Acute Burn Injury Research Articles

113 Long-term Reconstructive Surgery of the Burned Hand: 16-year Experience at a Major Burn Center

Abstract Introduction Early excision and grafting for deeper hand burns is important for preservation of long-term hand function. Little information exists on long-term reconstructive and revision operations after acute grafting. Limited quantitative data is available on early predictors of this outcome. This study retrospectively examines a cohort of patients who underwent excision and grafting of acute hand burns and details their reconstructive course in the years after injury. Predictors of future reconstructive hand surgery are examined. Methods A retrospective review was conducted using medical records of patients admitted with acute burn injury to a major regional burn center from February 1999 to October 2015 and who subsequently underwent excision and grafting for closure of the acute wound. Information collected included demographics, burn size and etiology, anatomical involvement, grafting, contracture release, local tissue rearrangement, and regional and distant flaps. Regression analysis assessed for demographic and clinical predictors for future contracture release with grafts and/or local tissue rearrangement surgery. Results A total of 704 hands in 532 adults (71% male, median age 40 years, average burn size 14.9% TBSA) met study criteria (Table 1). Ninety-eight patients underwent at least one reconstructive surgery (122 burned hands). Mean length of follow-up was 1000 days. Multivariable logistic regression analysis showed that male gender was negatively associated (p< 0.001; OR 0.369; 90% CI, 0.233–0.584) with contracture release with graft whereas white race (p=0.030; OR 2.060; 90% CI, 1.192–3.560) and burn size ≥21% TBSA (p< 0.001; OR 3.962; 90% CI, 2.224–7.057) were positively associated. Males had a negative association (p=0.023; OR 0.527; 90% CI, 0.332–0.837) and burn size a positive association with local tissue rearrangement (5–10% TBSA - p=0.041; OR 2.149; 90% CI, 1.161–3.975 and >21% TBSA - p< 0.001; OR 4.230; 90% CI, 7.927). Conclusions Approximately 1 in 6 acutely grafted hands underwent at least one reconstructive surgery of clinically significant contractures, primarily in digits and web spaces. Female gender and burn size were positive predictors of both categories of reconstructive surgery while white race was a positive predictor of release and graft.

593 Mortality of Burn patients over two decades: Improving outcomes in the elderly

Abstract Introduction Shifting paradigms in the care of burn patients over the past two decades have led to the improved survival of adult and pediatric patients, but the same trend has not been manifested in the elderly population. We aimed to review our patient population, particularly the elderly, for the last twenty years and examine the relationship of age to the TBSA (total burn surface area) LD50 (lethal dose, 50%). Methods This IRB approved study retrospectively analyzed acute burn patients admitted at two academic regional burn centers from January 1, 1999 to August 1, 2019. Data collected included age, gender, TBSA, mortality, mechanism of burn, inhalation injury, and presence of full-thickness burn. The relationship between mortality and TBSA and age was assessed using logistic regression. The TBSA LD50 was calculated conditional on age and confidence intervals were constructed based on 1000 bootstrap samples. Results A total of 9,721 patients were admitted for treatment of acute burn injury between the two institutions. In our population, flame was the most common cause of burn injury (51%), full-thickness burns were present 47% of the time, and mean TBSA was 13%. The average patient age was 28, although there were 789 patients over the age of 65. The TBSA LD50 relationship to age best fit a cubic regression model with a peak of 81% TBSA LD50 at 17 years of age, rapid decrease early in the 5th decade and a general leveling out at the nadir of 27% TBSA (Figure). The LD50 did not reach 30% until 78 years of age. Conclusions Over the past two decades, elderly patients treated at our hospitals appear to have improved survival in comparison to the outcomes reported nationally. Due the ongoing rapid aging of the population, it is important that we continue to focus on both improving survival and delivering the best care to this vulnerable part of the population. Moreover, this continuous model could be used to track improvements in care within our institution and serve as a template for a national model.

52 Impact of National Marijuana Legalization on Delirium Rates and Opioid Use in Acute Burns

Abstract Introduction Cannabis use has been associated with larger total burn size areas, longer hospital stays, and an increased number of operations. Legalization of marijuana in Colorado has led to marked increases in burn injuries. Tetahydrocannabinol (‘THC’) use has been shown to increase psychosis, anxiety, and depression, however, it is unknown how this has impacted rates of ICU related delirium in the burn context. Further, observational studies have shown that marijuana use has decreased opioid-related overdoses, but it is unknown how chronic marijuana use affects opioid consumption in the ICU. Thus, it is unknown how national marijuana legalization has impacted ICU rates of delirium and opioid use. As such, the objectives of this study are to describe trends of marijuana legalization on burns and determine if the amount of delirium and opioid use while in hospital has increased after national marijuana legalization. Methods We conducted a retrospective cohort study of 514 patients admitted to an ABA-verified centre one year prior to national marijuana legalization and one-year afterwards. Inclusion criteria consisted of an acute burn injury admission. Data included demographics, toxicology screening information, hospital rates of delirium, and pain medication use. Statistical analysis consisted of student’s t-test, one-way ANOVA, Kruskal-Wallis, Mann-Whitney U, Fisher’s exact, and χ2 test. P value of < 0.05 was considered statistically significant. Results Out of 514 patients, 422 were included; 203 prior to legalization (‘PL’) and 219 afterwards (‘AL’). Cohorts were similar regarding age, gender, inhalation injury, and smoking history. TBSA, length of stay, police custody, major psychiatric illness, alcoholism, and drug dependence were significantly higher in the AL cohort. Positive cannabinoid screens were similar in each cohort (13.3 versus 13.7%), however in both cohorts a large proportion of admissions did not have a toxicology screen completed (58.4–63.5%). Delirium rates (PL=0.5%, AL=4.1%; p=0.02) and opioid use (PL=48%; AL=52%;X2(1, N=422)=5.7, p=0.02) were significantly higher in the AL cohort. Conclusions National legalization of marijuana is associated with increased in-hospital delirium rates and opioid consumption in the acute burn context. Every effort should be made to ensure toxicology screens are completed on admission with the appropriate use of both opioid and adjunct pain medication regimens. In addition, for those not eligible for a toxicology screen due to delayed arrival time to the burn centre, an in-depth discussion should be completed to elicit drug history.

Development and validation of a screening tool for early identification of bloodstream infection in acute burn injury patients

BackgroundStandard diagnostic criteria are not useful for identifying bloodstream infection in patients with an acute burn injury patients. The study objective was to develop and validate a tool using common laboratory, clinical, and patient parameters for early identification of bloodstream infection after acute burn injury (within 10 days after a burn). MethodsWe retrospectively and prospectively reviewed for tool development the hospital course of patients with an acute burn injury (n = 156) and validated the tool in different cohorts (retrospective [n = 26] and prospective [n = 90]). The Pearson correlation identified independent variables associated with bloodstream infection (P < .1) in the development cohort that were then analyzed using binary logistic regression to identify the simplest model (P < .05; adjusted odds ratio >1). Classification and regression tree analysis was used to identify tool parameter breakpoints. Performance metrics were completed to evaluate and validate the tool. ResultsThe best model (P < .05) was: Ln [odds of bloodstream infection] = –96.749 + 3.230 (platelet volatility) + 2.235 (max temperature [°C]) + 0.339 (% full burn) + 0.242 (% partial burn) + 0.045 (max heart rate [bpm]), with a threshold probability categorizing bloodstream infection of >48%. The sensitivity, specificity, accuracy, false positive rate, false negative rate, and positive (+) and negative (–) likelihood ratios of the tool in the developmental cohort (n = 156) were 89%, 98%, 96%, 2%, 11%, 53, and 0·11, respectively; and in the prospective validation cohort (n = 90 were 91%, 90%, 90%, 10%, 9%, 9, and 0·1, respectively (n = 90). ConclusionThe validated bloodstream infection screening tool in patients with acute burn injury has excellent predictive ability to assist in the identification of patients for whom blood cultures should be requested.

Evaluating the Effects of a Trauma Recovery Program for Korean Burn Patients

Purpose: The current study aimed to investigate the effects of a trauma recovery program named the “My Special Program for Acute Burn Survivors (SPA)” program in Korean burn patients. Methods: This was a randomized pretest-posttest control group study that included patients with an acute burn injury. Participants in the intervention group ( n = 42) completed the “SPA” program, whereas those in the control group ( n = 43) received standard care. Participants completed baseline and follow-up measures that assessed perceived stress, psychological distress, and post-traumatic stress disorder (PTSD). Results: The results for perceived stress revealed a statistically significant change regardless of assigned group. For psychological distress, there was an interaction effect of time and condition in terms of the anxiety subscale only. The findings for PTSD revealed a statistically significant decrease in the total PTSD score for the intervention group only. Conclusion: The current study suggests that SPA interventions may help alleviate and prevent negative outcomes among burn patients.

Negative Pressure Wound Therapy in Conjunction With Artificial Dermis for Burned Hand Reconstruction.

Proper wound care along with the use of skin grafts over deep burn wounds has been the standard treatment. However, the goal in burn wound care has shifted from achieving a satisfactory survival rate to improving long-term form and function of the healed wound, which is sometimes hindered by scar contracture. This has prompted surgeons to find alternative ways to treat burn wounds without compromising function. Among burn cases, hand injuries are the most problematic when it comes to delicate function recovery. This study presents the results of conjunctive use of a bilayer artificial dermis, negative pressure wound therapy, and split-thickness skin grafts for grafting over acute burn wounds and scar-releasing defects after severe hand burns. Three months after the operation, the scar was soft and pliable, the aesthetic outcome was good, and the patients gained much improvement in hand function and quality oflife. The combined technique achieved a good scar quality and aesthetic effect on burned hands as well as excellent functional outcome, which resulted in major improvements and an independent life for the patient.

Treatment of Anaemia in Patients with Acute Burn Injury: A Study of Blood Transfusion Practices.

Objective: To determine blood transfusion practices, risk factors, and outcomes associated with the use of blood products in the setting of the acute management of burn patients at the Victorian Adult Burn Service. Background: Patients with burn injuries have variable transfusion requirements, based on a multitude of factors. We reviewed all acute admissions to the Victorian Adult Burns Service (VABS) between 2011 and 2017: 1636 patients in total, of whom 948 had surgery and were the focus of our analysis. Method and results: Patient demographics, surgical management, transfusion details, and outcome parameters were collected and analyzed. A total of 175 patients out of the 948 who had surgery also had a blood transfusion, while 52% of transfusions occurred in the perioperative period. The median trigger haemoglobin in perioperative was 80mg/dL (IQR = 76–84.9 mg/dL), and in the non-perioperative setting was 77 mg/dL (IQR = 71.61–80.84 mg/dL). Age, gender, % total body surface area (TBSA) burn, number of surgeries, and intensive care unit and hospital length of stay were associated with transfusion. Conclusions: The use of blood transfusions is an essential component of the surgical management of major burns. As observed in our study, half of these transfusions are related to surgical procedures and may be influenced by the employment of blood conserving strategies. Furthermore, transfusion trigger levels in stable patients may be amenable to review and reduction. Risk adjusted analysis can support the implementation of blood transfusion as a useful quality indicator in burn care.

Difficult Airway Management in Post - Burn Patient - A Case Study

We describe a case of a very difficult intubation in an acute burn injury patient, which was safely navigated through careful planning and teamwork. Multiple techniques were used as described by the difficult airway algorithm and the patient was finally intubated using a fibreoptic intubation technique. In this report, we provide various modes of airway management used and the most efficient technique when it comes to anticipated difficult airway management in an acute burn patient.

Effectiveness of a hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric burn injuries: a prospective randomised controlled trial

ObjectiveTo compare the effectiveness of two acute burn dressings, Burnaid hydrogel dressing and plasticised polyvinylchloride film, on reducing acute pain scores in paediatric burn patients following appropriate first aid.DesignSingle-centre, superiority,...

The Management of Burn Pain in a Pediatric Burns-Specialist Hospital.

Appropriate pain management for children who have experienced an acute burn injury is critical to improve patient outcomes and reduce potential morbidities. With 60% of our patients being under the age of 4years, pain management is crucial in reducing pain and anxiety in both patients and parents. It is imperative that appropriate pain relief is commenced from initial contact with healthcare workers as this will affect the success or failure of future wound procedures. Uncontrolled pain can negatively affect a patient, both short and long term. It may cause anticipatory anxiety for future medical procedures, increased pain and anxiety can decrease wound re-epithelialization which can lead to long-term consequences for growth and mobility, and increased pain can also influence the possibility of patients and families displaying signs of post-traumatic stress disorder. Pain management in the form of pharmaceuticals is imperative during burn wound treatment and should incorporate pain relief targeted at both background and procedural pain. It also requires a multimodal, individualized, and targeted approach combining both pharmaceutical and nonpharmaceutical techniques, including cold running water, multimodal distraction devices, hypnotherapy, and bubbles. We discuss the research and knowledge that our center has gained through treating pediatric patients with burns over the last 20years.

To determine the efficacy and safety of acetic acid gel in comparison to silver sulfadiazine cream in patients suffering from second-degree burns

Acetic acid solution is effective in healing of chronic wounds by its ability to eradicate biofilms. One percent silver sulfadiazine (SSD) cream is the commonly used topical antimicrobial agent in burn wound care. In our study, we compared the efficacy and safety of 1% acetic acid gel with 1% SSD in partial-thickness burn wound with &lt;20% total body surface area. Context: Bacterial colonization of burn wounds results in delayed wound healing. SSD is commonly used as a topical antibiotic in the second degree and third-degree burn wounds. The acetic acid solution is found to be clinically effective against the eradication of mature or chronic biofilm.[6] We have used 1% acetic acid gel as an anti-microbial dressing for acute burn wounds and compared it with 1% SSD. Aims: To evaluate the efficacy and safety of acetic acid gel with SSD cream in patients with second-degree burn wounds involving up to 20% of total body surface area. Outcome parameters evaluated were Wound healing (BWAT score and status as on Day 21), Pain (VAS score), Healing quality (VSS score at 1 and 3 months) and adverse effects if any. Settings and Design: The study was conducted in the burn department affiliated with a tertiary care centre. It is a prospective randomized, investigator-initiated open-label case-control study. Inclusion criteria 1. Males and females between the ages of 18 and 65 years 2. Second-degree burn involving total body surface area up to 20% at 48 h of burn injury. Exclusion criteria1.Patients with pre-existing comorbidities. Uncontrolled diabetes Mellitus. Renal insufficiency.2. Patients with known keloid tendency3.Patients with electrical burn4. Patients with inhalation burn. Patients were included in the study in accordance with mentioned inclusion and exclusion criteria. Informed consent was obtained from all patients. All procedures contributing to this work comply with the ethical standards of the relevant national and institutional guidelines on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. The study group received 1% Acetic acid gel while the control group received 1% SSD cream for antimicrobial dressings. Simple randomization was followed for the allocation of patients. Outcome parameters were assessed, compiled, and were statistically analyzed. Subjects and Methods: Eighty cases were included in the study, forty in each group. Each group patient underwent dressing with respective allotted topical antimicrobial agent, and outcome parameters were compared. In both groups, Bates-Jensen Wound Assessment Tool (BWAT), Visual Analog Scale (VAS), and Vancouver Scar Scale (VSS) scores were documented. Parameters compared were wound healing, patient acceptability, any adverse events, and quality of the healed scar. Statistical Analysis Used: The data was compiled and analyzed statistically for Outcome parameters will be analyzed for distribution, central tendency, and variability by calculating Mean, SD and p-value using Microsoft excel software (2007). Results: At 21 days, the acetic acid group showed complete reepithelialization in 45% of the cases and complete granulation in 7.5% of the cases, whereas the SSD group showed complete reepithelialization in 32.5% of the cases. The remaining cases in both groups healed after 21 days. BWAT scores were reduced in both groups. Mean VAS and mean VSS scores were comparable in both groups. No adverse event was noted in any group due to respective agent. Conclusions: In our study, we found that 1% acetic acid gel was comparable to 1% SSD in terms of efficacy and is safe to use in partial-thickness burn wounds &lt;20% total body surface area (TBSA) with good clinical outcomes.

The efficacy of resistance training in addition to usual care for adults with acute burn injury: A randomised controlled trial

Resistance training immediately after a burn injury has not been investigated previously. This randomised, controlled trial assessed the impact of resistance training on quality of life plus a number of physical, functional and safety outcomes in adults with a burn injury.Patients were randomly assigned to receive, in addition to standard physiotherapy, four weeks of high intensity resistance training (RTG) or sham resistance training (CG) three days per week, commenced within 72h of the burn injury. Outcome data was collected at six weeks, three and six months after burn injury. Quality of life at 6 months was the primary endpoint. Data analysis was an available cases analysis with no data imputed. Regression analyses were used for all longitudinal outcome data and between-group comparisons were used for descriptive analyses.Forty-eight patients were randomised resistance training (RTG) (n=23) or control group (CG) (n=25). The RTG demonstrated improved outcomes for the functional domain of the Burn Specific Health Scale-Brief (p=0.017) and the Quick Disability of Arm Shoulder and Hand (p<0.001). Between group differences were seen for C-reactive protein and retinol binding protein (p=0.001). Total quality of life scores, lower limb disability, muscle strength and volume were not seen to be different between groups (p>0.05).Resistance training in addition to usual rehabilitation therapy showed evidence of improving functional outcomes, particularly in upper limb burn injuries. Additionally, resistance training commenced acutely after a burn injury was not seen to be harmful to patients.

Factors contributing to longer length of stay in Aboriginal and Torres Strait Islander children hospitalised for burn injury

BackgroundAboriginal and Torres Strait Islander children have higher incidence, severity and hospital length of stay for their acute burn injuries than other Australian children. We examined factors contributing to longer length of stay for Aboriginal and Torres Strait Islander children with an acute burn injury.MethodsBurns Registry of Australia and New Zealand admissions of children < 16 years of age between October 2009 and July 2018 were analysed. Descriptive statistics explored patient and injury characteristics; Cox-regression models estimated characteristics associated with longer length of stay. Knowledge Interface methodology and Indigenous research methods were used throughout.ResultsA total of 723 children were identified as Aboriginal and Torres Strait Islander and 6257 as other Australian. The median hospital length of stay for Aboriginal and Torres Strait Islander children (5 days [CI 5–6]) was 4 days longer than other Australian children (1 day [CI 1–2]). Remoteness, flame burns, high percentage total body surface area (%TBSA) and full thickness burns were factors associated with longer length of stay for Aboriginal and Torres Strait Islander children. Similar prognostic factors were identified for other Australian children along with Streptococcus sp. and Staphylococcus sp. infection.ConclusionRemoteness, flame burns, %TBSA, and full thickness burns are prognostic factors contributing to extended hospital length of stay for all Australian children. These factors are more prevalent in Aboriginal and Torres Strait Islander children, impacting length of stay. Treatment programs, clinical guidelines, and burns policies should engage with the unique circumstances of Aboriginal and Torres Strait Islander children to mitigate inequities in health.

Improvement in burn wound care: summary of the AWMF guideline for the treatment of thermal injuries in adults

More than half a million patients suffer from minor burns in Germany per year. In 2018, almost 2000 patients needed intensive care for their burn injuries. Despite high standards of burn care, mortality remains high. Burn injuries may lead to long-term sequelae. In order to provide up-to-date burn care, guidelines are available online with public access. This overview presents a summary of the German AWMF guideline for the treatment of thermal injuries in adults (https://www.awmf.org/leitlinien/detail/ll/044-001.html). Experts of eleven different medical organisations and specialties have contributed to this S2k guideline with their expertise. The focus of the article is on acute burn wound assessment, the indication for specialised care in burn centres, the management of the burn wound at the trauma scene and in hospitals as well as scar management and rehabilitation. This overview reports on the consensus-based treatment of acute burn wounds in adults in Germany. The article is intended to guide doctors and professional caretakers to perform state-of-the-art burn care. The current guideline aims to improve burn outcome.

Primary management of burn injuries: Balancing best practice with pragmatism.

Management of burns is an often-neglected area in training from undergraduate to specialist level. There is, however, a high burden of injury that affects a largely vulnerable population, for example, children, the elderly and epileptics. This CPD article highlights that first aid should include cooling the burn with cool running tap water up to 3-hours post injury (Burnshield may be used if cool running water is not available); removal of all blisters facilitates accurate assessment of the burn size and depth; formulas exist for the resuscitation of acute burn injuries of more than 10% – 15% total body surface area and prophylactic antibiotics should not be administered to patients with acute burns as the prevention of infection should lie with good wound care (including good wound cleaning and the use of topical antimicrobial dressings). A standardised approach to pain management with an incremental pharmacological approach should be followed whilst considering other issues such as neuropathic pain, anxiety and depression.

Hydrosurgical debridement versus conventional surgical debridement for acute partial-thickness burns.

Burn injuries are the fourth most common traumatic injury, causing an estimated 180,000 deaths annually worldwide. Superficial burns can be managed with dressings alone, but deeper burns or those that fail to heal promptly are usually treated surgically. Acute burns surgery aims to debride burnt skin until healthy tissue is reached, at which point skin grafts or temporising dressings are applied. Conventional debridement is performed with an angled blade, tangentially shaving burned tissue until healthy tissue is encountered. Hydrosurgery, an alternative to conventional blade debridement, simultaneously debrides, irrigates, and removes tissue with the aim of minimising damage to uninjured tissue. Despite the increasing use of hydrosurgery, its efficacy and the risk of adverse events following surgery for burns is unclear. To assess the effects of hydrosurgical debridement and skin grafting versus conventional surgical debridement and skin grafting for the treatment of acute partial-thickness burns. In December 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. We included randomised controlled trials (RCTs) that enrolled people of any age with acute partial-thickness burn injury and assessed the use of hydrosurgery. Two review authors independently performed study selection, data extraction, 'Risk of bias' assessment, and GRADE assessment of the certainty of the evidence. One RCT met the inclusion criteria of this review. The study sample size was 61 paediatric participants with acute partial-thickness burns of 3% to 4% total burn surface area. Participants were randomised to hydrosurgery or conventional debridement. There may be little or no difference in mean time to complete healing (mean difference (MD) 0.00 days, 95% confidence interval (CI) -6.25 to 6.25) or postoperative infection risk (risk ratio 1.33, 95% CI 0.57 to 3.11). These results are based on very low-certainty evidence, which was downgraded twice for risk of bias, once for indirectness, and once for imprecision. There may be little or no difference in operative time between hydrosurgery and conventional debridement (MD 0.2 minutes, 95% CI -12.2 to 12.6); again, the certainty of the evidence is very low, downgraded once for risk of bias, once for indirectness, and once for imprecision. There may be little or no difference in scar outcomes at six months. Health-related quality of life, resource use, and other adverse outcomes were not reported. This review contains one randomised trial of hydrosurgery versus conventional debridement in a paediatric population with low percentage of total body surface area burn injuries. Based on the available trial data, there may be little or no difference between hydrosurgery and conventional debridement in terms of time to complete healing, postoperative infection, operative time, and scar outcomes at six months. These results are based on very low-certainty evidence. Further research evaluating these outcomes as well ashealth-related quality of life, resource use, and other adverse event outcomes is required.

Outcome of Acute Burn Injuries in a Tertiary Care Centre of Kathmandu Nepal

Introduction Burn injuries are associated with higher morbidity and mortality especially in middle and low-income countries. The objective of the study is to assess the outcome of acute burn injuries in a tertiary care center of Kathmandu, Nepal.&#x0D; MethodsThis is a descriptive cross-sectional study of the clinical data of acute burn patients admitted from January 2016-December 2018.&#x0D; ResultsOut of 124 patients with burn injuries, there were more females (n=65, 52.4 %) than males (n=59, 47.6%). Flame burn was the most common mode of injury (n=71,57.3 %) followed by scald (n=22,17.7 %). Thirty-eight (30.6%) patients arrived to hospital on the same day of injury. The average time required to reach our hospital was 24 hours. The most frequently involved site was lower extremities (n=40, 32.26%) followed by upper extremities (n=33, 26.62%). Total body surface area (TBSA) involved in the burn injury ranges from 10% to 50% with a median of 15%. Hospital stay was 14 to 58 days with a median of 17 days. Partial thickness burn was seen in 114 (91.94%) patients whereas 10 (8.06%) patients had full thickness burn. Surgical intervention was needed in 71 (57.26%) patients. Among 71 patients, 12 patients underwent surgery twice. Fifty-two (41.94%) patients were managed conservatively. The mortality rate was 4.03%.&#x0D; ConclusionAdult female population is at high risk for burn injuries mostly due to flame burn. Delay in reaching care has also contributed for poor outcome of burn injuries. Majority of burn injury patients needed surgical intervention and hence improvement in surgical aspects can lead to better outcome of burn injuries.Keywords:

Outcome of Acute Burn Injuries in a Tertiary Care Centre of Kathmandu Nepal

Introduction: Burn injuries are associated with higher morbidity and mortality especially in middle and low-income countries. The objective of the study is to assess the outcome of acute burn injuries in a tertiary care center of Kathmandu, Nepal. Methods: This is a descriptive cross-sectional study of the clinical data of acute burn patients admitted from January 2016-December 2018. Results: Out of 124 patients with burn injuries, there were more females (n=65, 52.4 %) than males (n=59, 47.6%). Flame burn was the most common mode of injury (n=71,57.3 %) followed by scald (n=22,17.7 %). Thirty-eight (30.6%) patients arrived to hospital on the same day of injury. The average time required to reach our hospital was 24 hours. The most frequently involved site was lower extremities (n=40, 32.26%) followed by upper extremities (n=33, 26.62%). Total body surface area (TBSA) involved in the burn injury ranges from 10% to 50% with a median of 15%. Hospital stay was 14 to 58 days with a median of 17 days. Partial thickness burn was seen in 114 (91.94%) patients whereas 10 (8.06%) patients had full thickness burn. Surgical intervention was needed in 71 (57.26%) patients. Among 71 patients, 12 patients underwent surgery twice. Fifty-two (41.94%) patients were managed conservatively. The mortality rate was 4.03%. Conclusion: Adult female population is at high risk for burn injuries mostly due to flame burn. Delay in reaching care has also contributed for poor outcome of burn injuries. Majority of burn injury patients needed surgical intervention and hence improvement in surgical aspects can lead to better outcome of burn injuries.

Therapeutic Applications of Stem Cells and Extracellular Vesicles in Emergency Care: Futuristic Perspectives.

Regenerative medicine (RM) is an interdisciplinary field that aims to repair, replace or regenerate damaged or missing tissue or organs to function as close as possible to its physiological architecture and functions. Stem cells, which are undifferentiated cells retaining self-renewal potential, excessive proliferation and differentiation capacity into offspring or daughter cells that form different lineage cells of an organism, are considered as an important part of the RM approaches. They have been widely investigated in preclinical and clinical studies for therapeutic purposes. Extracellular vesicles (EVs) are the vital mediators that regulate the therapeutic effects of stem cells. Besides, they carry various types of cargo between cells which make them a significant contributor of intercellular communication. Given their role in physiological and pathological conditions in living cells, EVs are considered as a new therapeutic alternative solution for a variety of diseases in which there is a high unmet clinical need. This review aims to summarize and identify therapeutic potential of stem cells and EVs in diseases requiring acute emergency care such as trauma, heart diseases, stroke, acute respiratory distress syndrome and burn injury. Diseases that affect militaries or societies including acute radiation syndrome, sepsis and viral pandemics such as novel coronavirus disease 2019 are also discussed. Additionally, featuring and problematic issues that hamper clinical translation of stem cells and EVs are debated in a comparative manner with a futuristic perspective. Graphical

Role, Management, and Outcome of Free Flap Reconstruction for Acute Full-Thickness Burns in Hands

Severe thermal trauma to the hand can result in major impairment and reduced function due to defective healing or even extremity loss. Full-thickness injuries frequently incur exposure of tendons or bone and require an early and stable coverage with soft tissue transplants to allow for rapid induction of exercise and to preserve structures and hand function. Free tissue transfer to the hand after thermal trauma is a rare indication, and safety, management, and outcome of free flap surgery for severe acute burn injuries to the hand remains underreported. Patients with primary reconstructions of full-thickness burn injuries to the hand undergoing microsurgical free tissue transfer surgery were retrospectively assessed in a period from 2013 to 2016. Salvage strategy of the extremity, postoperative complications, length of hospital stay, and primary reconstructive result were quantified and analyzed. Functional outcome measures (range of motion and grip strength) were assessed during clinical follow-up examinations. During the investigated period, 13 patients were identified undergoing reconstruction of 14 hands via free flap transplantation after severe burn injury in the acute phase. Nine anteriolateral thigh flaps (64%), 3 latissimus dorsi flaps (18%), 1 serratus anterior flap, and 1 tensor fasciae lata flap (7%) were performed. In all cases, salvage of the affected extremity was achieved, although 1 flap (7%) was lost during the early postoperative period requiring secondary reconstruction via pedicled groin flap. Further complications were venous thrombosis (n = 2; 14%) and hematoma (n = 2; 14%). Mean length of hospital stay was 51 days. Functional outcome during follow-up examination after an average of 9.3 months was inhomogeneous depending on the pattern of injury and ranged from complete recovery to nearly entire loss of hand function. Free flap transfer can be a mandatory and valuable tool to cover full-thickness burn injuries of the hand early in the clinical course of thermal trauma and may provide extremity salvage by favorable means of reconstruction to achieve acceptable functional outcomes, in the most severe cases. Although microsurgical failure rates in burn patients are slightly higher than in free flap transfer to the upper extremity in general, it can be performed with reasonable risk-to-benefit ratio.