Burn Depth Research Articles

Skin graft take rate among minor burns – A cohort study to investigate the effect of factors such as burn depth, burn size, and timing of the operation

BackgroundIt has been known for decades that early excision of burns reduces morbidity and mortality. Early surgical excision and skin grafting has become the most important part of successful healing in burn management, especially in major burns. However it is not entirely clear whether early excision and skin transplantation has the same advantages in smaller burns and there is no consensus on the timing of skin grafting in this group. The aim was to investigate the effect of timing and other factors for skin graft take rate among minor burns. MethodsThis retrospective study included patients with thermal injury, a burn size smaller than 11 % total body surface area (TBSA), and who were treated with a skin graft operation. Take rate at the second dressing change after operation was used as main outcome, a cut-off of 95% take rate was for the multivariable logistic regression. ResultsA total of 195 patients were included, median (IQR) age was 42 (9–68) years, 65 % were male, and median (IQR) area of deep burns was 2 (1–4) % of the body surface area (BSA). Multivariable regression showed that smaller area of deep burns and scalds (compared with flame and contact burns) were associated with a take rate of ≥ 95 %. Age, timing of the skin graft transplantation, and plasma C-reactive protein showed no independent effect on take rate. The regression model was significant but weak (ROC AUC 0.71, 95 % CI 0.62–0.79). ConclusionOur results suggest that the extent and depth of the burn are the most important factors for skin graft take rate among minor burns, while timing of the transplantation is not associated with take rate for the skin graft. The advantageous effect of scalds may be interpreted to mean that scalds in general are more superficial than flame and contact burns, a difference that may not be detected by the use of a Lund and Browder chart. The conclusion is, however, tempered by the retrospective study design and the relatively low discriminatory power in our study.

Central Venous Catheter Use in Burn Patients: Complications and Preventive Measures

Summary: The use of a central venous catheter (CVC) is essential in the management of burn patients, especially due to the difficulty of venous access, the length of hospitalization, and the need for routine fluid replenishment and medication administration, particularly antibiotics. Aim of the study: The aim of this study is to identify the rate of complications associated with central venous catheters in the context of burn patients to discuss its indications and the benefit/risk ratio. Methods: This descriptive retrospective study was conducted in the Plastic Surgery Department of CHU Mohamed VI in Marrakech, involving patients who received a central venous catheter during their admission to the burn unit from March 2023 to March 2024. Data collection included basic demographic data, comorbidities, burn mechanism, burn depth, percentage of burned body surface area (BSA), central catheter location (subclavian, femoral, jugular), the site (healthy/burned), the duration of catheter placement, complications (infection and venous thrombosis), detection of germs during culture, and the length of hospital stay. Results: Infection and venous thrombosis were identified as the most frequent complications of CVC use. Further research is needed to evaluate the role of regular CVC changes (every 10 to 15 days after insertion) in preventing infections and to establish a clear anticoagulation protocol for preventing deep vein thrombosis (DVT). Conclusion: While CVCs can be a valuable resource in the treatment of burn patients, they are associated with significant risks, some of which may be life-threatening. The duration of CVC placement should be minimized, and blood cultures (preferably from the CVC tip) should be systematically sent after 10 days or at the first suspicion of complications to reduce the incidence and severity of CVC-related infections.

On-site burn severity assessment using smartphone-captured color burn wound images

Accurate assessment of burn severity is crucial for the management of burn injuries. Currently, clinicians mainly rely on visual inspection to assess burns, characterized by notable inter-observer discrepancies. In this study, we introduce an innovative analysis platform using color burn wound images for automatic burn severity assessment. To do this, we propose a novel joint-task deep learning model, which is capable of simultaneously segmenting both burn regions and body parts, the two crucial components in calculating the percentage of total body surface area (%TBSA). Asymmetric attention mechanism is introduced, allowing attention guidance from the body part segmentation task to the burn region segmentation task. A user-friendly mobile application is developed to facilitate a fast assessment of burn severity at clinical settings. The proposed framework was evaluated on a dataset comprising 1340 color burn wound images captured on-site at clinical settings. The average Dice coefficients for burn depth segmentation and body part segmentation are 85.12 % and 85.36 %, respectively. The R2 for %TBSA assessment is 0.9136. The source codes for the joint-task framework and the application are released on Github (https://github.com/xjtu-mia/BurnAnalysis). The proposed platform holds the potential to be widely used at clinical settings to facilitate a fast and precise burn assessment.

Topical application of anti-inflammatory agents on burn wounds and their effect on healing

Advancements in the treatment of burns have considerably improved overall survival rates, but they have also highlighted several long-term sequelae related to the injury. Hypertrophic scars can impair function, reduce quality of life, and require multiple procedures as well as physical therapy. The purpose of this study was to investigate the effects of topical application of anti-inflammatory drugs in the treatment of burns. Up to 15 deep-partial thickness burns were created on the dorsum of four anesthetized swine. Subsequently, the burn wounds were randomized to receive amiloride, celecoxib, dexamethasone or minocycline mixed in a hydrogel. Silver sulfadiazine cream and blank hydrogel acted as controls. The animals were followed for 90 days and the wounds were assessed on days 3, 7, 14, 28 and 90 post-burn. Assessments were performed using photographs (macroscopic healing, contraction), laser-speckle imaging (blood perfusion), 3D camera (scarring, pigmentation), and histology (inflammation, burn depth, epidermal maturation). Inflammation was present in all burn wound histology specimens and peaked on day 7 in all groups. Regardless of the treatment the burns progressed and were deeper on day 7 in comparison to day 3. The burns were 50 – 80 % healed by day 14, but no significant differences were observed. No differences in epidermal thickness, rete ridges, contraction, hypopigmentation, or scar elevation were seen on day 90. Topical anti-inflammatories did not significantly decrease inflammation or mitigate burn wound progression in deep partial thickness burns in pigs. Also, no significant differences in wound healing or quality of healing were observed.

Outcomes of burn patients presenting with hypotension within 48 hrs of admission to a level 1 Burn Centre

IntroductionBurns is one of the important presentations in trauma surgery in both first and third-world countries. Hypotension is often seen in the clinical presentation of a burn injury. Hypotension is the strongest independent predictor of an adverse outcome, according to a study done on emergency departments’ hospital outcomes; the lower the systolic, the worse the outcome. No direct study shows that presenting with or developing hypotension within 48hrs of admission and burn injury will have a worse outcome in our low-middle income setting. ObjectivesTo determine the outcomes of burn patients who developed hypotension within 48hrs of arrival at a Burn Centre in Johannesburg. In a singled time event. MethodsA retrospective descriptive study was conducted at a Level 1 Trauma Centre Burn unit in Johannesburg from 01 Jan 2019 – 31 Dec 2020. Patients who had a hypotensive episode at any point during the 48 h period were recruited. Hypotension was defined as a systolic blood pressure of less than 90mmhg. The patients were then divided into two groups: those who presented with or developed hypotension within 48hrs and those who did not. After that, the in-hospital mortality of both groups was to be determined. The study included all the patients who presented to the Burn Centre. Those younger than 18, or requiring readmission in the same study or delayed admissions of more than 24 h were excluded. Demographics, burn information, resuscitation data, outcomes and disposition status were evaluated. The STATA Statistics/Data Analysis version 16.0 was used to analyse the data. The level of significance was set at a p-value < 0.05. Ethical approval was obtained from the Human Research Ethics Committee (HREC) (medical) of the University of the Witwatersrand with the clearance number: M220132. ResultsOf the 132 patients seen, only 105 met the study inclusion criteria. Most patients were male: 91/105 (86.6 %). Flame burns accounted for the majority of the burns, 64/105 (60.95 %), followed by electrical burns, 26/105 (24.76 %). Hot water and chemical burns only accounted for 11/105 (10.48 %) and 4 (3.81 %) cases. Hypotension within 48hrs was noted in 37/105(35 %) of the cases. Hypotensive patients had an increased burn depth (p = 0.03), higher inhalation rate component (p = <0.001), greater lactate levels(p = 0.00001), higher baux score(p = 0.00001) and more likelihood of being placed on the ventilator (p = <0.00001) or dialysis (p = 0.008). Mortality was noted in 16 (43 %) of the patients who developed hypotension compared to 5 (7.4 %) patients of non-hypotensive patients (p < 0.001). The mortality of patients who presented with or developed hypotension was 9.59 times (95 % CI 3.1–29.4; p = 0.00001) higher than those who did not develop hypotension. Age and TBSA affected by burn, were found to have significant predictive value for mortality (p < 0.0001), respectively. Propensity matching was limited due to sample size. TBSA and the development of hypotension were matched, and the odds ratio of developing mortality was still increased. ConclusionHypotension was seen among burn injury patients admitted to a specialized intensive care unit. Hypotension was associated with higher TBSA % and increased age. In terms of characteristics, increased used of organ support was more likely with hypotensive patients with ventilation, inotropes, and dialysis. Length of stay was decreased in hypotensive patients. The odds of mortality were much higher in hypotensive patients, with age and TBSA being significant variables.

Individualized surgical treatment using decellularized fish skin transplantation after enzymatic debridement: a two years retrospective analysis

Treatment of burn injuries has developed over the past few years with the development of enzymatic debridement and new types of skin replacement materials beyond primary surgical therapy providing complex personalized therapy concepts with the goal of preserving and replacing the dermal layer of the skin.The aim of our study was to develop an individualized treatment algorithm for mixed depth burn wound and to evaluate the outcome of an individualized combined treatment of mixed depth burn wounds with an enzymatic debridement and decellularized fish skin.A total of 18 Patient treated could be analyzed with a mean age of 34.8 years and a mean follow-up of 447,6 days. The mean total burn surface area was 12.3%. All patients received an enzymatic debridement and an average area of ​​247.2 square centimeters decellularized fish skin. Days until complete epithelization was 49,4 ± 25,79. No Patient developed a scar contracture or a keloid. The POSAS Observer Scale showed an overall impression average of 2,2 ± 0,83. The POSAS patient scale showed an overall impression average 2 ± 0,7. The Vancouver Scar Scale showed an average score of 1,89 ± 1,45. In conclusion, a combined treatment of enzymatic debridement and decellularized fish skin, polylactide membrane or split skin grafts allows a more individualized therapy for mixed depth burn wounds. Fish skin was found to provide a satisfying result regarding the overall outcome of the developed scar tissue and could lead to a reduction of the area needed to be autologous transplanted.

Novel multi-spectral short-wave infrared imaging for assessment of human burn wound depth.

Burn depth determination is critical for patient care but is currently lacking accuracy. Recent animal studies showed that Short Wave Infrared (SWIR) imaging can distinguish between superficial and deep burns. This is a first human study correlating reflectance of multiple SWIR bands using a SWIR assessment tool (SWAT) with burn depth classifications by surgeons and histology. Burns and adjacent normal skin in 11 patients with thermal injuries were imaged with visual and narrow bands centred at 1200, 1650, 1940 and 2250 nm and biopsies were taken from select areas. Reflectance intensities for each band in 273 regions of interest (ROI) were divided by the normal skin reflectance and combined into three Reflectance Indices (RIs). In addition, burns in ROIs and biopsies were classified by five surgeons and three pathologists, respectively, as superficial partial, deep partial, or full thickness. Results show that for burn depth increase classified by the surgeons, reflectance increased at 1200 and 2250, decreased at 1940, and didn't change at 1650 nm. In contrast, all three RIs increase with burn depth and predict the deep and full depths ROIs representing operable regions (Area Under Curve >0.6507, p < 0.0001). Pathologists' classification matched surgeons' classification of burn category only in eight of 21 biopsies (38.1%), but reflectance at all bands and one RI for all deep partial and full thickness biopsies were larger than in non-biopsy normal and superficial partial thickness ROIs (p < 0.0118). In conclusion, multi-spectral imaging with a new SWAT is a promising approach for evaluation of burn wound depth.

Multi-Feature Extraction and Selection Method to Diagnose Burn Depth from Burn Images

Burn wound depth is a significant determinant of patient treatment. Typically, the evaluation of burn depth relies heavily on the clinical experience of doctors. Even experienced surgeons may not achieve high accuracy and speed in diagnosing burn depth. Thus, intelligent burn depth classification is useful and valuable. Here, an intelligent classification method for burn depth based on machine learning techniques is proposed. In particular, this method involves extracting color, texture, and depth features from images, and sequentially cascading these features. Then, an iterative selection method based on random forest feature importance measure is applied. The selected features are input into the random forest classifier to evaluate this proposed method using the standard burn dataset. This method classifies burn images, achieving an accuracy of 91.76% when classified into two categories and 80.74% when classified into three categories. The comprehensive experimental results indicate that this proposed method is capable of learning effective features from limited data samples and identifying burn depth effectively.

FP7.20 - Peri-orbital burns: A 5-Year Review of the Epidemiological Characteristics and Outcomes at a Regional Burns Centre in the UK 2019 – 2023

Abstract Background Burn injuries are a major cause of global morbidity. Despite being infrequent, peri-orbital and ocular burns can have significant implications on a patient’s vision and overall quality of life. In Northern Ireland, the current epidemiological landscape of peri-orbital burns is not clear. This study aimed at assessing the incidence of peri-orbital and ocular burns and the management outcomes of patients admitted at the regional burns unit in Northern Ireland 2019-2023. Methods Patients admitted to the regional burns unit in Northern Ireland between January 2019 and September 2023 with periorbital burns were identified from the burns unit electronic records, the burns unit database and hospital image database. Results Over 5 years, 100 patients with facial burns were treated, including 60 patients with eyelid burns. 71% were males and 29% were females with a mean age of 47 years. The mean burn size was 14% total body surface area. The burn depth varied; 55% superficial partial thickness, 22% mixed, 17% full thickness and 6% deep dermal. Majority of burns were flame burns 64%. In total, 7 patients sustained corneal burns, one patient responded to steroids, one underwent amniotic membrane grafting, one lost complete vision in both eyes, one had physical debridement and topical antimicrobials and three patients required periorbital reconstruction to maintain eye closure. Conclusion 60% of Facial burns were associated with eyelid burns, the majority of which were caused by flame burns and were managed conservatively with wound cleaning, physical debridement, and application of topical antimicrobials. Despite being rare, complete loss of vision was associated with mortality among our patients.

Assessing the Impact of Straw Burning on PM2.5 Using Explainable Machine Learning: A Case Study in Heilongjiang Province, China

Straw burning is recognized as a significant contributor to deteriorating air quality, but its specific impacts, particularly on PM2.5 concentrations, are still not fully understood or quantified. In this study, we conducted a detailed examination of the spatial and temporal patterns of straw burning in Heilongjiang Province, China—a key agricultural area—utilizing high-resolution fire-point data from the Fengyun-3 satellite. We subsequently employed random forest (RF) models alongside Shapley Additive Explanations (SHAPs) to systematically evaluate the impact of various determinants, including straw burning (as indicated by crop fire-point data), meteorological conditions, and aerosol optical depth (AOD), on PM2.5 levels across spatial and temporal dimensions. Our findings indicated a statistically nonsignificant downward trend in the number of crop fires in Heilongjiang Province from 2015 to 2023, with hotspots mainly concentrated in the western and southern parts of the province. On a monthly scale, straw burning was primarily observed from February to April and October to November—which are critical periods in the agricultural calendar—accounting for 97% of the annual fire counts. The RF models achieved excellent performance in predicting PM2.5 levels, with R2 values of 0.997 for temporal and 0.746 for spatial predictions. The SHAP analysis revealed the number of fire points to be the key determinant of temporal PM2.5 variations during straw-burning periods, explaining 72% of the variance. However, the significance was markedly reduced in the spatial analysis. This study leveraged machine learning and interpretable modeling techniques to provide a comprehensive understanding of the influence of straw burning on PM2.5 levels, both temporally and spatially. The detailed analysis offers valuable insights for policymakers to formulate more targeted and effective strategies to combat air pollution.

Could fasciotomy prevent amputation in patients with electrical burn injuries? Insights from a cross-sectional study in Indonesia.

The amputation rate resulting from electrical burn injuries remains high, yet no study has investigated whether early fasciotomy may reduce the amputation rate. The aim of this study was to analyze the success rate of fasciotomy in preventing amputation and determine the optimal timing for fasciotomy in electrical burn injuries. This study was conducted at Dr. Soetomo Hospital from January 2020 to July 2023. Total sampling was employed to recruit the patients. Clinical data, voltage characteristics, burn location, affected total body surface area, burn depth, hospital arrival time, and time interval from incident to fasciotomy were assessed. Chi-squared test was used to assess factors associated with the fasciotomy incidence and factors associated with amputation after fasciotomy. A total of 45 patients were included, of which 97.8% were male, with a mean age of 37.60 years old. Approximately 73% of patients had full-thickness burn injuries, with the left upper extremity being the most affected (80%). There are seven patients (15.6%) had fasciotomy and five (11.1%) patients had an amputation. Our data indicated a significant association between voltage characteristics and fasciotomy incidence (p=0.034). Additionally, our data indicated that earlier arrival to the hospital (p=0.002) and timely fasciotomy conducted upon arrival (p<0.001) were associated with a reduced rate of amputation. This study highlights that prompt arrival to the hospital and early fasciotomy may prevent amputation in patients with electrical burn injuries.

Advanced fluid management strategies in burn patients undergoing general surgery: a comprehensive review

Fluid management in burn patients undergoing general surgery poses unique challenges due to the complex pathophysiological changes associated with burn injuries. Effective resuscitation and perioperative fluid therapy are critical in optimizing outcomes and minimizing complications in this vulnerable patient population. This review explores the latest evidence-based approaches to fluid management in burn patients, emphasizing the importance of individualized strategies that consider burn size, depth, patient age, comorbidities, and surgical factors. We examine the role of advanced hemodynamic monitoring, crystalloid versus colloid solutions, and the integration of goal-directed therapy protocols. Additionally, we discuss the implications of burn-related complications such as systemic inflammatory response syndrome (SIRS), sepsis, and multi-organ dysfunction on fluid management strategies. By synthesizing current research and clinical guidelines, this review aims to provide a comprehensive framework for clinicians to enhance perioperative care in burn patients undergoing general surgery.

A novel causative factor of injury: Severe burns related to fires and explosions of lithium-ion batteries of electric motorcycles

Severe burns related to fires and explosions of lithium-ion batteries of electric motorcycles have not been reported to date. We retrospectively studied 419 patients admitted to our burn intensive care unit from January 2016 to December 2021. Of these 419 patients, 26 (22 male, 4 female; median age, 42 years) had burns related to lithium-ion battery fires and explosions, and all of their injury characteristics were similar to those of traditional flame burns. Lithium-ion battery-related burns were the eighth most common cause of burn injuries among all hospitalized patients. The 26 patients comprised 10 unemployed and 16 employed individuals. Twenty-three patients were injured at home during the battery charging process, and three were injured outdoors (one by a fire while the electric motorcycle was stationary and the others two by a fire while riding the motorcycle). The burn sites were distributed over the whole body; the burn area ranged from 10 % to 100 % of the total body surface area, and the burn depth ranged from superficial second-degree burns to third-degree burns. Twenty-three patients had inhalation injuries, and ten underwent prophylactic tracheostomy and intubation. Multiple operations were required for wound repair. Although convenient, lithium-ion electric motorcycles can also cause severe burns. To prevent these injuries, we must increase public safety awareness and education, develop new battery energy storage systems and battery management systems, and ensure the safety of batteries. Consumers should be aware of the potential dangers of lithium-ion batteries and comply with related security measures.

Coagulation depth estimation using a line scanner for depth-resolved laser speckle contrast imaging.

Partial-thickness burn wounds extend partially through the dermis, leaving many pain receptors intact and making the injuries very painful. Due to the painfulness, quick assessment of the burn depth is important to not delay surgery of the wound if needed. Laser speckle imaging (LSI) of skin blood flow can be helpful in finding severe coagulation zones with impaired blood flow. However, LSI measurements are typically too superficial to properly reach the full depth of the adult dermis and cannot resolve the flow in depth. Diffuse correlation spectroscopy (DCS) uses varying source-detector separations to allow differentiation of flow depths but requires time-consuming 2D scanning to form an image of the burn area. We here present a prototype for a hybrid DCS and LSI technique called speckle contrast diffuse correlation spectroscopy (scDCS) with the novel approach of using a laser line as a source and using the speckle contrast of averaged images to obtain an estimate of static scattering in the tissue. This will allow for fast non-contact 1D scanning to perform 3D tomographic imaging, making quantitative estimates of the depth and area of the coagulation zone from burn wounds. Simulations and experimental results from a volumetric flow phantom and a gelatin wedge phantom show promise to determine coagulation depth. The aim is to develop a method that, in the future, could provide more quantitative estimates of coagulation depth in partial thickness burn wounds to better estimate when surgery is needed.

Hyperbaric oxygen (HBO2) therapy in thermal burn injury revisited. Pressure does matter. Review.

ABSTRACT Smolle C, Auinger D, Lindenmann J, Smolle J, Smolle-Juettner FM, Kamolz LP. Hyperbaric oxygen (HBO2) therapy in thermal burn injury revisited. Pressure does matter. Review. Undersea Hyperb Med. 2024 Second Quarter; 51(2):115-127. For over five decades, many experimental and clinical studies have shown predominantly positive but controversial results on the efficacy of hyperbaric oxygen (HBO2) therapy in burns. The study aimed to define a common denominator or constellations, respectively, linked to the effects of HBO2 in burns with a special focus on dosage parameters. Based on original work since 1965, species, number of individuals, type of study, percentage of total body surface area (TBSA), region, depth of burn, causative agent, interval between burn and first HBO2 session, pressure, duration of individual session, number of HBO2 sessions per day, cumulative number of HBO2 sessions and type of chamber were assessed. Out of 47 publications included, 32 were animal trials, four were trials in human volunteers, and 11 were clinical studies. They contained 94 experiments whose features were processed for statistical evaluation. 64 (67.4%) showed a positive outcome, 16 (17.9%) an ambiguous one, and 14 (14.7%) a negative outcome. The only factor independently influencing the results was pressure with ATA (atmospheres absolute) lower than 3 ATA being significantly associated with better outcomes (p=0.0005). There is a dire need for well-designed clinical studies in burn centers equipped with hyperbaric facilities to establish dedicated treatment protocols.

Modifying burn care in a low- and middle-income countries (LMIC) to meet global best practice: A burn unit or burn isolation ward?

The overwhelming burden of burns in low-income (LIC) and low-middle-income (LMIC) countries has been well-documented. Though best global practice is for major burns to be treated in burn units, the prohibitive cost makes it difficult. In this article we attempt to present the improvement in outcome recorded over a period of 3 years as we transitioned from nursing our burns patients in the general surgical wards (Group A), then a separate cubicle within the wards (Group B) and then an isolated burn ward (Group C). Other practices such as physiotherapy, traditional wound dressings, and limb splinting remained the same.Data of patients who met criteria for burn unit admission during these periods were analysed and compared. The groups were matched across age, depth of burn, total body surface area burned (TBSA) and length of hospital stay (LOHS). There was an improvement in the lethal area 50% (LA50) at 31.1 %, and in mean LOHS of 18 ± 3.8 days in group C.Most LICs and LMICs do not have functional health insurance schemes for burns patients and overall resources allocated for healthcare cannot support a state-of-the-art burn unit. Our report attempts to encourage such countries to adapt global practice to their economic reality. Minimal changes like an isolated burn ward, separate shower room for wound dressings, strict hygiene practices, and limiting visitor traffic may go a long way to improve burn patient outcome.

Nanocellulose significantly reduces number of anesthetics, hospital days, and in-patient dressing changes compared to PU-Foam Dressing: A prospective cohort study in children

BackgroundPediatric thermal injuries can have profound physical and psychological effects. Long-term care, including wound dressing selection, significantly impacts outcomes. This study compared treatment related variables and long-term results of bacterial nanocellulose (BNC) and polyurethane foam (PU-foam) dressings in pediatric burn care. MethodsA prospective cohort study comparing BNC (2018–2020) and PU-foam (2016–2018) in pediatric burn patients. Data included demographics, wound characteristics, infection rates, treatment duration, anesthesia procedures, dressing changes, scar assessments (POSAS, VSS), colorimeter measurements, and quality of life (CDLQI). Regression analyses were performed to correct for differences in burn depth. ResultsAfter correction for burn depth, BNC showed a shorter hospital stay duration (p = 0.007), a lower number of procedures under general anesthesia (p<0.0001) and a reduced number of inpatient dressing changes (p = 0.006), compared to PU-foam, whereas wound infection rates did not differ between the treatment groups (p = 0.169). Scar outcomes (POSAS, VSS, colorimeter measurements) and quality of life (CDLQI) were comparable for both treatments. DiscussionBNC dressing benefits include significantly fewer anesthesia procedures, a reduced number of inpatient dressing changes and a shorter hospital stays, supporting the use of BNC dressing. Long-term scar outcomes with BNC are comparable to established dressings like PU-foam. Further randomized trials are necessary to confirm these findings.

Histological Depth of Burn with Bipolar Plasma Arc – Is That the Cause for Urethral Sphincter Damage in Bipolar Transurethral Resection of the Prostate?

Introduction: The bipolar plasma button is gaining acceptance as a modality to perform endoscopic enucleation of the prostate. The plasma arc during activation of the button electrode extends for a distance beyond the edge of the evaporated area as seen on endoscopy. The extent of tissue affected by the intense heat of the arc is not certain. The histologically measurable depth of burn may have relevance during apical dissection, where thermal spread has been implicated in sphincter injury. Objectives: Our objective was to assess the histological depth of burn in animal tissue using a bipolar button electrode. Materials and Methods: Using a KENTAMED hARTT 400 electrosurgical unit machine, the following cuts were made over three freshly acquired goat liver specimens in a normal saline bath: (a) 280 W single superficial cuts using cutting current, (b) 280 W multiple deep cuts in the same groove using cutting current, and (c) 140 W, 2 s contact with coagulation current. Samples were fixed in neutral buffered formalin and processed paraffin embedded, and sections were stained with hematoxylin and eosin. The extent of thermal effect beyond the evaporated tissue edge was assessed on histopathology by a senior pathologist. Results: The histological depth of injury (involving about 5–6 rows of hepatocytes) did not extend more than 0.5 mm beyond the grossly visible edge of evaporated tissue. Conclusions: We found that the histological depth of burn in animal tissue extended only 0.5 mm beyond the grossly visible edge of the evaporation defect unlikely contributing to sphincter injury.

Acceleration of wound healing using adipose mesenchymal stem cell secretome hydrogel on partial-thickness cutaneous thermal burn wounds: An in vivo study in rats.

The intricate healing process involves distinct sequential and overlapping phases in thermal injury. To maintain the zone of stasis in Jackson's burn wound model, proper wound intervention is essential. The extent of research on the histoarchitecture of thermal wound healing and the application of mesenchymal stem cell (MSC)-free-based therapy is limited. This study aimed to assess the efficacy of MSC-secretome-based hydrogel for treating partial-thickness cutaneous thermal burn wounds. Eighteen male Wistar rats were divided into three groups, namely the hydrogel base (10 mg), hydrogel secretome (10 mg) and Bioplacenton™ (10 mg) treatment groups. All groups were treated twice a day (morning and evening) for 7 days. Skin tissue samples from the animals were processed for histological evaluation using the formalin-fixed paraffin-embedded method on days 3 and 7. This study's findings showed that secretome hydrogel expedited thermal burn wound healing, decreasing residual burn area, boosting collagen deposition and angiogenesis, guiding scar formation, and influencing the inflammation response facilitated by polymorphonuclear leukocytes and macrophages. The secretome hydrogel significantly improves healing outcomes in partial-thickness cutaneous thermal burn wounds. The administration of secretome hydrogel accelerates the reduction of the residual burn area and promotes fibroblast proliferation and collagen density. The repairment of histo-architecture of the damaged tissue was also observed such as the reduction of burn depth, increased angiogenesis and epidermal scar index while the decreased dermal scar index. Furthermore, the secretome hydrogel can modulate the immunocompetent cells by decreasing the polymorphonuclear and increasing the mononuclear cells. Thus, it effectively and safely substitutes for thermal injury stem cell-free therapeutic approaches. The study focuses on the microscopical evaluation of secretome hydrogel; further research to investigate at the molecular level may be useful in predicting the beneficial effect of secretome hydrogel in accelerating wound healing.

Використання безконтактного термографа FLIR One для оцінювання глибини опікової рани

The treatment of burn injuries is complicated by the proper diagnosis of areas requiring immediate necrectomy (deep burn) and those that can heal on their own (superficial burn). Non-contact thermography using the FLIR One device may be a reliable, non-invasive, and cost-effective method for assessing the depth of thermal injury. Aim - to study the temperature of healthy skin, deep and superficial burns using the FLIR One non-contact thermograph, the temperature difference between them, and the diagnostic value of the method for assessing burn depth. Materials and methods. The study involved 22 patients with limb burns. Thermometry of the affected areas was performed using the FLIR One thermograph within the first 48 hours after injury, before and during wound sanitation, with images analyzed using the FLIR One application. Results. The temperature of healthy skin was 34.7°C (34.4-35.1°C), the temperature of superficial burns was 35.8°C (35.5-36.2°C), and the temperature of deep burns was 32.4°C (32.0-32.8°C). The difference between healthy skin and deep burns was 2.3°C (2.2-2.4°C), and between superficial and deep burns was 3.4°C (3.0-3.8°C). A temperature of 33.7°C with non-contact thermography indicated a deep burn with 95% sensitivity and specificity. A decrease in the temperature of the affected skin by more than 2.0°C compared to healthy skin (2.2-2.4°C) or superficial burns (3.0-3.8°C) also indicated deep thermal damage. Conclusions. Thermography using FLIR One is a reliable and accessible method for analyzing the depth of burn wounds. The temperature of healthy skin during thermography is 34.7°C (34.4; 35.1)°C and is lower than the temperature of superficial burns (35.8°C (35.5; 36.2)°C) but higher than the temperature of deep burns (32.4°C (32.0; 32.8)°C). A temperature of 33.7°C with high sensitivity and specificity indicates a deep burn. The study showed that a temperature decrease of more than 2.0°C compared to healthy skin or superficial burns indicates deep thermal damage. The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child and child's parents was obtained for the research. The authors declare no conflict of interest.