3rd Degree Burns Research Articles

Clinical Nutrition in Diabetes Mellitus with 3rd Degree Burns and Foot Ulcer as Complicated

Burns are complex injuries that lead to hyperglycemia as a stress response. Diabetes Mellitus (DM) is a hormonal and metabolic disorder categorized by impaired insulin secretion and yielding to elevate plasma glucose levels and therefore complicates the therapy of burns, it is also developed via uncontrolled stress reaction to the burn. Also, DM will impact on nutrition and lifestyle of burn patients. This review provides pathophysiology, difficulties and managements of burns related to the patients with DM to offer evidence-based care to seriously ill people. Performing a treatment for diabetic burn patient is difficult for healthcare professionals. Traumatic burn in non-diabetic people may develop stress-induced hyperglycemia which ends up with DM due to endocrine complications from their injury. The higher risk for burn injuries is found in pre-existing DM. Special medical plan should be employed to control burns. Additionally, treatments for present burn must be reformed to avoid diabetes mellitus, management of glucose level, and help healing process in diabetic foot ulcer.

SENSITIVITY RESEARCH ON MODELS OF EARTH ENTRY AND IMPACT EFFECTS BY ASTEROIDS

Asteroid impact on Earth is one of the potential threats to human beings. Engineering models of Earth entry and impact effects by asteroids have been developed in order to estimate ground hazard by planetary defense communities nowadays. However, there are large uncertainties in input parameters of these models, which not only brings trouble to use of the model, but also greatly affects results of hazard estimate. Ranges of input parameters are analyzed, of Which baseline values are taken as maximum probability values or recommended values in literatures. Furthermore, by changing one or more input parameters based on ranges and baseline values, AICA (Asteroid Impact Consequence Analysis) code developed by authors of this paper, are used to study sensitivity of output parameters, such as energy deposition, airburst altitude, radius of 4psi overpressure and 3rd degree burn, to input parameters. The results are given for stony asteroids with diameter of 60~300~m and entry velocity of 12~40~km/s. It is indicated by results that airburst altitude of asteroid trends to decrease, with increase of size, strength at 1st breakup and mass fraction of debris cloud, and with decrease of entry velocity and ablation coefficient. Drag coefficient of asteroid and fragment, as well as strength scaling exponent, has little effect on airburst altitude and ground damage range. Radius of overpressure and thermal radiation damage generally increases with increase of size and entry velocity. If mass fraction of debris cloud is less than 50%, airburst altitude and ground damage range will fluctuate. But a large value for mass fraction of debris cloud, such as 80%, is reasonable according to analysis of many meteor events at present. Luminous efficiency only affects damage range of thermal radiation. Under the computational condition in this paper, radius of 3rd degree burn is less than that of 4-psi overpressure, indicating that the main type of ground hazard is overpressure caused by airburst.

VEGETABLE CELLULOSE NANOFIBER DRESSING AIDS IN THE HEALING PROCESS OF THIRD-DEGREE BURNS? STUDY ON RATS.

ABSTRACT Background:The treatment of 3rd degree burns represents a major medical challenge. Pinus vegetable cellulose is a biomaterial with characteristic similar to bacterial cellulose. Aim:To evaluate the safety of cellulose membrane (Pinus sp) in the treatment of 3rd burns in rats and to compare its effectiveness with the bacterial membrane already on the market. Method:Thirty-three Wistar rats were beaten with a 3rd degree burn on back skin by applying water at 98º C for 30 s. Then, they were divided into three groups (n=11): group 1 - simple dressing with gauze; group 2 - dressing with bacterial cellulose membrane; and group 3 - dressing with vegetable cellulose membrane. The animals were maintained for 15 days to check the general clinical status, macroscopic aspect, contraction of the wounds and microscopic analysis for the degree of healing and collagenization. Results:They were clinically well during the experiment. During the removal of the dressing, there was bleeding in the wound of the control group, unlike the groups treated with cellulose membranes, which protected the bed from injury. The macroscopic evaluation showed a greater contraction of the wounds treated with the membranes in relation to the control. A microscopic analysis revealed that most of the wounds were in advanced healing degree with predominance of mature collagen in all groups. Conclusion: Pinus sp cellulose membrane showed efficacy similar to that of the bacterial membrane in the treatment of 3rd degree burns.

Post-Burn Microstomia Prevention: Application of a New Therapeutic Device

Introduction: Our goal is to demonstrate an appliance that can prevent post-burn microstomia. Perioral burns result in contracture of facial tissue during healing. It may cause limited oral access due to the sphincteral nature of orbicularis oris muscle. The literature has demonstrated that burn contractures and scar formation can be modified with pressure and splinting. Technique: The patient was a 50-year-old woman who had a 3rd degree burn. She had been treated with medicinal and palliative treatments, but due to burn scar that involved all her peri-oral tissues she had progressive microstomia. We fabricated microstomia prevention device for her in order to prevent further progression of microstomia. As the patient was completely edentulous, we decided to fabricate a tissue-supported appliance. Conclusion: This appliance is made with very simple equipment and is easy to fabricate.

Coverage of Severely Burn Injured Knee with Supercharged Reverse ALT Flap: Avoiding Limb Amputation

Primary skin and soft tissue reconstruction of large defects around the knee may be a challenge for the plastic surgeon. Fasciocutaneous flaps play an essential role in achieving functional and aesthetic restoration. We present the surgical reconstruction of an extensive 3rd degree burn injury with knee joint capsule and ligaments involvement in a 51-year-old patient. Devitalized structures were firstly debrided and a supercharged reverse anterolateral thigh (RALT) flap was used to cover the resultant tissue defect. The ALT fascia was employed to reconstruct the damaged joint capsule in order to restore articular function. The supercharged RALT flap has a greater blood supply compared with standard flaps and enables us to use larger flaps to reconstruct extensive knee and proximal leg tissue defects.

Secreted responses of umbilical cord mesenchymal cells to full thickness swine burns are refined by the zone of injury

Background & Aim Primary treatment of battlefield burns is often inadequate due to delayed field evacuation or limited care in mass casualty incidents. Untreated burns expand in depth and surface area and elicit a hyper-immune response until the damaged tissue is removed. Third degree (full-thickness) burns penetrate the dermis and comprise 3 concentric zones of injury. The central zone of coagulation is irrevocably damaged while the surrounding zone of stasis is at risk. Tissue in the outermost zone of hyperemia can be saved despite an acute inflammatory response and increased perfusion. Mesenchymal stromal cells (MSCs) reportedly improve outcomes as post-surgical burn treatments. We assessed in vitro whether MSCs may also benefit burn sequelae if applied prior to surgical intervention. Methods, Results & Conclusion Nine anaesthetized swine received 3rddegree burns on the inner flank by a heated brass bar. After 30 minutes, the burn was excised ∼1 cm outside the zone of hyperemia. Control (unburned) samples were also excised. The burn center (zones of coagulation and stasis) and margin (zone of hyperemia) were isolated by dissection. Human umbilical cord MSCs (UC-MSCs), were co-incubated with 0.4 +/- 0.005g of tissue using a 6-well Transwell system for 24, 48 or 72 hours (h) in xeno-free media. Secreted proteins were assessed by multiplex ELISA of 115 analytes. Within 24h of exposure to any burn tissue, UC-MSCs increased output of inflammation mediators including fractalkine, GCP-2, GRO-β, I-309, IL-19, MCP-3, MIP3-α, MMP-2 and TSLP. IL-2Ra and MIG were specifically elevated in response to the necrotic center tissue, followed by β-NGF and IL-3 at 48h and SCF and SCGF-β at 72h. Intriguingly, the burn margin stimulated production of wound healing molecules in addition to inflammation mediators. G-CSF, HGF, IL-1β, IL-1RA, LIF and TECK increased significantly at 24 hours, followed by IL-20, IL-35, MDC, sCD163 and sTNF-R1 at 72h. Thus, UC-MSCs exhibit refined soluble responses that may improve outcomes for severe burn patients that initially receive sub-optimal treatment and delayed definitive care. The observed zone-specific responses suggest that the molecular mechanisms of MSC treatments may differ if the cells are applied before or after surgical debridement and depending on their localization within the wound. UC-MSCs delivered to unsalvageable tissue can produce a response focused on managing inflammation, while UC-MSCs delivered to the viable peripheral zone additionally promote wound healing.

Overview of caustic ingestion cases at theChildren's Hospital of Vilnius University Hospital Santaros klinikos between 2011 and 2018.

Although not common, caustic ingestion can cause serious injury and sequelae. Clinical symptoms do not always represent thedepth of lesions of theintestinal tract, which makes management of these patients difficult. Between 2011 and 2018, we performed aretrospective one-centre study on ingestion of corrosive agents by children. We used ICD-10 codes of X49, X54.X, and T28.2. Cases of eye or skin burns were excluded. Sixty-five cases were found. Due to alack of data, we analysed 56 cases. Themajority of them were boys (64%); 41% of patients were between 12 and 24 months old. Themedian age was one year. In 68% of cases, thecorrosive substance was alkali: laundry detergent pods and sodium hydroxide accounting for 25% and 14%, respectively. Of the hospitalised patients and all those admitted to thepaediatric intensive care unit (PICU), 78% had oesophagogastroduodenoscopy (EGD), 61% within 24 h after ingestion. The time of EGD was not known for 29% of patients. Nine (29%) had 2nd- or 3rd-degree burns of theoesophagus or the stomach, one of them did not have any visible changes of thelips and oral mucosa or any symptoms. Physicians should be suspicious about potential lesions of thegastrointestinal tract when managing caustic ingestion cases. It is recommended to perform EGD for symptomatic children within 24 hours after theaccident.

49 Indocyanine Green Angiography in the Surgical Evaluation of Partial Thickness Burn Wounds

Abstract Introduction While treatment of 1st and 3rd degree burns is fairly well understood, second-degree burns pose a challenge. This can lead to delayed treatment, or unnecessary operations, either of which can lead to scarring, contractures, infections, and poor cosmetic outcomes. While Laser Doppler Imaging has been used to differentiate second degree burns it is not reliable in studying uneven surfaces, requires long scan times, and has limited penetration. ICG angiography, which has gained wide use in breast reconstruction, can circumvent many of these issues. In this study, we used ICG angiography to investigate 2nd degree burns in an effort to develop an objective measure to differentiate deep from superficial 2nd degree burns. Methods All patients with 2nd degree burns covering greater than 1% total body surface and consented to the study were enrolled. Exclusion criteria included iodide allergy and the inability to follow up. All burns presented within 48 hours of injury. Patients were evaluated with ICG imaging on presentation and re-imaged at 24-hour intervals up to 72 hours after the initial injury and at the time of excision. The patients were managed by a blinded Burn Surgeon, with follow up pictures performed at 2 weeks, 1 month, 6 months, and 1 year. All images were analyzed using software to determine if areas with different scores ended up receiving operative or conservative treatment. Results Thus far 6 patients have enrolled in the study. All patients presented following flash burns, with BSA ranging from 10–30%. Of the 6 patients, only one required operative treatment. For the five patients treated conservatively areas of burn presented with SPY Q readings ranging from 70–110. These readings improved universally with each subsequent image, often by 10–20 each image, although one burn was found to double its perfusion by 72 hours post-injury. In contrast, the patient requiring operative intervention presented with a SPY-Q reading of 20–30. While there was a minor improvement, the maximum reading the area of resection reached was only 40–50. The patient was eventually taken to the OR for debridement and STSG. Conclusions While these preliminary results are limited due to the small sample size of our population, we feel that this study demonstrates the utility of ICG angiography in the diagnosis of second-degree burns. Our previous work on a porcine model verified that SPY can be used to measure both vertical and horizontal burn progression, and our early results in this study show a sharp difference between the patients treated conservatively, and the one patient requiring operative intervention. Applicability of Research to Practice Using these results, we plan to develop an objective cut off that will serve as a benchmark for when operative intervention is required. And with a secondary objective to evaluate the level excision.

Evaluation of bacteriophage products against burn wound Methicillin-resistant Staphylococcus aureus (MRSA) infections

Abstract Background The major problem in the management of burn wounds are infections. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major cause of infection in burn wounds. Antibiotic resistant bacteria around the world has become a major therapeutic challenge. Bacteriophages and their lysine are suggested as an antimicrobial alternative agent. Phage display technique is suggested for production of recombinant lysine by Nano carrier technology. The approach of this study was to evaluate the potential of recombinant Nano phage efficacy in MRSA burn wound infection in vivo. Materials and methods The 3rd degree burn wounds were induced in 54 rats and infected with MRSA ATCC 33591 via the topical route in four groups. Burn wound size was measured in 0, 14, 21, 28 days. The efficacy of Nano phage gel was assessed on the basis of percentage collagen deposition, granulation tissue, neovascularization, fibroblastic maturity, re-epithelization, and scar formation in rats following treatment in 14, 21, 28 days. Results The results showed that the percentage of wound size were 3 cm on base line day and the average macroscopic wound healing rates were increased in the prevention groups receiving the recombinant Nano phage gel and natural phage gel, in the treatment groups with secondary infection receiving the recombinant Nano phage gel and the natural phage gel, and in the two control groups respectively. The average microscopic wound healing rates were increased in the prevention groups receiving the recombinant Nano phage gel and natural phage gel, in the treatment groups with secondary infection receiving the recombinant Nano phage gel and the natural phage gel, and in the two control groups respectively. Conclusions In conclusion the recombinant Nano phage gel is efficacy to treat and prevent MRSA burn wound infection.

A pilot survey of Southeastern firefighters: Safety practices, use of protective gear, and injury

IntroThere were over 60 firefighter line of duty deaths and roughly 30,000 injuries in the United States in 2016. Modern thermoprotective gear has reduced the risks firefighters face from both thermal and inhalation injury, but must be used properly to be effective. The purpose of this study is to examine gear use and associated injury in firefighters. MethodsSurveys were distributed with questions about demographics, gear usage, and maintenance practices. If previously injured, firefighters described the injury, treatment, and recovery. ResultsOf the 50 surveys distributed, 37 were returned (72%). A majority of respondents (70%) reported wearing incomplete gear. Those who reported injury were more likely to have omitted gear (81% vs 45%). For all respondents, the items most commonly omitted were hood (58%), gloves (22%), and earflaps (22%). Regular cleaning of gear was not practiced by 39% of burned respondents and 46% had not had their gear sized within 2 years. Serious burns were reported by 41% of respondents. Mean burn size was 7% total body surface area (TBSA), and 11% reported self-treating their burns, including 63.5% who continued to work despite suffering a 2nd or 3rd degree burn injury. Only 17% were treated at a burn center, and this group missed anywhere from two shifts to 8 months of work. ConclusionsFirefighters risk injury by omitting gear and not adhering to National Fire Protection Association (NFPA) guidelines on gear sizing, maintenance, and station wear. Firefighters also frequently self-treat serious burns despite unique considerations regarding re-injury. National trends related to gear use and injury risk should be studied further, and standards should be developed for ensuring safe return to work.

CRYSTALLOGENIC PROPERTIES OF THE BLOOD SERUM OF RATS UNDER MODELING A THERMAL INJURY

Aim. To study the crystallogenic and initiating potential of biological fluids in rats under normal conditions and when modeling a contact thermal injury. Material and methods. To this end, we used our own model of contact thermal burn. This experiment involved the impact of a hot plate on the back of the animal, with the lesion area amounting to 20% of the body surface (3rd degree burn). This model of thermal injury was reproduced in 30 Wistar rats. 24 hours after the burn experiment, the animals were subjected to blood tests. Subsequently, an evaluation of the blood crystallogenic and initiating properties was performed. The range of basic substances used in teziographic tests was rather conventional and included 0.45, 0.9 and 3% sodium chloride solutions, as well as 0.1 N hydrochloric acid and sodium hydroxide solutions. The results of own and initiated crystallization of biological fluids were evaluated using the authors’ system of semi-quantitative indicators. Results. It is found that, in comparison with intact animals, micro-preparations of dried blood serum from rats after thermal trauma demonstrate a significant inhibition of both own crystallization and that initiated by various basic substances. This phenomenon is manifested in a significant decrease in the index of structural facies (in a crystalloscopic test), the main teziographic coefficient and the belt coefficient. The pathological nature of the observed shifts in the crystallogenic properties of biological fluids emphasizes a sharp increase in the degree of destruction demonstrated by the crystalline elements of the blood samples of rats in the main group. Conclusion. The conducted research shows that a model thermal injury in rats is accompanied by significant shifts in the crystallostasis of an animal organism, which are manifested in a significant change in the crystallogenic and initiating properties of the blood serum.

Suppression of TRPV1 and P2Y nociceptors by honokiol isolated from Magnolia officinalis in 3rd degree burn mice by inhibiting inflammatory mediators

Burn pain is one of the worst imaginable pain, associated with considerable morbidity and mortality worldwide. The management of pain made significant progress; however, more research is needed for burn pain. In the present study, the antinociceptive effect of honokiol extracted from Magnolia officinalis was assessed for 3 consecutive days. The third-degree burns were induced by the hot water method. The honokiol both by intraperitoneal (i.p) and intra plantar (i.pl) route and in combination with tramadol (i.p) was found to be effective in significantly reducing the mechanical allodynia, hyperalgesia, thermal hyperalgesia and paw edema. Honokiol also succeeded in reducing weight loss and spontaneous pain behavior in mice. Honokiol treatment both i.p and ipl decrease significantly the loss of total protein (3.3 and 3.4 g/dl of total protein) and albumin (2.2 and 2.6 g/dl of total albumin) respectively. It also significantly recovers the normal balance of blood electrolytes and normalizes blood profile. Effect of honokiol on cytokines and mRNA expression levels of TRPV1 and P2Y were also assessed. Honokiol significantly decreases the expression of TNF-α, IL-1β and IL-6 and decreases expression level of TRPV1 and P2Y. Additionally, TRPV1 and P2Y proteins expression levels were also assessed by Western blot in paw skin tissue, sciatic nerve and spinal cord which were remarkably down-regulated by honokiol. Histological analysis of vehicle control and drug-treated paws were also performed through hematoxylin and eosin (H&E) staining which exhibited that honokiol significantly reduced the dermal layers distortion and inflammation associated with the burn. The antioxidant enzymes and nitric oxide (NO) were also determined through ELISA. Honokiol treatment also potentiates the expression of reduced glutathione and glutathione S-transferase, and catalase levels and reduced significantly the nitric oxide (NO) as compared to the burn-induced group. It can be concluded on the base of the results that honokiol has a significant analgesic activity through its action on cytokines and by downregulating TRPV1 and P2Y receptors. It also has a protective role against burn damage by upregulation of antioxidants.

2 Examining 1:1 Versus 4:1 Packed Red Blood Cell to Fresh Frozen Plasma Ratio Transfusion During Pediatric Burn Excision

Blood transfusions after major burn injury are common due to operative losses, blood sampling, and burn physiology. Burn patients lose an estimated 2% blood volume per percent burn excised, making large burn excisions a major source of blood loss. While a massive transfusion protocol improves outcomes in adult trauma patients, there remains a paucity of literature examining its effect in the critically ill pediatric population. The purpose of this study was to prospectively examine the outcomes of major pediatric burns receiving a 1:1 vs 4:1 red blood cell (RBC) to fresh frozen plasma (FFP) transfusion strategy during massive burn excision. Children with >20% total body surface area (TBSA) 2nd and 3rd degree burns were randomized to a 1:1 or 4:1 RBC/FFP transfusion ratio during burn excision. Parameters measured included patient demographics, burn size, Pediatric Risk of Mortality (PRISM) scores, Pediatric Logistic Organ Dysfunction (PELOD) scores, clinical laboratory values, and total blood products transfused during operative interventions and hospitalization. Blood stream infections (BSI), urinary tract infections (UTI), and pneumonia (PNU), were documented using the burn consensus guidelines for infection. A total of 68 children were randomized into two groups (34 patients in the 1:1 group and 34 patients in the 4:1 group). Mean age (7.4 ± 5.5 v 8.2 ± 5.3 years), TBSA (39% ± 16 v 43% ± 24), and PRISM scores (9.5 ± 6 v 11 ± 6) did not significantly differ between groups. Estimated blood loss also did not significantly differ between groups (453 cc v 450 cc, p = 0.42). No significant differences were noted in ventilatory days (5 v 9, p = 0.47) or overall length of stay (57 v 60, p = 0.24). An equal number of infections were identified in both populations (24 patients each). Although no differences were identified in blood stream infections (20 v 18, p = 0.46), a higher number of pneumonias were documented in the 4:1 group (68 v 116, p = 0.08). On multivariate analysis, significantly higher TBSA (p < 0.001) and PRISM scores (p < 0.05) were identified in the 4:1 group when controlling for infection count. No significant differences were identified in outcomes between a 1:1 and 4:1 massive transfusion strategy as measured by overall ventilator days, length of stay, or rates of infection. These findings would suggest noninferiority to either transfusion practice based on outcomes. Further work will be necessary to fully elucidate these results. This work is an interim analysis of an ongoing study that suggests higher transfusion requirements may occur in higher risk patients such as those with larger TBSA burn sizes or mortality scores.

Assessment of the impact of oxandrolone on outcomes in burn injured patients

The purpose of this study is to use a retrospective cohort of burn patients to evaluate the contribution of oxandrolone on burn care outcomes. Longitudinal clinical data is used to analyze outcomes from a new perspective. Our random-effects longitudinal regression analysis model used temporal clinical data to evaluate oxandrolone’s impact on outcomes (oxandrolone/non-oxandrolone n=50/11, median length of stay [LOS]=42.2/39.3, mean weight (kg)=192.2/207.6, mean initial prealbumin (mg/dL) 10.1/7.5). The resultant predictive models (p<0.001) described how certain factors influence clinically significant outcomes via a robust data analysis method. LOS was predicted and extended by a greater magnitude of 3rd-degree versus 2nd-degree burns (1.01 versus 0.85 additional days for each %TBSA, p<0.001). Weight was decreased by LOS (145.2g lost per day, p<0.001). Oxandrolone improved prealbumin (3.503mg/dL increase, p<0.001) but instead did not influence patient weight (p>0.05) nor LOS (5.27days shortening, p=0.361). Prealbumin over time was also influenced by initial value (0.293mg/dL, p=0.003), LOS (0.072mg/dL increase per additional day, p<0.001), and the presence of inhalation injury (2.652mg/dL decrease if present, p=0.009). Oxandrolone appears to benefit anabolic protein production. It is difficult to isolate the role of oxandrolone on major outcomes due to the concomitant influence of other variables.

Recurrent bacteremia: A 10-year retrospective study in combat-related burn casualties

IntroductionSurviving the first episode of bacteremia predisposes burn casualties to its recurrence. Herein, we investigate the incidence, mortality, bacteriology, and source of infection of recurrent bacteremia in military burn casualties admitted to the U.S. Army Institute of Surgical Research Burn Center over a 10year period. MethodsBacteremia was defined as the growth of Gram-positive or Gram-negative organisms in a blood culture that excluded probable skin contaminants. Recurrent bacteremia was defined as a subsequent episode of bacteremia ≥7 days after the first episode. Polymicrobial bacteremia was the presence of more than one pathogen in the same blood culture. Bacteremia was attributed to UTI, pneumonia, or wound sepsis. All other bacteremias were considered non-attributable bloodstream infections. Univariate and multivariate analyses determined factors predictive of clinical outcome. ResultsOut of 952 combat-related burn casualties screened, 166 cases were identified; 63% (non-recurrent) and 37% (recurrent) with median time to recurrence of 20 days. Univariate and multivariate analysis showed that the mortality rate was two and nine-fold, respectively, higher with recurrent bacteremia. Univariate analysis found that except for urinary tract infection, large burn size (>20%), 3rd degree burns, increased injuiry severity, perineal burns, and mechanical ventilator days were independent factors predictive of recurrence of bacteremia as well as increased mortality in the recurrent bacteremia cohort. Acinetobacter baumannii complex (63%) was prevalent in the non-recurrent group, while Klebsiella pneumoniae (46% vs. 30%) and Pseudomonas aeruginosa (35% vs. 26%) were prevalent in recurrent bacteremia. Half of the recurrent bacteremia cases were polymicrobial, compared to 9% in non-recurrent bacteremia. Pneumonia was prevalent in non-recurrent bacteremia (38%) and a combination of pneumonia and wound sepsis (29%) in recurrent bacteremia casualties. ConclusionsRecurrent bacteremia increases mortality in military burn casualties. Additional research is needed to address and mitigate the underlying causes, thereby improving survival.

Volume- vs. rate-based tube feeding in burn patients: A case-control study

BackgroundProper nutrition is critical in healing burn wounds. Tube feeding is routinely employed to help meet nutritional goals; however, the complexities of burn care frequently involve pausing feeds. Volume-based tube feeding delivers a 24-h goal volume compared to administering a fixed hourly rate. This study aims to assess whether volume-based tube feeding is superior to traditional rate-based tube feeding at meeting nutritional goals. MethodsStarting in January 2016, a single burn center implemented a volume-based tube feeding protocol. All patients for the calendar year 2016 who required tube feeds for at least 5 continuous days were compared to all patients from the prior calendar year 2015. Demographics, burn characteristics, and tube feeding details were compared with univariable analysis. Daily tube feed goals were the primary outcome and length of stay was assessed as a secondary outcome; both were evaluated with multivariable analysis using linear modeling. ResultsThirty patients met study criteria. The cohort was 30.0% female and 93.3% were flame burns, with a mean age of 44.2 years and mean total body surface area (TBSA) of 30.6%. All patients suffered 3rd degree burns. Pausing tube feeds for fasting before an operation was the most common reason feeds were held accounting for 33.7% of all held days. Volume-based tube feeding was the only independent predictor of increasing tube feed goals with an average goal met of 91.4% vs. 74.1%, (linear coefficient 10.05, 95% CI 4.49–15.61, p-value 0.001). Tube feed hours held was the only independent predictor of lower tube feed goals (linear coefficient −5.52, 95% CI −7.73–−3.31, p-value < 0.001). Volume-based tube feeding was not associated with a significant difference in length of stay after controlling for covariates. Rate-based feeds showed an adjusted mean stay of 33.6 (SD 7.5) days vs. 36.3 (SD 11.1) days for volume-based feeds (linear coefficient 0.84, 95% CI −13.6–15.2, p = 0.905). ConclusionsVolume-based tube feeding was superior to rate-based tube feeding in maximizing daily nutritional goals. Perioperative care was the most common reason for holding tube feeding. Additional studies are needed to assess whether volume-based feeding is associated with improved clinical outcomes.

Efficacy of Topical Enalapril in Treatment of Hypertrophic Scars.

BACKGROUNDAngiotensin II activation by angiotensin-converting enzyme (ACE) is a significant mediator in wound healing and collagen production. In this study, the effect of topical application of ACE on hypertrophic scar formation has been studied in a clinical trial.METHODSThirty patients with hypertrophic scar and itching after treatment of 2nd or 3rd degree burns participated in this double-blinded clinical trial. Subjects had two same-degree scars on symmetrical sites of body which were randomly allocated into two groups. One side was treated with 1% enalapril ointment and the other side with placebo twice daily. During a 6-months follow-up, a scoring table for itching was completed on a daily basis by patients. Furthermore, a single surgeon measured size of scars once a month. The mean size, thickness and itching score were calculated for each scar and compared between medication and placebo-treated scars. RESULTSThe mean size of scars in enalapril treated side was significantly less than scars in the placebo side. Additionally, enalapril treated scars had significantly lower itching scores compared to the placebo group.CONCLUSIONTopical enalapril significantly decreases the clinical parameters of hypertrophic scar and also itching as an indirect indicative of scar improvement. Furthermore, enalapril proved to be clinically safe for patients with low incidence of adverse drug reactions and acceptable cost effectiveness.

Effectivness of Micropore Tape in Treatment of Hypertrophic Scar after Wrist Burn

Abstract Background: Burns are caused by exposure to excessive heat as flame, hot surfaces, scalding liquids, friction, electricity and chemical burns. Hypertrophic scarring is a frequent and undesirable complication of burn injuries.Aim of Study: This study was conducted to investigate the effectiveness of micropore tape in treatment of hypertrophic scar after wrist burn.Subjects and Methods: Thirty patients complaining of hypertrophic scar after wrist burn selected from learning hospitals (Al-Kaser Al-Ayni Hospital and Om El-Masryeen Hospital) in Cairo shared in this study. Their ages were ranged from 20 to 45 years. Patients who are suffering from malignant tumors, patients with 3rd degree burns of wrist and patients with major burns covering more than 20% of TBS were excluded from this study. They were divided into two equal groups: Group (A) who received micropore tape treatment in addition to normal physical therapy program (stretching exercises and strengthening exercises), routine medical treat-ment and traditional care (dressing) 30 minutes 3 sessions/ week for 12 weeks. Group B who received normal physical therapy program (stretching exercises and strengthening exercises), routine medical treatment and traditional care (dressing) 30 minutes 3 sessions/ week for 12 weeks. Pigmen-tation, vascularity, pliability and height were measured by Vancouver scar scale. Results: The results showed that there is significant difference in Vancouver scar scale in group A pre and post treatment and there is significant difference in Vancouver scar scale in group B pre and post treatment and there is a significant difference in Vancouver scar scale between group A and B pre and post treatment as group A improved more than group B.Conclusion: It can be concluded that micropore tape with physical therapy treatment has an effect on hypertrophic scar after wrist burn more than physical therapy only.

295 Burn Patients that Exceed the Average Length of Stay

Burn patients show a high variability and poor predictability in their length-of-stay (LOS) due to the complexity of burn injury itself and various complications. To focus care expectation and prognosis we aimed to identify key factors that contribute to prolonged LOS. A retrospective cohort-study was conducted in an adult burn-center between January 2006 and December 2016. We excluded patients that died during hospitalization and patients with <10% TBSA burn. Patients were then stratified into expected-LOS (<2days LOS/%TBSA) and longer-than-expected-LOS (>2days LOS/%TBSA). We assessed demographics, burn etiology, comorbidities, and in-hospital complications. Logistic regression and propensity matching (adjustment/matching for age, gender, inhalation injury, and TBSA% of 3rd degree burns) was utilized. There were 583 patients that met inclusion criteria; and of those, 477 showed an expected-LOS whereas 106 exceeded that time frame. Patients who exceeded their LOS were significantly older, had greater 3rd degree TBSA% burn, and a larger proportion of inhalation injuries (p<0.05). Additionally, there was a significantly greater proportion of these patients that had in-hospital complications of infection, sepsis, and organ failure (p<0.05). Interesting, exceeding LOS patients also had a higher number of pre-existing psychiatric conditions such as depression or schizophrenia. In-hospital complications have a high influence on exceeding the average LOS in burn patients. Burn patients also have a unique and complex set of pre-existing medical conditions such as mental health issues that further complicate their treatment and interferes with an early recovery and discharge. More studies are need to investigate how to modify these critical factors. Progress has been made to update the 1day/%TBSA convention to better aid health care providers in giving appropriate outcomes for patients and their families and to supply intensive care units with valuable data to assess the quality of their care and improve patient prognosis.

412 Volume vs. Rate-Based Tube Feeding in Burn Patients: Improving Nutrition

Proper nutrition is critical in healing from burns. Tube feeding is routinely employed to help meet nutritional goals, especially in intubated patients and large burns; however, the complexities of burn care frequently involve pausing tube feeding. Volume-based tube feeding is a strategy that provides goal volumes based on available hours per day compared to fixed hourly rates. This study aims to assess whether volume-based tube feeding is superior to traditional rate-based tube feeding at meeting nutritional goals. Starting in January 2016, a single burn center implemented a volume-based tube feeding protocol. All patients for calendar year 2016 requiring tube feeds for at least 5 continuous days were compared to all patients from the prior calendar year 2015. Demographics, burn characteristics, and tube feeding details were compared with univariate analysis. Daily tube feed goals and length of stay were primary outcomes; both were assessed with multivariate analysis using linear modeling. Thirty patients met study criteria. The cohort was 30.0% female and 93.3% flame burned, with a mean age of 44.2 years and mean TBSA of 30.6%. All patients suffered 3rd degree burns. Pausing tube feeds for perioperative care was the most common reason tube feeds were held at 33.7% of all held days. Volume-based tube feeding was the only independent predictor of increasing tube feed goals with an average goal met of 91.41% (SD 19.41) vs. 74.14% (SD 21.72), (linear coefficient 10.05, 95% CI 4.49–15.61, p-value 0.001). Tube feed hours held was the only independent predictor of lower tube feed goals (linear coefficient -5.52, 95% CI -7.73 - -3.31, p-value <0.001). Volume-based tube feeding was not associated with a significant difference in length of stay after controlling for covariates. Rate-based feeds showed an adjusted mean stay of 33.6 (SD 7.5) days vs. 36.3 (SD 11.1) days for volume-based feeds (linear coefficient 0.84, 95% CI -13.6 - 15.2, p=0.905). Perioperative care was the most common reason for holding tube feeding. Volume-based tube feeding was superior to rate-based tube feeding in maximizing daily nutritional goals. Additional studies are needed to assess whether volume-based feeding is associated with improved clinical outcomes. Volume-based tube feeds optimize nutritional goals and thus should be the preferred method of tube feeding in patients who require such nutritional support.