Acute Burn Injury Research Articles

Effect of Pulsed Magnetic Field Therapy on Pain in Children with Acute Burn Injury

AbstractBackground: Pain management is essential in burn injury for children to better out come during all stages of treatment and rehabilitation.Aim of Study: Was to determine effect of pulsed magnetic therapy on pain in children after second degree of burn.Subjects and Methods: We have utilized children with acute burn injury, experimental design study, randomized, convenate on forty child, subjects divided into two group, control group (A) received specific design physical therapy program me and study group (B) received specific design physical therapy program me in addition to pulsed magnetic field therapy. Pulsed electromagnetic therapy application 3 days weekly, 20 minutes every session received pulsed elec-tromagnetic field. Pain was assessed with Wong backer faces pain scale in both groups after three days of injury and after three weeks of injury results. There were significant decrease in pain post application of pulsed electromagnetic field com-pared to its pre application, there was significant decrease in pain, post application of specific design physical therapy programme compared to its pre application and a significant decrease in the pain of study group compared with that of control group post-treatment (p=0.0001).Conclusions: The present study demonstrate that pulsed electromagnetic field justify amount of improvement in pain relieve in acute burn injury.

Acute Phase Response in Critically Ill Elderly Burn Patients.

Survival of elderly burn patients remains unacceptably poor. The acute phase, defined as the first 96 hours after burn, includes the resuscitation period and influences subsequent outcomes and survival. The aim of this study was to determine if the acute phase response post burn injury is significantly different in elderly patients compared with adult patients and to identify elements contributing to adverse outcomes. Cohort study. Tertiary burn center. Adult (< 65 yr old) and elderly (≥ 65 yr old) patients with an acute burn injury. None. We included all patients with an acute burn injury greater than or equal to 20% total body surface area to our burn center from 2011 to 2016. Clinical and laboratory measures during the acute phase were compared between adult and elderly patients. Outcomes included clinical hemodynamic measurements, organ biomarkers, volume of fluid resuscitation, cardiac agents, and the inflammatory cytokine response in plasma. Data were analyzed using the Student t test, Mann-Whitney U test, and Fisher exact test. A total of 149 patients were included, with 126 adults and 23 elderly. Injury severity was not significantly different among adult and elderly patients. Elderly had significantly lower heart rates (p < 0.05), cardiac index (p < 0.05), mean arterial pressure (p < 0.05), PaO2/FIO2 (p < 0.05), and pH (p < 0.05), along with higher lactate (p < 0.05). Organ biomarkers, particularly creatinine and blood urea nitrogen, showed distinct differences between adults and elderly (p < 0.05). Elderly had significantly lower levels of interleukin-6, monocyte chemotactic protein-1, monocyte chemotactic protein-3, and granulocyte-colony stimulating factor during the acute phase (p < 0.05). Overall mortality was significantly higher in elderly patients (5% vs 52%; p < 0.0001). Response to the burn injury during the acute phase response after burn is substantially different between elderly and adult burn patients and is characterized by cardiac depression and hypoinflammation.

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

BackgroundBurns are a painful and traumatic experience, particularly in children. Reduced pain and anxiety positively influences re-epithelialisation rates in paediatric burn patients, however current literature fails to fully explain the effects of pain and anxiety and their links with wound healing. This study will determine if Burnaid® hydrogel dressing is an effective treatment for reducing pain in the acute period of a burn injury. It is hypothesised that a reduction in pain will then improve re-epithelialisation time in comparison to plastic wrap, which is standard practice at our institution — a metropolitan tertiary paediatric hospital located in Brisbane, Australia.Methods/designA randomised controlled trial will be conducted to assess the effectiveness of Burnaid® as an analgesic adjunct to cold running water first aid for the treatment of paediatric burns. Participants will include children aged between 0 and 16 years with an acute thermal burn injury (total burn surface area < 20%) presenting to the Department of Emergency within 24 h of the burn occurring. Participants will be randomised into one of two groups: (1) Burnaid® hydrogel (intervention arm) or (2) plastic wrap (control arm). Participants will also be stratified into one of two groups based on factors that influence pain intensity: (1) high pain risk or (2) low pain risk. High pain risk factors include foot burns, hot coal/ash/fire pit burns, burn area greater than 5%, and circumferential burns. The primary outcome is the intervention’s effect on reducing acute pain. Secondary outcomes include days to re-epithelialisation, pulse rate, temperature, salivary cortisol and α-amylase, anxiety, and cost-effectiveness. Sample size calculations have shown that 36 participants will be recruited into each group.DiscussionThis study will provide comprehensive data on the analgesic properties of Burnaid® as an adjunct to first aid for the treatment of acute paediatric thermal burns. If the intervention is effective in reducing pain, Burnaid® will be integrated as standard practice within the hospital’s Department of Emergency. This study replicates a real-world scenario in order to identify clinically significant analgesic and wound-healing effects.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12617001274369. Prospectively registered on 5 Sept 2017.

A ZnO-curcumin nanocomposite embedded hybrid collagen scaffold for effective scarless skin regeneration in acute burn injury.

Scar formation in severe burn injury is a major health concern. Herein, we developed a hybrid collagen scaffold with an incorporated ZnO-curcumin nanocomposite, which facilitates scarless wound healing. Biocompatibility and hemocompatibility studies unveiled that the hybrid scaffold is apt for in vivo wound healing studies. Histological and immunohistochemical analyses demonstrate that the hybrid scaffold accelerated scarless burn wound healing in albino rats owing to the ZnO-curcumin nanocomposite induced up-regulation of angiogenesis and TGF-β3 expression. The semi-quantitatively measured scar elevation index of the hybrid scaffold-treated animals is on a par with that of the unwounded or normal skin. The studies suggest that the prepared hybrid biomaterial could be a potential candidate for scarless healing in severe burn injuries.

Versatile use of the posterior interosseous flap in the reconstruction of complex upper limb defects.

Reconstruction of the complex upper extremity defects is a challenging procedure for reconstructive surgeons because of the complex anatomical and functional structure of this region. In reconstruction, local and regional flap options involving the composite tissues are restricted. The posterior interosseous flap (PIO) has been presented 'in a single study' with a wide variety of uses, and in this study, the versatility of PIO has been tried to be emphasized by its multitude uses as well as its chance at adaptability to each case. Hence, due to this, the objective to highlight the versatile utility of the PIO flap in clinical practice and to present a good option for the reconstruction of complex upper limb defects for various cases have been targeted. We used 26 PIO flaps in 25 patients (18 male and seven female patients) with upper limb defects. The main etiological causes were burn contracture, traffic accident, firearm and acute burn injury. Twenty-two flaps were harvested as fasciocutaneous and four flaps as osteo-fasciocutaneous manner, which were applied to the metacarpal defects. In this study, 25 flaps were transferred as pedicled flaps, of which 23 and 2 flaps had reverse and antegrade blood flows, respectively, whereas one flap was used as a free flap. The mean follow-up period was 14 months. All flaps except one, which had partial necrosis and secondary healed, survived completely. All patients were able to gain basic functions for daily routine activities in the late postoperative period. Patients and/or their parents were satisfied with the postoperative functional and aesthetic improvements. Many advantages of the PIO flap make it useful for the reconstruction of upper limb complex defects. It can be versatilely used based on changing its flow direction and enrichment of contents.

Surface pH and acute burn wound healing

Context: There is a lacuna in our knowledge to objectively assess the progression of healing in an acute burn wound. Aim: This study aims to validate if a trend in changes of wound surface pH can be used as a reliable indicator to prognosticate wound healing in acute thermal burns. Materials and Methods: Hospital-based longitudinal observational study was conducted in the department of burns of a tertiary care center. One hundred and twenty-three patients with acute thermal burns in the age group of 15–60 years with total burn surface area between 30%–60% were included in the study. Surface pH of wound from a specific area of dimension 10×10 cm was measured on day 1, 3, 5, 7, 9, 11, 13, and 15 using HANNA HI 99181 pH meter and the trend of wound surface pH level changes over time was observed. Wound healing was clinically assessed by wound grading chart on day 7 and 15. Results: The trend of reducing pH values had a negative correlation coefficient of - 0.95 with improved wound healing, and the trend of increasing pH values had a positive correlation coefficient of 0.74 with deteriorating wound. This is statistically highly significant with P Conclusion: The analysis showed that the trend of change in pH value over time has high statistical significance with wound healing in burns patients with reducing trend, i.e., toward slightly acidic pH being associated with better wound healing and increasing trend, i.e., toward alkalinity suggesting worsening of wounds. Hence, wound surface pH can be used as a reliable indicator to prognosticate wound healing in acute thermal burns.

The use of hyperbaric oxygen therapy in the treatment of necrotizing soft tissue infections, compromised grafts and flaps, hidradenitis suppurativa, and pyoderma gangrenosum

Hyperbaric oxygen therapy (HBOT) is used in the management of a wide array of disease states, including acute thermal burn injuries, carbon monoxide poisoning, and decompression sickness, to name a few. Although HBOT is approved by the Undersea and Hyperbaric Medical Society for the treatment of only 14 conditions, it has been used "off-label" in the management of a variety of dermatological diseases. This review investigates the utilization of HBOT in dermatology and appraises the evidence behind its use. We focus on the role of HBOT in treating necrotizing soft tissue infections, compromised grafts and flaps, hidradenitis suppurativa, and pyoderma gangrenosum.

Effect of small molecular weight soybean protein-derived peptide supplementation on attenuating burn injury-induced inflammation and accelerating wound healing in a rat model

The populations most afflicted by burn injuries have limited abilities to support the significant specialized requirements and costs for acute and long-term burn injury care. This article describes the results of optimizing the use of readily absorbed small molecular weight soybean protein enzymolysis-derived peptide to attenuate rat burn injury-induced inflammation and accelerate wound healing. A major full-thickness 30% total body surface area burn-injury rat model was utilized and the systemic white blood cell (WBC) counts, the relative level of stimulation index of respiratory burst, and the inflammatory markers procalcitonin (PCT), tumor necrosis factor-α (TNF-α), chemokine (C–C motif) ligand 3 (CCL-3), chemokine (C–C motif) ligand 11 (CCL-11) and interleukin-10 (IL-10) were assessed. The burn injury-induced neutrophil and macrophage immune cell infiltration of the cutaneous tissues was detected by immunohistochemical analysis of the protein markers myeloperoxidase (MPO) and cluster of differentiation 68 (CD-68). The local induction of the burn injury-induced toll-like receptor 4/nuclear factor kappa-light-chain-enhancer of activated B (TLR4/NF-κB) signaling pathway in the effected cutaneous tissues was determined by the quantification of the protein expression of TLR4 and phosphorylated NF-κB/p65 using Western blots. In addition, burn wound size and healing rate were assessed biweekly for 8 weeks by imaging and measuring the burn wound surface area, and the angiogenesis protein marker of cluster of differentiation 31 (CD-31) expression in cutaneous tissues was also detected by immunohistochemical analysis. The results showed that nutrient supplementation with optimized readily absorbed small molecular weight soybean protein-derived peptide resulted in a dramatic anti-inflammatory effect as evidenced by the significant increase in the burn injury-induced systemic white blood cell counts and their relative level of stimulation index of respiratory burst, reduction in the burn injury-induced activation of NF-κB transcriptional signaling pathways, significant reduction in the local burn injury-induced cutaneous infiltration of neutrophils and macrophages at all measured time points, reduction in wound size and improved rate of burn injury wound healing with increased CD-31 protein expression. These results indicated that dietary supplementation with small molecular weight soybean-derived peptides could be used as an adjunct therapy in burn injury management to reduce inflammation and improve overall patient outcomes.

Synechococcus elongatus PCC7942 secretes extracellular vesicles to accelerate cutaneous wound healing by promoting angiogenesis.

Poor wound healing affects millions of people worldwide each year and needs better therapeutic strategies. Synechococcus elongatus PCC 7942 is a naturally occurring photoautotrophic cyanobacterium that can be easily obtained and large-scale expanded. Here, we investigated the therapeutic efficacy of this cyanobacterium in a mouse model of acute burn injury and whether the secretion of extracellular vesicles (EVs), important mediators of cell paracrine activity, is a key mechanism of the cyanobacterium-induced regulation of wound healing.Methods: The effects of Synechococcus elongatus PCC 7942 on burn wound healing in mice under light or dark conditions were evaluated by measuring wound closure rates, histological and immunofluorescence analyses. A series of assays in vivo and in vitro were conducted to assess the impact of the cyanobacterium on angiogenesis. GW4869 was used to interfere with the secretion of EVs by the cyanobacterium and the abilities of the GW4869-pretreated and untreated Synechococcus elongatus PCC 7942 to regulate endothelial angiogenesis were compared. The direct effects of the cyanobacterium-derived EVs (S. elongatus-EVs) on angiogenesis, wound healing and expressions of a class of pro-inflammatory factors that have regulatory roles in wound healing were also examined.Results: Synechococcus elongatus PCC 7942 treatment under light and dark conditions both significantly promoted angiogenesis and burn wound repair in mice. In vitro, the cyanobacterium enhanced angiogenic activities of endothelial cells, but the effects were markedly blocked by GW4869 pretreatment. S. elongatus-EVs were capable of augmenting endothelial angiogenesis in vitro, and stimulating new blood vessel formation and burn wound healing in mice. The expression of interleukin 6 (IL-6), which has an essential role in angiogenesis during skin wound repair, was induced in wound tissues and wound healing-related cells by S. elongatus-EVs and Synechococcus elongatus PCC 7942.Conclusion: Synechococcus elongatus PCC 7942 has the potential as a promising strategy for therapeutic angiogenesis and wound healing primarily by the delivery of functional EVs, not by its photosynthetic activity. The promotion of IL-6 expression may be a mechanism of the cyanobacterium and its EVs-induced pro-angiogenic and -wound healing effects.

Various Modalities of Scalp Reconstruction: A Review of Literature and Case Series

Background: The human scalp has various functions from protecting the skull bone to providing an aesthetic look. Various condition of the scalp that can cause full or partial thickness scalp loss are trauma (gunshot, RTA, avulsion injuries), acute and post burn injuries, post tumour excision defects and scalp infection etc.Subjects and Methods:This retrospective observational study was conducted over a period of 3 years in a tertiary care centre and the different etiologies of scalp injuries along with the various techniques of scalp reconstruction were discussed.Results:A total of 50 patients of both sexes and any age with full or partial thickness scalp defects were admitted. The most common age of presentation was 20-40 years age (40%) with trauma (56%) being the most common etiology followed by burns in 30% patients. 40 % of the patients were reconstructed with skin grafts while in 30% patients local flaps and in 10% patients tissue expanders were used.Conclusion: An aesthetically pleasing scalp reconstruction requires a precise preoperative planning with detailed knowledge of scalp anatomy and blood supply. The wide armamentarium of techniques for reconstruction allows the plastic surgeon to give a much pleasing final result.

A pilot study to compare the efficacy and safety of Betafoam® and Allevyn® Ag in the management of acute partial thickness burns

Betafoam® is a new polyurethane foam dressing containing 3% povidone-iodine. This pilot study aimed to assess the performance of Betafoam® for the management of acute partial thickness burn wounds, by comparing its efficacy and safety with those of a silver foam dressing, Allevyn® Ag Gentle. This randomized, two-arm, pilot study was conducted between June 2016 and February 2017 at 2 sites in the Republic of Korea. A total of 32 patients (aged ≥19 years) with acute partial thickness burn wounds and burn total body surface area ≤15% were randomized to treatment with Betafoam® or Allevyn® Ag Gentle dressings for 28 days. Endpoints included target lesion re-epithelialization, infection, pain, and adverse events. Mean time to complete re-epithelialization was similar in the Betafoam® and Allevyn® Ag Gentle groups (12.53 ± 1.13 vs 9.88 ± 1.02 days, P = 0.1556). All patients had complete re-epithelialization by day 28, and none had a burn wound infection during the study period. Analgesic use and patient-reported pain scores during dressing changes were not significantly different between dressing groups. No adverse events were associated with application of the dressings. The results of this first-in-human study suggest that Betafoam® has comparable wound healing efficacy to Allevyn® Ag Gentle, with no notable safety concerns.

Burn injury and multiple sclerosis: A retrospective case-control study

ObjectivesThe purpose of this study was to determine whether having a previous diagnosis of multiple sclerosis (MS) changed acute care needs in burn-injured patients. MethodsThis was a retrospective case-control study that included adult (aged ≥18years) patients with an acute burn injury. Control patients were matched with eleven patients with a history of MS at a 4:1 ratio. Outcomes included fluid resuscitation volumes, temperature, heart rate, mean arterial pressure, in-hospital complications, and hospital length of stay (LOS). ResultsThere were fifty-five patients included and of those, eleven had a documented history of MS. Fluid resuscitation volumes, temperature, heart rate, and mean arterial pressure were similar between groups during the resuscitation period (p>0.05). LOS was similar between both groups (12, IQR: 2–17 vs. median 16, IQR: 12–21; p=0.090). However, when normalized to % TBSA burn, patients with MS had a significantly higher median LOS/% TBSA burned (1.2, IQR: 0.7–2.0 vs. 2.1, IQR: 1.1–7.1; p=0.031). ConclusionsPatients with concurrent burn injuries and MS have a significantly longer LOS/% TBSA burn suggesting that more time is required to heal their wounds. Surprisingly, there were no other significant differences in the after the burn acute phase between these two cohorts.

The Effect of Platelet-Rich Plasma on the Zone of Stasis and Apoptosis in an Experimental Burn Model.

The zone of stasis that forms in acute burn is initially viable, but coagulation progresses to necrosis in the process that follows. This study investigates the effects of platelet-rich plasma (PRP) on apoptosis in the burn zone of stasis and on the viability of living tissue. Burns were established in the right ears of 20 female New Zealand rabbits using the "comb burn" model. Platelet-rich plasma was obtained from blood collected from rabbits' ears (n = 10) and was injected subcutaneously into the zone of stasis (n = 10). The same amount of saline solution was injected into the zone of stasis of the control group rabbits (n = 10). Histological and immunohistochemical apoptosis analysis was performed to evaluate viable areas. Apoptosis levels were higher in the control group than in the experimental group. The area of viable tissue in the zone of stasis was greater than in the control group. Infection-induced neutrophil infiltration was statistically significantly lower in the experimental group. In this animal model, apoptosis count and viable tissue area measurement and the anti-inflammatory results in the burn area confirm that PRP therapy has a statistically significant positive impact on the survival of the zone of stasis and in acute burn injury.

Sepsis criteria versus clinical diagnosis of sepsis in burn patients: A validation of current sepsis scores

BackgroundSepsis remains an ongoing diagnostic challenge in burns, especially with the signs of sepsis being ubiquitously present during the acute period after injury. We aimed to determine the predictive validity of 3 current sepsis criteria in the burn population. The criteria of interest included the American Burn Association sepsis criteria, Mann-Salinas et al predictors of sepsis, and the Sepsis-3 consensus definition. MethodsAdult patients with an acute burn injury who were diagnosed prospectively with sepsis by the burn team using specific clinical markers were included in this cohort study. Sepsis predictors were collected from patient charts and used to calculate the results of the 3 criteria, then subsequently compared to the clinical diagnosis. ResultsOf the 418 patients in the study, which took place from 2000 until 2016, 88 (21%) were septic; the mean age was 50 ± 18 years with a mean percent total body surface area burn of 30% ± 17%. Inhalation injury was present in 50%, median length of stay was 49 (29–71) days, and mortality was 19%. The American Burn Association, Mann-Salinas, and Sepsis-3 criteria were positive in 59%, 28%, and 85% respectively, P < .05. The most reliable predictors included increased oxygen requirements, altered mental status, hypothermia, hyperthermia, tachycardia, and hypotension. ConclusionThe Sepsis-3 criteria was the most predictive, followed by the American Burn Association and Mann-Salinas criteria. However, no criterion alone had the accuracy to be a diagnostic standard within this burn population. We recommend sepsis is clinically assessed, diagnosed, and documented prospectively by the burn team, and not by the application of retrospective criteria.

Efficacy of hypnosis on pain, wound-healing, anxiety, and stress in children with acute burn injuries: a randomized controlled trial.

No randomized controlled trial has investigated the efficacy of hypnosis for reducing pain and improving wound-healing in children with burns. This randomized controlled trial aimed to investigate whether hypnosis decreases pain, anxiety, and stress and accelerates wound-healing in children undergoing burn wound procedures. Children (4-16 years) with acute burns presenting for their first dressing change were randomly assigned to a Hypnosis Group who received hypnosis plus standard care or a Standard Care Group who received standard pharmacological and nonpharmacological intervention. Repeated measures of pain intensity, anxiety, stress, and wound-healing were taken at dressing changes until ≥95% wound re-epithelialization. Data for 62 children were analyzed on an intent-to-treat basis using Generalized Estimating Equations (n = 35 Standard Care Group; n = 27 Hypnosis Group). An effect on the primary outcomes of pain and wound healing was not supported {self-reported pain intensity largest Mean Difference [MD] = -0.85 (95% confidence interval [CI]: -1.91 to 0.22), P = 0.12; MD for re-epithelialization = -0.46 [95% CI: -4.27 to 3.35], P = 0.81}. Some support was found for an effect on the secondary outcomes of preprocedural anxiety (MD = -0.80 [95% CI: -1.50 to -0.10], P = 0.03 before the second dressing change) and heart rate as a measure of stress (MD = -15.20 [-27.20 to -3.20], P = 0.01 and MD = -15.39 [-28.25 to -2.53], P = 0.02 before and after the third dressing change). Hypnosis may be effective for decreasing preprocedural anxiety and heart rate in children undergoing repeated pediatric wound care procedures but not for reducing pain intensity or accelerating wound healing.

342 Serial Soft Casting for Soft Tissue Contracture After Acute Burn Injury

342 Serial Soft Casting for Soft Tissue Contracture After Acute Burn Injury

Grip and Muscle Strength Dynamometry in Acute Burn Injury: Evaluation of an Updated Assessment Protocol.

External stabilization is reported to improve reliability of hand-held dynamometry, yet this has not been tested in burns. We aimed to assess the reliability of dynamometry using an external system of stabilization in people with moderate burn injury and explore construct validity of strength assessment using dynamometry. Participants were assessed on muscle and grip strength three times on each side. Assessment occurred three times per week for up to 4 weeks. Within-session reliability was assessed using intraclass correlations calculated for within-session data grouped before surgery, immediately after surgery and in the subacute phase of injury. Minimum detectable differences were also calculated. In the same timeframe categories, construct validity was explored using regression analysis incorporating burn severity and demographic characteristics. Thirty-eight participants with total burn surface area 5% to 40% were recruited. Reliability was determined to be clinically applicable for the assessment method (intraclass correlation coefficient >0.75) at all phases after injury. Muscle strength was associated with sex and burn location during injury and wound healing. Burn size in the immediate period after surgery and age in the subacute phase of injury were also associated with muscle strength assessment results. Hand-held dynamometry is a reliable assessment tool for evaluating within-session muscle strength in the acute and subacute phase of injury in burns up to 40% total burn surface area. External stabilization may assist to eliminate reliability issues related to patient and assessor strength.

Clinical Epidemiology of Acute Burn Injuries at Nepal Cleft and Burn Centre, Kathmandu, Nepal.

Burn injury is a global health problem mainly occurring in developing countries. The Nepal Cleft and Burn Centre at Kirtipur Hospital, Kathmandu, has been providing the acute burn care since 2013 with 7 intensive care unit beds, 30 general beds, and 2 dedicated operating rooms. A similar descriptive study was performed in this center in 2014. These studies will be helpful for developing prevention strategies and monitoring the progress in the standard of care of acute burn patients. This is a descriptive retrospective study of the clinical data of acute burn patients admitted from January 1, 2015 to December 31, 2016. There were a total of 567 patients who came from 63 of 75 total districts of Nepal. Two hundred ninety-six (52.2%) patients were females and 271 (47.8%) were males. Two thirds of the patients were young adults. Most of the injuries occurred inside the house (72.1%). Flame burn was the most common mode of injury (66%) followed by scald (21.6%). Only 64 (11.3%) patients arrived on the same day of the injury. The longest time elapsed was 60 days with a median of 4.3 days. Range of total body surface area (TBSA) involved was 1% to 95%. The mean and median TBSAs were 25% and 15%, respectively. Range of hospital stay was 1 to 105 days with a median of 13.3 days.A total of 448 surgical procedures were performed in 384 patients (67.7%). A total of 110 (19.4%) patients died at the hospital. Only 13 patients (3%) survived deep burn injury involving 40% or more TBSA with either cadaveric skin allograft or with skin allograft from the live relatives. The outcome of burn injuries in Nepal is very poor. Children and females are at high risk. There is a lack of knowledge about burn prevention, proper first aid, and skin donation among the Nepalese population. Delay in presentation and extensive burns are poor prognostic factors. Awareness programs about the proper first aid and the need of a skin bank has to be done to improve the burn scenario in Nepal. Availability of allograft can increase the chances of survivability of patients with extensive burns in Nepal.

(134) - Evaluating the impact of high fat diet on pain behaviors in mice with acute burn injury

Acute pain is a prevalent and debilitating complication following burn injury and has the potential in certain individuals to become chronic pain. There is a paucity of preclinical and clinical research that has addressed this large clinical problem. Our recent work has been focused on developing a burn injury model that will allow for mechanistic investigations for acute and chronic burn injury pain. Our group has previously reported that mice given a high fat/rich carbohydrate diet (54% kcal from fat, 25% kcal from carbohydrate (CHO))develop mechanical allodynia. The present work sought to examine whether this high fat, high CHO diet may affect pain behaviors related to acute burn injury and whether it would lead to prolonged pain behaviors consistent with chronic burn pain. Mice were given either a normal chow or a high fat/high CHO diet and then either were given burn or sham injury on the right hind paw. Pain behaviors were observed over a 28 day period after the burn injury and included mechanical and thermal assessments. Results indicate that both normal chow and high fat diet burn injured mice exhibited significantly reduced mechanical pain thresholds for two weeks after burn injury. After 14 days, both burn injury groups displayed increased mechanical pain thresholds that by 28 days, were surprisingly higher than baseline. Overall, the high fat diet burn group was not found to display greater levels of allodynia compared to the normal chow burn group and there was no evidence that the current model or the high fat diet led to pain behaviors consistent with chronic pain. Preliminary investigations into proportions of mast cell degranulation show that burn injury led to a higher percentage of degranulated mast cells compared to sham injury and that dietary influence may also have a small impact.

Physical, functional, and psychosocial recovery from burn injury are related and their relationship changes over time: A Burn Model System study

ObjectiveWhile burn injuries can have dramatic effect on patients’ physical health, they can also lead to intense psychological distress, loss of important social and role functioning, and alterations in outward appearance. We aimed to identify potential leading indicators of recovery in the post-discharge period following acute burn injury and hospitalization. MethodUsing data derived from the Burn Model System National Database, we identified five outcomes of interest measured at four time points (Pre-burn/Discharge, 6 months, 12 months, and 24 months post-discharge), including mental health, physical functioning, community integration, life satisfaction, and satisfaction with appearance. We applied cross-lagged panel analysis to the sample of 1052 injured patients admitted to burn intensive care units. ResultsOverall, there was little mean change in the five measures after the 6-month assessment. A time-varying panel model was superior to a time-invariant model, showing that the process of recovery itself may change over the course of two years post-burn. Physical functioning is an important predictor throughout this period, while satisfaction with appearance is quite predictive of other factors at discharge, but somewhat less predictive later. Overall mental health functioning is less predictive at discharge but at later intervals was a meaningful leading predictor of the other outcomes. ConclusionsRecovery from burn injury is complex and the most important facets of recovery change over time. Future research should focus on developing treatments to help patients adjust to post-burn appearance in the early post-discharge period, and mental health interventions may be effective as patients progress in recovery.