developed infections tended to have, on average, a higher total body surface area (TBSA), higher abbreviated burn severity index (ABSI) scores, and longer hospital stays. Patients who were admitted to the burn unit after 2006 had significantly shorter stays in the burn unit. TBSA and ABSI scores were lower in the patient cohort admitted after 2006. Patients exhibiting a TBSA greater than 30% had significantly longer hospital stays and antibiotic treatment periods. TBSA and ABSI scores were significantly higher in patients who died. The results of binary logistic regression indicate that a higher ABSI score increases the odds ratio of developing an infection. Bacteria number had no significant effect on the odds of patient death but positively influenced the odds ratio of developing an infection. TBSA was negatively associated with the risk of developing an infection and was an insignificant predictor of mortality. Conclusions: To gauge the optimal treatment for a burn patient, it is crucial for practitioners to correctly select, dose, and time antibiotics for the patient. Monitoring bacterial colonisation is vital to nip rising infection in the bud and ensure the correct antibiotic selection. This will help prevent the development of multi-resistant bacteria.

BACKGROUNDAlthough electrical burns are less prevalent than other types, they put socioeconomic burden on communities, yielding higher mortalities. Therefore, the frequency and causes of electrical burns in the largest burn center in northern Iran were studied.METHODSAll patients with electrical burn injuries admitted to Velayat Hospital, Rasht, Iran participated in this descriptive cross-sectional study. The data collection tool was a checklist including demographic data, damage mechanism, voltage classification (high or low), injured organ, ICU need, length of stay (LOC), electrical burn severity (degree and area of burns based on TBSA), surgical interventions, and return to work. All data were gathered through HIS system and analyzed.RESULTSMost electrical burns occurred in men (99.4%) and most of whom had electricity-related jobs (26%). The majority of victims had third-degree burns (63%), and electrical current-induced burns in entry points occurred in the upper and lower extremities, head and other organs ranked the first to fourth, respectively. Most burns happened due to abrupt contact with electrical current (83.33%) in routine home activities (52.78%). The mean LOC was 8.73 days, suggesting that LOC increased significantly, if the electrical current entered the body through lower extremities, while it decreased significantly, if the electrical current exited through lower extremities. CONCLUSIONThe majority of electrical burn victims were men. Most burns occurred in urban communities in summer. Most people were affected by high voltage electricity.

Thousands of people are injured in motor vehicle collisions daily and the mandated installation of airbags protects passengers but can also cause injuries from deployment including cutaneous burns. We sought to characterize the patterns and outcomes of burns resulting from airbag deployment by performing a retrospective review of all patients evaluated by the burn service from May 1, 2015 to April 30, 2019. Inclusion criteria were patients of all ages with burn injuries related to airbag deployment. Demographic data, burn characteristics, and outcomes were reviewed. Seventeen patients met the inclusion criteria: 82.4% female and 17.6% male. The average age was 40.4 years. Fifteen patients had second-degree and two had third-degree burns. The average TBSA was 0.45%. The hands or upper extremity (88%) were most often injured, but there were two chest, one neck, and one anterior thigh burns. Eight patients suffered multiple burns. Burn etiology (chemical vs thermal) was often not specified. No patients required hospitalization or surgical intervention, and all wounds healed with wound care. The average time to re-epithelialization was 11 days. Although airbags prevent mortality and serious injury, the exothermic chemical reaction that inflates the airbag is responsible for deployment-related burns. Since there is a chemical and thermal component, all airbag-related burns should undergo chemical decontamination on the initial presentation. Burns related to airbag deployment tend to be small and do not require grafting; however, patients suffer from associated pain, scarring, and burn management can be a financial and time burden to the patient.

Parkin mutation may be associated with serious akinesia in a patient with Parkinson's disease

Pediatric upper extremity burns are common. Though current American Burn Association guidelines recommend burn unit referral for burns involving the hands or major joints, many minor injuries are treated in the emergency department (ED) or outpatient setting. Despite the large number of burn patients managed by primary care providers, no large studies have been performed to assess effectiveness. A retrospective 5-year review of the epidemiology and outcomes associated with pediatric upper extremity burns treated at an urban ED was performed. Two hundred sixty-nine patients were identified. The mechanism of burn, percentage of total body surface area (%TBSA) affected, plastic surgery consultations (for wound management recommendations and additional treatment), complications, and surgical interventions were examined. Mechanisms of burn included direct contact (47%), scald (29%), flame (12%), electrical (10%), and friction or chemical (1.5%). Fifty percent of patients suffered from burns over less than 1% TBSA; close to 95% had burns on less than 5% TBSA. Seventy-five percent of patients had second-degree burns, 21% had first-degree burns, and 2% had third-degree burns. Forty patients (15%) had a plastic surgery consult. Seven patients (3%) required skin grafting. Complications occurred in five (2%) patients and included two cases of hypertrophic scarring; two patients with flexor contractures, one case of compartment syndrome requiring fasciotomy, and one late infection. These results suggest that although significant burns are usually cared for in specialized burn centers, the majority of childhood burns to the upper extremity are relatively minor and often treated in the primary care setting. Most patients had small areas of injury and healed without complications. Contact burns are an ever-increasing proportion of childhood burns and should be seemingly preventable. Education to parents and primary care physicians should be reemphasized. It appears that minor upper extremity burns treated by our urban ED staff are handled appropriately and result in favorable outcomes.

A 6-month-old boy presents with a temperature of 38.9°C and barking cough of 3 days’ duration as well as a rash over his body for 1 day. On physical examination, his temperature is 37.5°C, respiratory rate is 28 breaths/min, and blood pressure is 87/52 mm Hg. He appears nontoxic and has a barking cough, injected conjunctiva with whitish discharge, dry lips, mild inspiratory stridor, a blanching erythematous maculopapular rash on his trunk and extremities, and small cervical lymph nodes. The rest of his physical findings are normal. His Hgb is 12.8 g/dL (128 g/L), WBC count is 11.7×103/mcL (11.7×109/L) with 75% neutrophils and 23% lymphocytes, and platelet count is 515×103/mcL (515×109/L). His stridor is considered to be due to viral croup, and he is treated with intramuscular (IM) dexamethasone and nebulized racemic epinephrine. A lateral neck radiograph reveals widening of the retropharyngeal space (Fig. 1), and he is started on clindamycin. CT scan of the neck reveals a right retropharyngeal abscess (Fig. 2). He continues to have high spiking fevers and experiences stridor at rest. He is started on IM dexamethasone every 6 hours, and his fever subsides the following day. Figure 1. Lateral neck radiograph showing widening of the retropharyngeal space. Figure 2. CT scan of the neck showing a right retropharyngeal abscess (arrow). On hospital day 6, the corticosteroids are stopped, but the fever returns the following day. Two days later, an erythematous maculopapular rash reappears, and the child’s lips are dry and cracked. On day 10, repeat CT scan shows that the retropharyngeal abscess has resolved. An additional imaging study reveals the cause of his symptoms. A 3-month-old previously healthy girl presents to the ED with a 1-day history of a blistering rash. Her parents noted an erythematous area on her occiput after …

Intrapleural Photodynamic Therapy for Mesothelioma: What Place and Which Future?

Iatrogenic third-degree burn caused by off-label use of an infrared radiant heat lamp in a patient with accidental hypothermia

Background: Firecracker injuries are very common in India. They are mostly used during the various festivals celebrated in India. This study analyses the profile and outcome of firecracker injuries in the emergency department (ED). Materials and Methods: This was a retrospective observational study of all firecracker-related injury patients presenting to our ED. Details of the incident, injuries, management, and outcome were noted. Data were extracted from the ED triage software and hospital electronic database. Results: We received a total number of 13,604 trauma patients to our ED, among which 92 (0.7%) had firecracker burst-related injury. The mean age of the patient was 27 (standard deviation 11.6) years. Male (97.8%) predominance was noted. Majority of them were triaged to Priority II, i.e., 64 (70%) patients and 6 (6%) in Priority I. The mean number of incidents per month during the festive season of Diwali was 3.25 compared to 3.95 during the rest of the year. The majority of the injuries had sustained lacerations (78.5%), followed by abrasions (12.9%). Among all patients, only 4.3% (4) suffered second- and third-degree burns each. It was noted that the upper limbs (79.6%) were most commonly involved as expected, followed by the face (16.1%). The new injury severity score was more than 5 in (6.4%) of patients. Most patients were taken up for emergency procedures such as wound wash, debridement, suturing, or nailing of the fractures in the ED. Majority (81.5%) required hospital admission and had to undergo major surgical intervention. The rest were either discharged stable or discharged against medical advice after primary care. Conclusions: This study has expressed the pattern of firecracker injuries. An alarmingly high number of young adolescents with significant upper limb injuries were noted. Public awareness and education along with increase legislative enforcement are needed for the betterment and well-being of the mass during the festival season to prevent the catastrophe since these injuries are prevalent in the productive age groups.

Acute Surgical Management of Hand Burns

Severe thermal injury induces inflammatory and hypermetabolic responses that are associated with morbidity and mortality. However, it is not well-documented whether the causes of burns affect inflammation, hypermetabolism, and morbidity. The aim of the present study was to determine whether there is a difference in degree of inflammation, hypermetabolism, endocrine and acute-phase response, and clinical outcome between pediatric patients with scald and flame burns. None. Children with burns requiring surgical intervention were enrolled in this cohort study and divided into two groups, scald or flame burn. In a second assignment, we analyzed the study populations in representative subgroups containing individuals with third-degree burns of 40% to 60% total body surface area. We determined clinical outcomes, resting energy expenditures, cytokine profiles, acute-phase proteins, constitutive proteins, and hormone panels. Statistical analysis was evaluated by analysis of variance, Student's t test corrected with the Bonferroni post hoc test, and the propensity score. Statistical significance was set at p < .05. A total of 912 patients were identified. Six hundred seventy-four had a flame burn and 238 had a scald burn. There was a significant difference (p < .05) in burn size (flame, 48% ± 23%; scald, 40% ± 21%), third-degree burn (flame, 39% ± 27%; scald 22% ± 25%), age (flame, 8 ± 5 yrs; scald, 3 ± 3 yrs), and mortality between groups. Propensity analysis confirmed the type of burn as a significant risk factor for morbidity and mortality. Subanalysis conducted in a representative patient group suffering from 40% to 60% burn total body surface area revealed that flame burns lead to significantly increased hypermetabolic, inflammatory, and acute-phase responses when compared to scald burns (p < .05). The frequency of sepsis was 3% in the scald burn group, while it was 14% in the flame group (p < .001). Multiorgan failure occurred in 14% of the scald patients, while it occurred in 17% of flame patients. The mortality in patients suffering from a scald burn was 3% compared to 6% in the flame-burned group (p < .05). The type of burn affects hypermetabolism, inflammation, acute-phase responses, and mortality postburn.