Burn Dressings Research Articles

Which Part of a Shrimp Has More Economic Value, the Shell or the Meat?

Using locally available resources to sustain the local economy has been (and in some parts of the world still is) looked at as a valuable survival skill. The rising cost of finite petroleum resources have increased the demand for manufacture of products from abundant natural resources (such as agricultural or forest-based feedstock) and new resource-based economic development. The environmental consciousness resulted in pursuing more sustainable alternatives to conventional plastics, and from this viewpoint, many attractive properties of biopolymers inspired multiple big industry players in using them for the development of the materials of the future. One such example is the broad applications opportunities for chitin derivatives. Although chitin and chitin derivatives worth $63B worldwide there is not (yet) a single chitin production plant in North America. Another reason for the current limitations in utilizing chitin to its full potential is the process that is required to extract the chitin from raw biomass. The current process employs harsh conditions (acidic and alkaline treatment at elevated pressure and temperatures) which result in the degradation of the chitin structure, thus changing the properties of the biopolymer. Due to the aforementioned limitations, there is no surprise that chitin materials have not been previously produced and marketed. It is well known that ionic liquids (ILs) are great solvents when it comes to biomass processing, from lignocellulosic biomass to crustacean waste, with the vision that one day the ILs will replace the current chemical-, waste-, and energy-intensive processes. The annual available chitin in freshwater and marine ecosystems is roughly 600 and 1,600 million tons, respectively. Even though the United States is among the three largest seafood markets in the world, 85% of US seafood consumption depends on importation and only 5% is from US aquaculture production. Taking shrimp aquaculture for example; shrimp meat is pealed for food consumption, currently the main profit source, and the large amounts of shrimp shells are treated as waste and thrown away (at a cost), leading to environmental pollution. What if the shrimp shell waste is turned into valuable products and becomes the main source of profit? Chitin and its deacetylated derivative, chitosan can be manufactured into many forms (fibers, films, high surface area nanomats, beads, hydrogels) and can be used in different industrial sectors such as water treatment, food processing, agriculture, nutrition, cosmetics, and medical applications. Due to chitin’s non-toxicity, non-allergenicity, biocompatibility, biodegradability, and bioactivity, diverse medicinal applications of chitin include both pharmacological and biotechnological materials and products. Emerging end-use biomedical applications include organ dressings, vascular implants, burn dressings, structural surgical implants, bio-textiles, and bone growth scaffolds, among others. Chitin can provide millions of dollars in revenues and have a significant impact on the economy if it is effectively isolated and used in high value products. This presentation will discuss this one example that illustrates the importance of the IL research in shell waste biomass processing and ultimately in delivering materials suitable for a myriad of applications that are still to be discovered. Development of such technologies requires creative thinking, changing the way we look at existing technologies, and push society away from a dependence on oil that grows steadily. Figure 1

Delayed Healing Associated with Silver Sulfadiazine Use for Partial Thickness Scald Burns in Children

Burns are a leading cause of injury in children. Management principles vary widely, with no consensus about the best treatment. The purpose of this study was to compare outcomes of three different dressings for pediatric partial-thickness scald burns. A retrospective, single-center study was conducted for patients 0-16 years old with a diagnosis of acute partial-thickness scald burn between July 2007 and December 2012. Data regarding prehospital, inpatient, and outpatient course were collected. Cohort was stratified into topical antimicrobial (TA) ointment, silver sulfadiazine (SS), and biosynthetic dressing (BD) groups for analysis. The primary outcome of interest was time to full healing. One hundred and seventy-seven patients met all study criteria. Overall, mean total body surface area burned was 8.3 per cent. TA was used in 24 per cent cases, SS in 32 per cent, and BD in 44 per cent. The groups were comparable in terms of presenting burn characteristics and hospital course with the exception of the BD group being associated with greater extent of injury. Patients treated with SS had a significantly longer time to full healing and increased requirement of compression garments for scar therapy. Based on these data, the authors have amended their practice and presently use BD or TA dressings to improve healing.

419 Bridging Burn Care

The Rhode Island Burn Center is a hybrid program where high-quality burn care is delivered on many units, both pediatric and adult, throughout our hospital campus. With pressure from health insurances, patients are being discharged more frequently from the Emergency Department with larger burns than in the past, as well as more quickly after an acute hospital admission. Many patients when discharged from the hospital, require ongoing dressing changes at home with help from various community nursing agencies throughout the region. Due to the smaller number of patients with burns, community nursing agencies are infrequently exposed to burn care and therefore have limited experience with burn dressings, including types of dressings and functional application of dressings. Bridging Burn Care was implemented to address this need. A lecture titled “Basics of Burn Care” was offered to community nursing agencies by our Burn Program Manager (BPM). This lecture reviewed classification and current treatment for burns, recommendations for patient centered dressing removal, and practical application of burn dressings to encourage function. A questionnaire was distributed to the nurses to assess their comfort with burn care before and after the lecture. Co-visits to patients’ homes with a nurse from the community nursing agency and the BPM were also offered to support the nurses in the home in applying the knowledge provided by the lecture. Nurses were variable in their comfort and experience with burn care with scores of 1–3 (Ave 2.1) on a 5 point scale (1 = Not at All Comfortable, 5 = Extremely Comfortable) prior to the lecture. Their comfort with burn care increased after the lecture to an average of 3.6 on the same scale. Co-visits with a nurse from the community nursing agency and the BPM have occurred for 3 patients to-date and have been well received by both the community nurses and the patients/families. This bridge provides continuity of the patient’s burn care during the transition from the hospital to home, supports the community nurses knowledge/application of burn care, and promotes ongoing communication with the Burn Center. With the smaller volume of patients with burns that our region receives, it is difficult for community nurses to remain up-to-date with the latest treatments for burns and maintain their confidence and competence with burn dressings. Providing a “Burn Care Bridge” between the hospital and the community, which supports both the patient/family and community nursing agencies, improves the continuity of care and quality of the burn care that takes place in the community. These types of programs have the potential to decrease return visits to Emergency Departments, improve healing, and optimize function allowing patients with burns to return to activities of daily living sooner.

An Improved Method for the Preparation for New Antibacterial Dressing Crosslinked with Carboxymethyl Chitosan

A new antibacterial acellular dermal matrix (AADM) dressing can not only resist infection, but also accelerate wound healing. AADM was prepared by SDS (0.40%), trypsin (0.40%) and keratin (0.30%), and then cross-linked with carboxymethyl chitosan (1%) with glutaraldehyde, whose tensile strength (MPa) is 10.66, thickness (mm), 0.53, the rate of permeable steam (g • m-2 • 24h-1), 3640, porosity (%), 81, degradation time in vitro (h), 24.33, pH, 6.5, and the average inhibition rate, more than 70%. At the same time, scanning electron microscopy showed that the structure of AADM was evacuated and the pores were interconnected. On such basis, a conclusion was drawn: the properties of AADM has been sharply increased, compared with acellular dermal matrix, which cannot resist infection, and the new antibacterial acellular dermal matrix completely meets the clinical requirements for burn dressings.

The Effect of a Multi-Dimensional Play Program on Children’s Pain Intensity During Burn Dressing Change in Burn Intensive Care Units: A Clinical Trial

The Effect of a Multi-Dimensional Play Program on Children’s Pain Intensity During Burn Dressing Change in Burn Intensive Care Units: A Clinical Trial

Cost-effectiveness of silver dressings for paediatric partial thickness burns: An economic evaluation from a randomized controlled trial

BackgroundPartial thickness burns of up to 10% total body surface area (TBSA) in children are common injuries primarily treated in the outpatient setting using expensive silver-containing dressings. However, economic evaluations in the paediatric burns population are lacking to assist healthcare providers when choosing which dressing to use. The aim of this study was to conduct a cost-effectiveness analysis of three silver dressings for partial thickness burns ≤10% TBSA in children aged 0–15 years using days to full wound re-epithelialization as the health outcome. MethodThis study was a trial based economic evaluation (incremental cost effectiveness) conducted from a healthcare provider perspective. Ninety-six children participated in the trial investigating Acticoat™, Acticoat™ with Mepitel™ or Mepilex Ag™. Costs directly related to the management of partial thickness burns ≤10% TBSA were collected during the trial from March 2013 to July 2014 and for a one year after re-epithelialization time horizon. Incremental cost effectiveness ratios were estimated and dominance probabilities calculated from bootstrap resampling trial data. Sensitivity analyses were conducted to examine the potential effect of accounting for infrequent, but high cost, skin grafting surgical procedures. ResultsCosts (dressing, labour, analgesics, scar management) were considerably lower in the Mepilex Ag™ group (median AUD$94.45) compared to the Acticoat™ (median $244.90) and Acticoat™ with Mepitel™ (median $196.66) interventions. There was a 99% and 97% probability that Mepilex Ag™ dominated (cheaper and more effective than) Acticoat™ and Acticoat™ with Mepitel™, respectively. This pattern of dominance was consistent across raw cost and effects, after a priori adjustments, and sensitivity analyses. There was an 82% probability that Acticoat™ with Mepitel dominated Acticoat™ in the primary analysis, although this probability was sensitive to the effect of skin graft procedures. ConclusionThis economic evaluation has demonstrated that Mepilex Ag™ was the dominant dressing choice over both Acticoat™ and Acticoat™ with Mepitel™ in this trial-based economic evaluation and is recommended for treatment of paediatric partial thickness burns ≤10% TBSA.

The use of a chitosan dressing with silver in the management of paediatric burn wounds: a pilot study.

Traditional burn dressings demonstrate unfavourable tendencies of shrinking when wet and failing to maintain their integrity when manipulated. To overcome these obstacles, gel-forming fibre dressings have emerged as an alternative. Our objective was to observe the clinical properties and healing ability in the setting of burn wounds in a paediatric centre of a chitosan-based dressing containing silver. A sample of 12 partial-thickness burns in 10 children were identified for treatment with the chitosan-based silver dressing. The dressings were moistened before application, and monitored for any shrinkage on application. Patients were monitored for healing at outpatient follow-up visits and the dressings were allowed to separate as healing occurred. We treated 12 burns in 10 children with an average age of 5.2 years. The burns had an average proportion of total body surface area (TBSA) of 3.6 % and involved the trunk and all extremities. Wounds healed mostly or completely in an average of 8.3 days. Dressings retained their size when wet and integrity when removed. No burns were found to be infected at any point in the study. The chitosan-based dressing offered an optimal environment for moist wound management, and did not demonstrate the shrinkage or disintegration that diminishes the clinical usability of widely used hydrofibre dressings. The burns healed within an expected period of time, and did not undergo any infectious processes. Based on the results of this pilot study, the chitosan-based silver dressing is deserving of further study as an alternative to traditional burn dressings.

Preparation, antimicrobial and antioxidant evaluation of indole-3-acetic acid-based pH-responsive bio-nanocomposites

Nanocomposites were synthesized among citric acid, ethylene glycol and indole-3-acetic acid by condensation followed by incorporating silver nanoparticles (AgNPs) in a hydrogel. The formation of parent hydrogel and their nanocomposites were identified by Fourier transform infrared spectroscopy. The incorporation of silver nanoparticles in the hydrogel network, surface morphology and size of nanoparticles were established by ultraviolet spectroscopy, scanning electron microscopy and transmission electron microscopy, respectively. The thermal properties of the hydrogels were studied by TGA–DTA analysis. The parent hydrogel (ICE) and nanocomposites revealed a good pH-sensitive swelling behavior at acidic media than in basic media. In vitro examination of fungal activity revealed all prepared hydrogels as effective against Aspergillus fumigatus, Rhizopus oryzae and Candida albicans. Further, the antibacterial properties of the optimum sample were successfully evaluated against Gram-positive (Bacillus aureus, Staphylococcus aureus) and Gram-negative (Escherichia coli) bacteria. The prepared nanocomposites showed a higher antimicrobial activity than that of the parent hydrogel. Further, the radical scavenging ability of the hydrogel and nanocomposites were estimated using DPPH (2,2-diphenyl-1-picryl-hydrazyl) and nitric oxide radicals. The prepared nanocomposites with tuned antibacterial, antifungal and antioxidant properties can be used for wound healing, burn dressing, treatment of topical fungal infections and for other biomedical applications.

DEXMEDETOMIDINE PREMEDICATION WITH KETAMINE AND PROPOFOL DURING BURNS DEBRIDEMENT AND DRESSINGS

Background: Burn patients undergo frequent extensive burn debridement and painful dressing changes. Ketamine and Propofol are the most common anesthetic used along with Opioids and Benzodiazepines in burns dressings. Studies have shown that concomitant use of Dexmedetomidine with Propofol and Ketamine. Objectives: To study the effects of Dexmedetomidine as premedication with Ketamine and Propofol as sole anesthetic agents during burns debridement and dressing. Materials and methods: Total 60 Patients of scheduled for elective burn debridement and dressings at P.R.H. Loni admitted in the wards were enrolled for the study. Patients satisfying the following eligibility criteria were selected and grouped those who received Ketamine and Propofol (Group B) with and without Dexmedetomidine (Group A) and both the groups were assessed to find out difference in the dose requirement, haemodynamic variables and recovery time (using Ramsay Sedation scale). Results: The haemodynamic parameters like heart rate, systolic and diastolic Blood pressure was significantly higher in Group A as compared to Group B. The recovery time in Group A was 12.9 mins as compared to 9.5 mins in Group B. It was observed that dose requirement of Ketamine (228.8±21.9) and Propofol (263.2 ± 22.5) was significantly more in Group A as compared to Group B (101.1±20.3 and 120.8±22.4 respectively).Conclusion: Dexmedetomidine (1μg/kg IM dose) is a good anaesthetic adjuvant that decreases the requirement of Propofol and Ketamine during burns debridement and dressings, maintains stable intraoperative haemodynamics and also has an excellent recovery profile. Key words: Dexmedetomidine; Haemodynamic Changes; Ketamine; Propofol; Recovery Time.

Blood and Tissue Silver Levels Following Application of Silver-Based Dressings to Sulfur Mustard Chemical Burns.

Silver-based dressings are commonly used in burn care. Silver sulfadiazine use is associated with elevated blood, urine, and tissue levels of silver ion. We examined wound and tissue levels of silver ion in a two-species model of sulfur mustard chemical burn injury treated with two different silver-based dressings. Superficial dermal and moderate thickness dermal chemical burns were induced in 16 hairless guinea pigs and in 16 Gottingen minipigs by exposure to sulfur mustard vapor. After debridement, silver-nylon burn dressings or silver-calcium alginate dressings were applied and changed every 7 days until wound healing or a maximum of 60 days post exposure. At autopsy, liver, spleen, and wound samples were harvested. Silver ion was measured using inductively coupled plasma-mass spectrography with a lower level of detection of 0.02 parts per billion. Negligible silver ion levels were found in the liver (mean < 0.003 μg/g of tissue) and spleen (mean < 0.05 μg/g) of all 32 animals. Wound biopsies showed silver ion levels ranging from 0.07 to 19.5 μg/g of tissue. Wound levels were higher in minipigs than in hairless guinea pigs and were higher in animals treated with silver-nylon burn wound dressings than with silver-calcium alginate dressings. Silver ion could be detected in some wounds 40 days after dressings were removed. In a chemical burn model, application of silver-nylon or silver-calcium alginate dressings is associated with elevated wound levels but negligible tissue levels of silver ion.

Let it go: recommencing music therapy on a paediatric burns ward after the Nepal earthquake

Introduction: Each year, approximately 350–400 paediatric burns patients are treated at Kanti Children’s Hospital (KCH) in Kathmandu. This presentation discusses the recommencement of a family-centred music therapy programme on the burns ward at KCH after the 2015 Nepal earthquake.Objective: The primary objective was to re-establish psychosocial support for patients and their families in order to manage pain and anxiety, promote relaxation and build resilience during hospitalisation.Methods: An Australian and Dutch music therapist collaborated to provide music therapy sessions three days a week. Vocal/instrumental improvisation was utilised to support individual children during burns dressings and bedside procedures. Group sessions in shared rooms encouraged creative interaction between patients, their families and hospital staff. Audio/video case vignettes will illustrate the efficacy of these music therapy interventions in a post-earthquake environment.Discussion: Flexibility, sensitivity and perseveran...

The Effect of Distraction Technique on the Pain of Dressing Change among 3-6 Year-old Children

Background Burn dressings, debridement, surgical incisions, skin grafting and physical therapy are some of painful treatments of burn. According to the studies, distraction techniques have a significant effect on patients’ pain. The present study was designed and conducted to determine the effect of distraction on pain of dressing change in second degree burn in 3-6 year-old children. Materials and Methods This randomized controlled trial study, was conducted on 80 hospitalized children with second degree burn in 2015. Playing a video computer game for children during the dressing change procedure was the intervention for the interventional group. Also the intensity of pain was measured by behavioral pain scale for children (FLCC scale) during dressing. This scale was completed for patients without no intervention in the control group during dressing. Results Pain intensity mean in the interventional group (2.575 ± 1.807) had significant changes in comparison with the control group (8.025 ± 1.187) (P<0.001). 70% of children in the control group experienced severe pain due to dressing change, but most children in the intervention group (77.5%) had a little pain. Conclusion According to the results it seems that distraction intervention has a significant positive effect on the pain of dressing change in children. Further studies are recommended for the development of this technique in health care centers.

Effect of transcranial direct current stimulation on pain anxiety during burn wound care

BackgroundChanges in neuronal activity by cathodal transcranial direct current stimulation (tDCS) of the sensory cortex can relieve acute pain. Studies have demonstrated high correlation between burn pain and anxiety in burn patients. The aim of this study was to assess the effect of tDCS on pain anxiety in patients with severe burn. MethodsIn a controlled randomized clinical trial, 60 subjects who were hospitalized during the year 2014 in the Department of Burn and Reconstructive Surgery of Imam Reza Hospital of Mashhad were selected as the sample for this study. The patients were randomly assigned to one of the two groups. A cathodal stimulation group that received real 1.0mA tDCS over sensory cortex lasted 20min and the control group received sham tDCS. Pain anxiety was obtained by self-report pain anxiety questionnaire before and after stimulation. It was also completed immediately after burn dressing. The data were analyzed by performing the Chi-square, Fisher's exact, independent samples t, paired samples t, Mann-Whitney and Wilcoxon tests using SPSS 11.5 software. ResultsPain anxiety score reduced significantly in the real tDCS compared with sham group (23.4±3.8 versus 29.3±2.0, p≤0.001). After stimulation there was a decrease in pain anxiety score in real tDCS group (p=0.010). ConclusionAccording to our study, cathodal cortical stimulation with tDCS is associated with significant reduction in pain anxiety in burn patients.

Extra-large negative pressure wound therapy dressings for burns – Initial experience with technique, fluid management, and outcomes

ObjectiveThe use of negative-pressure-wound-therapy (NPWT) is associated with improved outcomes in smaller burns. We report our experience using extra-large (XL) NPWT dressings to treat ≥15% total body surface area (TBSA) burned and describe our technique and early outcomes. We also provide NPWT exudate volume for predictive fluid resuscitation in these critically ill patients. MethodsWe retrospectively reviewed patients treated with XL-NPWT from 2012 to 2014. Following excision/grafting, graft and donor sites were sealed with a layered NPWT dressing. We documented wound size, dressing size, NPWT outputs, graft take, wound infections, and length of stay (LOS). Mean NPWT exudate volume per %TBSA per day was calculated. ResultsTwelve burn patients (mean TBSA burned 30%, range 15–60%) were treated with XL-NPWT (dressing TBSA burned and skin graft donor sites range 17–44%). Average graft take was 97%. No wound infections occurred. Two patients had burns ≥50% TBSA and their LOS was reduced compared to ABA averages. XL-NPWT outputs peaked at day 1 after grafting followed by a steady decline until dressings were removed. Average XL-NPWT dressing output during the first 5 days was 101±66mL/%BSA covered per day. 2 patients developed acute kidney injury. ConclusionThe use of XL-NPWT to treat extensive burns is feasible with attention to application technique. NPWT dressings appear to improve graft take, and to decrease risk of infection, LOS, and pain and anxiety associated with wound care. Measured fluid losses can improve patient care in future applications of NPWT to large burn wounds.

Scar outcome of children with partial thickness burns: A 3 and 6 month follow up

IntroductionThere is a paucity of research investigating the scar outcome of children with partial thickness burns. The aim of this study was to assess the scar outcome of children with partial thickness burns who received a silver dressing acutely. MethodChildren aged 0–15 years with an acute partial thickness burn, ≤10% TBSA were included. Children were originally recruited for an RCT investigating three dressings for partial thickness burns. Children were assessed at 3 and 6 months after re-epithelialization. 3D photographs were taken of the burn site, POSAS was completed and skin thickness was measured using ultrasound imaging. ResultsForty-three children returned for 3 and 6 month follow-ups or returned a photo. Days to re-epithelialization was a significant predictor of skin/scar quality at 3 and 6 months (p<0.01). Patient-rated color and observer-rated vascularity and pigmentation POSAS scores were comparable at 3 months (color vs. vascularity 0.88, p<0.001; color vs. pigmentation 0.64, p<0.001), but patients scored higher than the observer at 6 months (color vs. vascularity 0.57, p<0.05; color vs. pigmentation 0.15, p=0.60). Burn depth was significantly correlated with skin thickness (r=0.51, p<0.01). Hypopigmentation of the burn site was present in 25.8% of children who re-epithelialized in ≤2 weeks. ConclusionThis study has provided information on outcomes for children with partial thickness burns and highlighted a need for further education of this population.

An assessment of early Child Life Therapy pain and anxiety management: A prospective randomised controlled trial

IntroductionBurns remain extremely painful and distressing in young children. The consequences of poorly managed pain and anxiety can be life-long. Whilst Child Life Therapy (CLT) has been shown to be effective in many situations, few studies have looked at the effectiveness of CLT in regard to reducing pain and anxiety in children undergoing burn dressing changes. MethodsA prospective, randomised controlled trial was conducted, comparing CLT versus standard care in relation to pain and anxiety scores of children undergoing their initial burn dressing change. Pain and anxiety were assessed by an independent observer and questionnaires completed by the child, parent/caregiver and nursing staff. Results50 subjects were recruited in each treatment group; median age 2.3 years (CLT) and 2.2 years (standard care). The median total body surface area (TBSA) burnt was 0.8% (CLT) and 0.5% (standard care). The majority were partial thickness dermal burns (88% CLT, 94% standard care). Rates of parent anxiety and pre-procedural child pain and anxiety were similar. Combined and scaled pain and anxiety scores in the CLT group were significantly less than in the standard treatment group (p=0.03). Whilst pain was significantly better in the CLT group (p=0.02), fear scores, wound outcomes and the need for skin grafting were not statistically different in either group. ConclusionsThe presence of a Child Life Therapist, with their ability to adapt to the environment, the child and their family, significantly reduced the experience of pain during paediatric burn dressings.

Desenvolvimento e caracterização de filmes compósitos de quitosana e zeólitas com prata

Resumo Zeólitas foram submetidas à troca iônica ou impregnação com prata e posteriormente adicionadas em filmes de quitosana para a confecção de curativos para queimaduras. As zeólitas foram avaliadas por Ressonância magnética nuclear (RMN), Fluorescência de raios X por reflexão total (TXRF), Microscopia eletrônica de varredura (MEV). Os filmes poliméricos foram analisados com relação às suas propriedades mecânicas, permeabilidade ao vapor d’água (PVA) e liberação de prata. Observou-se que o procedimento de troca iônica não alterou a morfologia das zeólitas de partida. Grumos de zeólita foram observados nas micrografias dos filmes e estes influenciaram nas propriedades mecânicas devido à desorganizaçao local no empacotamento das cadeiras poliméricas da quitosana. A metodologia de troca iônica ou impregnação influenciou diretamente na quantidade de prata presente superficialmente na zeólita e consequentemente alterou o perfil de liberação de prata em uma solução simulada de exudato de ferida. Os modelos cinéticos sugeriram que a liberação da prata não foi essencialmente regulada pela lei de difusão de Fick.

The efficacy of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting: a systematic review of the literature.

The aim of this systematic review was to determine the supporting evidence for the clinical use of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting. Two authors searched three databases (Ovid Medline, Ovid Embase and The Cochrane Library) for relevant English language articles published through September 2014. Reference lists, conference proceedings and non-indexed academic journals were manually searched. A separate search was conducted using the Internet search engine Google to source additional studies from burns advisory agencies, first aid bodies, military institutions, manufacturer and paramedic websites. Two authors independently assessed study eligibility and relevance of non-traditional data forms for inclusion. Studies were independently assessed and included if Hydrogel-based burn dressings (HBD) were examined in first aid practices in the pre-hospital setting. A total of 129 studies were considered for inclusion, of which no pre-hospital studies were identified. The review highlights that current use of HBD in the pre-hospital setting appears to be driven by sources of information that do not reflect the paramedic environment. We recommend researchers in the pre-hospital settings undertake clinical trials in this field. More so, the review supports the need for expert consensus to identify key demographic, clinical and injury outcomes for clinicians and researchers undertaking further research into the use of dressings as a first aid measure.

In-situ photo-assisted deposition of silver particles on hydrogel fibers for antibacterial applications.

Silver nanoparticles (AgNPs) have attracted intensive research interest and have been recently incorporated in polymers, medical devices, hydrogels and burn dressings to control the proliferation of microorganisms. In this study a novel silver antibacterial coating was deposited for the first time on hydrogel fibers through an in-situ photo-chemical reaction. Hydrogel blends obtained by mixing different percentages of silver-treated and untreated fibers were characterized by thermogravimetric analysis (TGA), Fourier transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX). Four different fluids, such as phosphate buffered saline (PBS), simulated body fluid (SBF), chemical simulated wound fluid (cSWF), and deionized water (DI water), were used for evaluating the swelling properties. The results obtained confirmed that the presence of silver did not affect the properties of the hydrogel. Moreover, the results obtained through inductively coupled plasma mass spectrometry (ICP-MS) demonstrated very low silver release values, thus indicating the perfect adhesion of the silver coating to the substrate. Good antibacterial capabilities were demonstrated by any hydrogel blend on Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) through agar diffusion tests and optical density readings.

Operative trauma in low-resource settings: The experience of Médecins Sans Frontières in environments of conflict, postconflict, and disaster

Conflicts and disasters remain prevalent in low- and middle-income countries, and injury remains a leading cause of death worldwide. The objective of this study was to describe the operative procedures performed for injury-related pathologies at facilities supported by Médecins Sans Frontières (MSF) to guide the planning of future responses. A retrospective review of a prospectively collected database of all MSF procedures performed between July 2008 and June 2014 for injury-related indications was completed. Individual data points included country of project and date of procedure; age, patient sex, and the American Society of Anesthesiologists' score of each patient; indication for surgery, including mechanism of injury; operative procedure; operative urgency; operative order; type of anesthesia; and intraoperative mortality. Injury severity was stratified according to operative order and urgency. A total of 79,715 procedures were performed in MSF projects that met the inclusion criteria. Of these, 35,756 (44.9%) were performed specifically for traumatic indications across 17 countries. Even after excluding trauma centers, 29.4% (18,329/62,288) of operative cases were for injuries. Operative trauma procedures were performed most commonly for road traffic injuries (29.9%; 10,686/35,756). The most common procedure for acute trauma was extensive wound debridement (31.6%; 3,165/10,022) whereas burn dressings were the most frequent planned reoperation (27.1%; 4,361/16,078). Trauma remains an important component of the operative care provided in humanitarian assistance. This review of procedures performed by MSF in a variety of settings provides valuable insight into demographics of trauma patients, mechanisms of injury, and surgical capabilities required in planning resource allocation for future humanitarian missions in low- and middle-income countries.