Burn Cases Research Articles

Analysis and comparison of injury rate State Fire Brigade workers and Volunteer Fire Brigade members

Background. Firefighter profession is characterized by a high level of risk due to the threat, mainly related to rescue and fire extinguishing, workouts, training and other actions. They result from the firefighters’s duties and affect the health and life of the firefighters on duty. The aim of the study was to assess the specificity of injuries in the State (SFB) and Volunteer Fire Brigade (VFB), assessment of the cumulation of health-related behaviors based on the Modified Inventory of Behaviors by Juszczynski, and the effect of the cumulated behaviors on the injury rate, both in the State and Volunteer Fire Brigades. Material and methods. The sample included the occupationally active firefighters from the Volunteer Fire Brigade in the Opole and Lower Silesia voivodeships. The applied approach involved the application of an anonymous questionnaire filled out by volunteers participating in the study. The questionnaire included basic data on their service (State or Volunteer Fire Brigade), age, gender and the presence or absence of contusions, and a possible form of treatment to be applied. Moreover, the Modified Inventory of Health-Related Behaviors by Juszczynski was applied. The questionnaire contained 18 statements describing health-related behaviors. Results. The comparison of the results corresponding to physical activity among the firefighters from the State and Volunteer Fire Brigade indicates that all the firefighters from the State Fire Brigade were physically active. In the case of the Volunteer Fire Brigade (VFB) there were 20 firefighters including 6 firefighters who did not practice any form of physical activity. In State Fire Brigade (SFB) there were 29 firefighters who had sustained contusion and 5 healthy ones. In both groups, the subjects most often sustained contusions while performing other types of physical activity than rescue and fire fighting actions. The majority of firefighters (16 in SFB and 11 in VFB) sustained joint sprain. Despite the numerous fire extinguishing interventions, the cases of burns poisoning are rare. The results also suggest that the surveyed firefighters neglect the recommended dietary habits and rest. Conclusions. 1. The results indicate no statistically significant differences between SFB and VFB membership and the circumstances of injuries sustained. 2. The membership in SFG and VFB has an effect on undertaking physical activities, however, it has no effect on injuries/contusions. 3. Neither SFB nor VFB firefighters believe that correct eating habits and rational rest are important.

Ocular damages inflicted by criminal injuries

Purpose: to analyze eyeball and appendage damages inflicted by criminal injuries of patients who sought assistance by the emergency ophthalmological care unit in Perm.Materials and methods. The data of the patients’register and medical histories of the ophthalmological department of the State Clinical Hospital No. 2 named after Dr. F. H. Gral of Perm for 2018–2020 were retrospectively analyzed.Results. Out of 30428 cases of domestic injuries, 847 (2.8%) were received under criminal circumstances. The victims, predominantly male (77.6%), and of working age (93.7%), were delivered by ambulance in 51.6% of cases. The majority of people sought assistance within 24 hours (90%). The injuries were inflicted by strangers (59.5%) or acquaintances of the patients. 1257 eyes were injured. The prevailing conditions were contusions (46.9%), while the most common traumatizing factor was first punch (79.6%). Combined damages to the eyeball and appendage were more common, claiming 72.6%. Visual acuity fell below 0.1 in 5.6% of cases, 0.1–0.6 in 57.6%, 0.7–1.0 in 36.8% of cases. 45.9% of all cases were represented by eye burns: mainly they were chemical burns (99.5%) of which the overwhelming type was burns caused by gas spray irritants (97.9%). In burn cases, visual acuity was below 0.1 in 1.4% of cases, 0.1–0.6 in 62.6%, 0.7–0.8 in 36% of cases. The wounds inflicted to the eye amounted to 7.2%, the damaging factors being handgun bullet, glass, metallic objects. Injuries of the eyelids and the eyeball were observed. Most of the injuries were mild (91.3%). 5.83% of the victims needed hospitalization in an ophthalmological in-patient facility.Conclusion. The eye trauma, especially one of a criminal nature, is a social problem, and its analysis is highly relevant. The data obtained illustrates the need to increase the general culture of the population, to improve sanitary and educational work, and optimize medical care for those suffered.

Exploring the therapeutic potential of acetonic plant extracts in the healing of skin wounds infected with multidrug resistant pathogens.

Open wounds are easily susceptible to infection by multi-drug resistant (MDR) pathogens. The emergence of MDR super bacteria such as Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus spp, fungi such as Aspergillus niger and Candida spp, has been identified to significantly increase the incidence rate. Therefore, it is necessary to develop a suitable barrier to prevent infection and enhance wound healing. On the other hand, medicinal plants could represent a significant source of new antimicrobial drugs for combating MDR pathogens. Out of 60 clinical skin burn cases, 51 patients (85%) had polymicrobial infections, while the remaining had monomicrobial infections. Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumonia were identified as the most common bacterial isolates based on morphological and biochemical tests. However, Candida albicans, Candida parasitosis, Candida glabrata, Candida famata, Aspergillus niger, and Exophilia spinifera were the most common fungal isolates found in skin burn cases. MDR classification was reported in 21 of the 39 bacterial isolates and 8 of the 27 fungal isolates. The antimicrobial activity of tested acetonic plant extracts rosemary, henna, and licorice against MDR isolates was compared to the commercial antibiotic agents. Acetonic rosemary extract outperformed henna and licorice extracts in antibacterial activity, while licorice extract outperformed henna and rosemary extracts on antifungal activity. As a result, rosemary and licorice extracts were chosen to prepare a topical cream for further in vivo wound healing and histopathology. Based on the antimicrobial potential of acetonic plant extracts against MDR isolates, BI-41 and FI-17 were chosen for in vivo wound healing. BI-41 stands for the molecularly identified species Pseudomonas aeruginosa SSM-15, while FI-17 stands for molecularly identified species Aspergillus niger SSM-27. In vivo testing showed that both cream formulas had excellent healing properties when administered topically. In vivo histopathological examination revealed that acetonic rosemary and licorice extract could be promising for wound healing, combating MDR pathogens of burn wound infections.

An unusual case of severe electric burn of the skull: A rare incident

An unusual case of severe electric burn of the skull: A rare incident

Alleged Murder, Uncovered the Mystery as Suicide: A Crime Scene Investigation Case Study

The primary goal of every investigation is to find out the actual truth of any fact and prove or disprove any allegations with the help of scientific evidence according to the law. This case study is an excellent example to understand the crime scene investigation for forensic and law enforcement professionals, especially in the burning cases. The background of the present case is that one 18-year-old girl was admitted to a Government hospital in West Bengal, India, with 68% burns injuries at night. The hospital authorities informed the police about the matter. Accordingly, the local police rushed to the hospital and recorded the statement of the victim girl. A case was registered by the police against the unknown miscreant in the local police station on the basis of the statement of the victim girl. Three days later the victim girl died from his injuries. The case was amended under section 302 Indian Penal Code. On requisitioned by the Deputy Commissioner of Police, a forensic team under the leadership of the author (TKMukherjee) visited and examined the crime scene and unearths the actual truth.

Solar Burns to the Reconstructed Breast: A Rare Complication following Breast Reconstruction.

Background:Burns to the breast are a rare complication after breast reconstruction. Decreased sensation and radiation therapy may contribute to the development of burns. Solar burns may also be related to wearing dark-colored clothing. This literature review aims to analyze the incidence of solar burns on alloplastic and autologous breast reconstruction following mastectomy. Also included is the first published report of a delayed breast burn years after alloplastic reconstruction.Methods:A PubMed literature search of articles was performed using the search formula “burns” AND “breast reconstruction.” s were evaluated for relevance based on inclusion and exclusion criteria. Pertinent reference bibliographies were then screened for additional relevant resources.Results:The PubMed search resulted in 598 articles, of which 12 met inclusion criteria with 22 cases of solar burns to reconstructed breasts (23 including the addition of our case report). Five occurred following alloplastic reconstruction with 80% of these patients radiated and 100% wearing dark clothing. The remaining 18 patients had autologous reconstruction with 50% wearing dark clothing. Twenty-two percent of patients in the autologous group required surgical debridement as compared to 40% of the alloplastic group.Conclusions:Solar burns in autologous and alloplastic breast reconstruction, while rare, pose significant complications in the reconstructed breast and appear to be exacerbated by radiation and dark-colored clothing. Patients should be counseled accordingly with discussion of this potential risk in a comprehensive informed consent, and precautions should be recommended to avoid this type of injury.

Investigation of the relationship of growth hormone, insulin-like growth factor (IGF)-1, and IGF-binding protein-3 levels with graft viability in autograft-transplanted pediatric patients with major burns

BackgroundIn our study, we investigated graft viability, Growth Hormone (GH), Insulin-like growth factor (IGF)-1, and IGF-binding protein (IGFBP)-3 in autograft-transplanted pediatric major burn cases. MethodsThis descriptive study was conducted with the participation of pediatric patients with major burn wounds. The laboratory data and characteristics of the patients were accessed retrospectively, and the obtained data were recorded in the data form developed by the researchers. In the analysis of the data, descriptive statistical methods, chi-squared test, Wilcoxon signed-rank test, one-way ANOVA, and post hoc analyses were used. ResultsThe sample of our study consisted of 93 pediatric major burn patients with a total burnt body surface area of more than 20%. It was found that 65.59% of the patients were between the ages of 1 and 5, 63.43% of them were in the 41–55 percentile range, 58.06% had a hot liquid burn, 74.2% had a second-degree burn, 60.21% had a burn percentage in the range of 21–40 of their total body surface area. It was determined that the GH and IGF-1 levels of the patients who experienced loss after graft transplantation remained below the normal value in the first 14 days, and the differences in the GH and IGF-1 values between the patients with good functioning grafts and those with graft loss were statistically significant (p < 0.01). It was found that the IGFBP-3 value remained low on the 14th day in the patients with good functioning grafts, and the difference in the IGFBP-3 values between the patients with good functioning grafts and those with graft loss was statistically significant (p < 0.05). ConclusionToday, it is known that the parameters of GH, IGF-1, and IGFBP-3 are related to many problems. However, no study examining their relationships with graft viability in autograft-transplanted pediatric patients with major burns was encountered. Our study may be the first to determine that changes in these three laboratory parameters negatively affect the healing of burn wounds.

The Electronic Gadgets Explosion Burn

With the technological progress of humans and the need to stay connected by various means of communication including laptops and smartphones, security measures must follow the qualities of computers as well as their chargers. Explosion burns of electronic gadgets are rarely reported in the scientific literature. We report three cases of explosive burns of electronic gadgets including one by explosion of a laptop computer. The aim of our work is to explain the explosion mechanism and emphasize the safety measures to be followed to limit this type of accident, which can be serious and sometimes fatal.

Therapeutic Effect of Autologous Activated Platelet-rich Plasma Therapy on Mid-dermal to Full-thickness Burns: A Case Series

Although modern medicine has made great strides in the management of burn injuries, associated complications such as pain, infection, dyspigmentation, and scarring have yet to be fully dealt with. Although skin grafting and meshing are routinely performed on burn patients, this method poses a risk for adverse effects. Activated autologous platelet-rich plasma (aaPRP), which is increasingly used in the field of plastic surgery, contains growth factors beneficial for wound regeneration. Seven cases of burns with varying severity and conditions that were treated with intralesional subcutaneous injection and intravenous aaPRP are presented and discussed herein. This case series indicates that subcutaneous and intravenous aaPRP is a safe procedure with the potential to be an alternative when skin grafting cannot be done or as an adjunct treatment to skin grafting.

Prevalence of burns in children 0 to 14 years admitted into Paediatric surgical ward of Murtala Muhammad Specialist hospital Kano-Nigeria

&lt;em&gt;&lt;strong&gt;Background:&lt;/strong&gt; Burns internally, means an injury due to either fire or chemical on the human. In fact burn injury is a major public health problem and leading cause of childhood mobility and mortality world Wide. About 60% of all burn patient suffers from burn of intermediate severity corresponding to less than 10% of the body surface these patients can be treated as our parents. The objectives of the study are (a) To determine the age and gender group that has the highest occurrence of burns from Jan 2019 to Jan 2020 in patient admitted into paediatric surgical ward of Murtala Muhammad Specialist Hospital Kano. (b) To Identify the possible causes of paediatric burns in Paediatric surgical ward of Murtala Muhammad Specialist hospital Kano. (c) Identify the number of children with burns from January 2019 to January 2020. &lt;strong&gt;Methods: &lt;/strong&gt;A retrospective study designed and census sampling technique was used were all the patients with burns were record.&lt;strong&gt; Results: &lt;/strong&gt;The study shows that children aged 2 – 5 years have the highest occurrence of burns.Also Males have the highest prevalence within these months with about 58.6% compared to females. The most common cause of domestic paediatric burns admitted in Murtala Muhammad Specialist Hospital from January 2019 – January 2020 is fire and flame burn injury.the study also revealed that 87 children ranges from 0 – 14 years admitted with cases of domestic burns during the period of the study at Murtala Muhammad Specialist Hospital Kano.&lt;strong&gt; Conclusion: &lt;/strong&gt;In the research, it is seen that burns are accidents damage to skin cause by heat, flame, chemical, electricity and radiation. Risk factors of burns include: gender, age, occupation that increase exposure to fire, easy access to chemical e.t.c. therefore, proper health education should be introduced especially to mothers and caregivers who do not have knowledge of the causes and preventive measures.&lt;/em&gt;

Invasive Aspergillus outbreak in inhalation injury: a case presentation and literature review

BackgroundInvasive pulmonary aspergillosis often occurs in patients with poor immune function, who abuse steroids or broad-spectrum antibiotics, or who use intravenous drugs. Among the Aspergillus genus of pulmonary infection, Aspergillus fumigatus is the most important pathogen, followed by Aspergillus flavus, Aspergillus niger, and Aspergillus terreus. Inhalation injury complicated by Aspergillus infection has atypical clinical manifestations. Diagnosis is difficult, and it is easy to make mistakes in treatment. Moreover, there are few cases of burn inhalation injury complicated with pulmonary Aspergillus.Case presentationWe report a case of severe burns combined with severe inhalation injury, early pulmonary aspergillosis, and severe respiratory failure due to treatment discontinuation. Through analyzing the processes of diagnosis and treatment in the present case and performing a literature review, we explore feasible diagnosis and treatment plans.ConclusionsEarly application of a variety of diagnostic measures can be used to identify Aspergillus infection, and targeted anti-infection treatment is likely to reverse a severe adverse prognosis.

Art Therapy in Burn Cases: A Review and Case Examples.

In this article, we provide an overview of the literature on contributions of art making and medical art therapy for patients with burn injuries. The potential value of art therapy in addressing the complex physical and psychosocial needs of burn patients is discussed through examination of 7 peer-reviewed articles. Two case examples of burn survivors, 1 pediatric and 1 adult, are included to demonstrate the use of art therapy in an inpatient and outpatient setting, respectively. Art therapy and other intervention strategies for overall psychosocial adjustment of burn patients are often underutilized. Further research in art therapy is needed to examine the psychosocial aspects of burns patients and the potential role that medical art therapy may have in a burn care center.

The Epidemiology of Unintentional Burn Case in Sanglah General Hospital, Denpasar, from 2014 to 2018

BACKGROUND: Burn injury is one of the serious public health problems. Many of burn patients end up with experiencing disability (morbidity). Meanwhile, the epidemiology of burn patients in eastern part of Indonesia is rarely reported. AIM: We aimed to investigate the sociodemographic characteristic of burn patients in Sanglah General Hospital as the center referral hospital for eastern part of Indonesia. MATERIALS AND METHODS: Viable data were collected from burn patients admitted to Burn Center of Sanglah Hospital between January 2014 and December 2018. A cross-sectional study design was used with statistical analysis which was performed using IBM Statistics 23 for Windows. RESULTS: A total of 725 subjects were involved in this study. Subjects were divided into two groups of emergency (n = 607, 83.72%) and non-emergency (n = 118, 17.28%). There were 525 (72.4%) burn subjects who were ≥17 years old with combustion caused by flame as the most common case (n = 264, 56.9%), whereas 200 (27.6%) subjects were &lt;17 years old, while the group of age 0–5 years old (n = 115, 57.5%) gave largest proportion admission in pediatric group of scalding as the main cause (n = 100, 69.4%). CONCLUSION: We found that adults and elders had the highest risk of acquiring combustion caused by flame. Scalding was the most burns case found in the pediatric population.

761 Burn first aid in Australian pre-hospital environments

IntroductionBest-practice burns first aid is well defined as 20 minutes of cool running water (CRW) within three hours of injury and an expectation of burn care in Australia. This study aims to identify barriers to applying this intervention and assess burn first aid knowledge amongst Australian paramedics.MethodsUsing multiple methods we assessed; 1) burn first aid adequacy in a cross-sectional study of health care professionals, utilizing a prospectively collected registry of patients managed at an Australian tertiary children’s hospital. Logistic regression models were used to evaluate the relationship between first aid adequacy between health services (eg. Paramedics and emergency departments). Then 2) paramedics completed a questionnaire containing demographic and clinical expertise and environment as well as recording immediate first aid management across five multiple choice burn case scenariosResultsOverall, 31.3% of children received adequate CRW from caregivers. Factors associated with caregiver inadequacy of CRW were very young age and early adolescence (p< 0.001) rural location ( P = 0.045), low socioeconomic status ( P = 0.030) amongst others. Paramedics and general practitioners provided adequate cooling to 184/735 (25.0%) and 52/215 (24.2%) of their patients, respectively. Local general hospitals provided adequate CRW to 1019/1809 (56.3%) patients. Paramedic questionnaire responses (n=326) identified 56% of paramedics answered all burn case scenarios correctly. Respondents who treated a burn within six months scored higher on burn first aid scenarios compared to paramedics who had not recently treated a burn (p=0.004).Conclusions: deficiencies remain in the cooling of paediatric burns patients at all levels of initial management. First aid delivery was significantly worse in children aged 0‐2, adolescents aged 15‐16, those living rurally, and the socioeconomically disadvantaged.

58 Burn Injuries in Asia: A Global Burden of Disease Study

IntroductionBurn injuries disproportionately affect low- and middle-income countries. Work conditions, rapid industrialization, social conditions, cultural activities, political conflict, and lack of access to safe and affordable surgery are key barriers to effective burn care in Asia. This study aimed to better define the burn burden in Asia, its sub-regions, and related sex and age disparities to elucidate populations where targeted burn care interventions are most needed.MethodsThe 2019 Global Burden of Disease (GBD19) of the Global Health Data Exchange was used to acquire 151,741 sources of epidemiological data on fire, heat, and hot substance-related injuries for 53 countries in Asia from 1990 to 2019. Measures used to derive summative statistics included incidence, deaths, disability-adjusted life years (DALYs), and mortality ratio (deaths: incidence) by year, sex, age, and location. Spatial mapping was performed to geographically delineate burn indicators.ResultsFrom 1990 to 2019, an estimated 117 million burns occurred in Asia. The relative proportion of global burns, deaths, and DALYs from Asia increased during that time. By 2019, 46% of global burn cases, 47% of deaths, and 46% of DALYs were from Asia. The two most burdened regions were South and Southeast Asia, accounting for 30-40% of all global cases, deaths, and DALYs. Compared to global averages, the incidence, death, and DALY rates for Asia were 32%, 22%, and 23% higher. Central Asia had the worst rates, averaging 2.9, 2.3, and 2.6 times the global averages. Throughout Asia, men were 32%, 63%, and 47% more likely to be burned, die, and suffer DALYs than women versus the global disparities of 7%, 26%, and 10%. Only South Asia’s trend was reversed with women suffering 15%, 20%, and 27% more burns, deaths, and DALYs than men. In Asia, those under 5 years were most impacted by DALYs (314 years/100,000 people), 5-14 year olds had the highest burn rate (219 cases/100,000), and 70+ year olds had the highest death rate (8.4 deaths/100,000) and mortality ratio (54%).ConclusionsIn 2019, Asia had an estimated 3.8 million burns comprising nearly half of all the world’s burn cases, deaths, and DALYs. While Asia’s burn indicators have declined since 1990, global improvements have surpassed Asia’s. South and Southeast Asia accounted for the greatest burden of burn morbidity and mortality, but Central Asia consistently had the highest rates relative to overall population. Men were more affected than women, except in South Asia, and the extremes of age (< 5 and 70+ years) suffered the greatest rates of disability and death.

T2 Global Hospital Infrastructure and Pediatric Burns

IntroductionLow income regions across the world carry the highest proportion and highest mortality burden of pediatric burns. In recent years, attention to remedy these inequities has shifted from isolated mission trips towards building infrastructure for lasting improvements in surgical care. This study aims to investigate disparities in pediatric burn care infrastructure and their relationship to mortality outcomes.MethodsThe multinational Global Burn Registry was queried for all burn cases between January 2018 and August 2021. Burn cases and mortality rates were compared across infrastructure factors by Pearson Chi-Square. Multinomial logistic regression was used to isolate independent modifiable risk factors for mortality controlling for total body surface area of burn (TBSA).ResultsThere were a total of 8537 cases of which 3492 (40.9%) were pediatric. Significantly lower mortality rates were found in facilities with sophisticated nutritional supplementation (p < 0.001), permanent internet connectivity (p < 0.001), reliable critical care access (p < 0.001), reliable burn OR access (p=0.003), dedicated burn unit (p < 0.001), and advanced plastic and reconstructive skills available (p=0.003); there was no significant difference if specialist capabilities in supportive fields (e.g. nephrology, cardiology) were available (p=0.063). Significant disparities were found in the availability of these resources between high and low income countries, as well granular information within low income regions: though blood transfusion access was limited in the African (49.0%) and South-East (50.6%) regions compared to full access in the Americas and Europe (p < 0.001), 100% of cases in the South-East had access to a specialized burn unit compared to 8.1% of cases in Africa. In a multinomial logistic regression controlling for TBSA, the most significant risk factor for mortality was limited critical care availability (OR 15.18, p< 0.001). The most significant protective factor was sophisticated nutritional access (OR 0.40, p=0.024).ConclusionsThis is the first quantitative analysis of disparities in global burn infrastructure and their impact on pediatric mortality. The identification of nutritional support as an independent and significant protective factor suggests that low-cost interventions in hospital nutrition infrastructure merit further study and may realize significant gains in global burn care. Granular information in the variability of regional needs will begin to direct targeted infrastructure initiatives rather than a one-size-fits-all approach in developing nations.

600 Reconstruction of Finger Contracture with an Expanded Dorsal Metacarpal Artery Perforator Flap

IntroductionThe first dorsal metacarpal artery perforator (DMCAP) flap is frequently used to cover exposed bone, tendon and neurovascular structures in the hand after trauma and burns. The size and width of DMCAP flap is limited and rotation arc generally lets to cover defects up to middle phalanx. Expansion of the DMCAP flap has not been reported in the literature and this technique might be solution to increase flap viability and size in order to cover defects up to distal phalanx. In this study, we will describe utilization of tissue expander to first DMCAP and present a case of electric burns in with flexor contracture.MethodsA nine-year-old male patient applied to our clinic with the complaint of inability to extend the second finger of the left hand after an electrical burn. Physical examination revealed flexor contracture in the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints. Reconstruction was planned for the patient with a two-session expanded first DMCAP flap.In the first session, a 16 cc 5x3 cm tissue expander placed through a 3 cm vertical incision at the fifth metacarpal level. From the second postoperative week, the tissue expander was inflated with 1 ml of isotonic three days a week. Six weeks later, the DMCAP area was enlarged by giving 45 cc saline.ResultsIn the second session, contractures at the level of the left hand 2nd finger DIP and PIP were excised.. Left hand 2nd finger was fixated in extension with K-wire. 9x3 cm DMCAP flap was elevated by dissection over the paratenon and the pedicle was preserved. The flap was adapted to the defect area on the volar face with 180-degree rotation angle. The flap donor site was closed primarily.There were no complications in the post-operative period. K-wire was removed at 6 weeks postoperatively. The patient was referred to the physical therapy.ConclusionsIn cases where the tissue defect cannot be closed with loco regional flaps, extra tissue can be provided by free flaps or using tissue expanders. Primary closure of the donor area, appropriate flap thickness for the finger, and aesthetically pleasing results are among the advantages of the expanded DMCA flap.. However, in tissue expander applications in the upper extremity, the patient should be followed closely, and pain and finger circulation should be constantly questioned.

728 Chemical Burns and Eyebrow Tinting: An Unusual Case

IntroductionHere we present the case of chemical burns following professional eyebrow tinting, a phenomenon rarely described in the literature.MethodsA 50-year-old previously healthy female presented to our emergency department for evaluation and treatment of chemical burns to her eyebrows. Fifteen days prior, she underwent professional eyebrow tinting by a local esthetician. Blistering developed the following day, and progressive swelling prompted her to present to an outside hospital. There she was prescribed acyclovir, ketoconazole cream, and silver sulfadiazine, but despite these measures, her symptoms progressed, leading to her presentation to our facility. Both brows were remarkable for significant swelling with exudative crushing on the surface concerning for superficial infection of partial-thickness chemical burns. She was prescribed bacitracin, prednisone, and clindamycin and discharged with instructions to follow up in burn clinic. Six days later, both brows had developed 2x3 cm scabs, but no signs of infection were appreciated. She was instructed to apply bacitracin/polymyxin B ointment to the scabbing areas and open wounds. Forty-nine days after her tinting, both brows were noted to be completely healed with no alopecia.ResultsBurns following cosmetic procedures most commonly occur during hair lightening treatments where products frequently contain caustic chemicals such a hydrogen peroxide or persulphates leading to oxidation reactions lightening the hair. Thermal burns in hair salons have also been reported to heated hair-dressing instruments or external heat to hasten the highlighting process.The periorbital area is becoming an increasingly popular target for nonsurgical cosmetic procedures, including permanent eyelid tattooing, eyelash dying, and extensions, more recently, eyebrow tinting. Eyebrow tinting involves the application of semipermanent dyes to give the appearance of a fuller brow. There are no FDA-approved brow tinting formulations, and many contain para-phenylenediamine (PPD), a dying agent frequently associated with allergic dermatitis and less commonly chemical burns. This patient underwent brow tinting in a professional setting and still experienced a chemical burn. As the popularity of brow tinting increases, some patients will undoubtfully seek out readily available, unregulated products for self-application. The potential for dermatitis and chemical burns following eyebrow tinting will only increase.ConclusionsEyebrow tinting is not a benign cosmetic procedure, and even professional application of dyes may lead to chemical burns. We believe an increased awareness of brow tinting and its potential complications is warranted given its increasing popularity, the preponderance of unregulated products, and the potential for poor cosmetic outcomes.

783 Use of Multidisciplinary Collaboration to Establish a Standardized Endotracheal Tube Wiring Guideline

IntroductionPediatric patients with facial burns and advanced airway needs precipitate acute situations requiring multidisciplinary team member collaboration. Significant facial burns, particularly involving considerable edema or smoke inhalation, may warrant dental or circum-mandibular endotracheal tube (ETT) wiring for stabilization. Guidelines were created, trialed, and revised based on patient outcomes and clinician feedback at a pediatric verified burn center.MethodsThe guideline was created by the burn team in 2019. This standard work was utilized with pediatric burn cases presenting to the burn center. Guideline variances, such as prolonged time from door to ETT wiring, prompted a gap analysis need to improve the process. Through two case review sessions held in 2020, a multidisciplinary team consisting of the burn providers, emergency department providers, nursing, and respiratory therapists revealed process knowledge deficits, unclear role expectations, and supply issues. Literature was reviewed and a myAmeriburn listserv inquiry of current practice was made to seek additional guidance.ResultsBased on feedback from the multidisciplinary group and data gathered from the literature and collegial burn community, action plans and guideline modifications were developed in 2021. The respiratory therapy department developed education for their staff highlighting use of twill tape and taping. The use of ETT suturing was removed from the guidelines.ConclusionsMultidisciplinary contribution and engagement was necessary to produce, execute, and evaluate the pediatric endotracheal tube wiring guidelines. Through dialogue, patient trial, and constructive feedback, guidelines were amended to produce a smoother team process and better patient experience. The standard work is currently being evaluated in its modified version.

The Future of Burn Care From a Complexity Science Perspective.

Health care is undergoing a profound technological and digital transformation and has become increasingly complex. It is important for burns professionals and researchers to adapt to these developments which may require new ways of thinking and subsequent new strategies. As Einstein has put it: "We must learn to see the world anew." The relatively new scientific discipline "Complexity science" can give more direction to this and is the metaphorical open door that should not go unnoticed in view of the burn care of the future. Complexity science studies "why the whole is more than the sum of the parts." It studies how multiple separate components interact with each other and their environment and how these interactions lead to "behavior of the system." Biological systems are always part of smaller and larger systems and exhibit the behavior of adaptivity, hence the name complex adaptive systems. From the perspective of complexity science, a severe burn injury is an extreme disruption of the "human body system." But this disruption also applies to the systems at the organ and cellular levels. All these systems follow the principles of complex systems. Awareness of the scaling process at multilevel helps to understand and manage the complex situation when dealing with severe burn cases. This paper aims to create awareness of the concept of complexity and to demonstrate the value and possibilities of complexity science methods and tools for the future of burn care through examples from preclinical, clinical, and organizational perspectives in burn care.