Management Of Burns Research Articles

The evaluation of burn knowledge and burn management skills of resident doctors of emergency medicine, general surgery and plastic surgery

Abstract Background/Aims: Our study aimed to assess the abilities of emergency medicine, general surgery, and plastic surgery resident doctors in diagnosing, treating, and managing burn patients. Methods: We conducted a survey study between 04.05.2015 and 04.08.2015 at university hospitals and training and research hospitals in Ankara. We collected information on the age, gender, experience, and hospital of the doctors, as well as their training and approaches to treating burn cases. We evaluated their knowledge in various areas, including clinical approaches to 2nd and 3rd-degree burn cases, escharotomy localizations, intubation indications, bulla treatment, referral and hospitalization indications, identification of inhalation burns, and fluid resuscitation. Results: The average age of the participants was 29.3±2.4 years, and 65.7% were male. We found that doctors who had received advanced burn life support training had better approaches to burn cases (p

Insight on Pediatric Burn Morbidity and Mortality at a Tertiary Indian Burn Care Center: A Case For Burn Prevention.

Pediatric burns pose a significant health burden in LMICs. Despite efforts to address burn prevention and management, morbidity and mortality rates remain high, particularly among children. Understanding pediatric burn epidemiology and predictors of clinical outcomes is crucial for developing effective prevention strategies and improving patient-care. This retrospective cohort study analyzed pediatric burn patients admitted to a tertiary burn-center in India, between March-2022 and December-2023. Demographic date, burn characteristics, treatments, complications and outcomes were collected. Statistical analysis, including logistic and linear regression, was conducted to identify predictors of mortality, sepsis, and hospital stay length. Among 332 pediatric burn patients, median age was 3 years, with a male predominance. Scald burns were the most common, followed by electrical and flame burns. Median total body surface area burned was 20%, with upper and lower extremities most affected. The incidence of electrical burns increased with age and was associated with a longer length of stay. Mortality rate was 14.2%, with age >10 years, male gender, and TBSA >30% predicting mortality. Complications like sepsis significantly increased mortality risk, while deep burns were associated with longer hospital stays. This study underscores importance of targeted prevention efforts and specialized care. Scald burns among young children highlight the need for safer cooking practices, while the high incidence of electrical burns in older children suggests age-specific education interventions are necessary. Predictors of mortality identified can guide risk assessment and resource allocation, emphasizing the importance of infection control and wound management strategies in improving outcomes.

Management of Pediatric Superficial Partial-Thickness Burns with Polyhexamethylene Biguanide: Outcomes and Influencing Factors.

Background: In burn care, achieving swift healing with minimal complications remains paramount. This investigation assesses the role of polyhexamethylene biguanide (PHMB) in managing pediatric superficial partial-thickness burns, focusing on the effects of various patient-specific factors on recovery. Methods: Through a retrospective analysis of 27 pediatric cases treated with PHMB, we evaluated the impact of age, burn size, dressing frequency, treatment delay, cold therapy application, and analgesic usage on the time until reepithelialization (TTRE). Results: The majority of patients benefited from early cold therapy, yet only 1 in 3 patients received analgesics. A mean healing time of 8.78 (SD: 2.64) days was observed, with the extent of the burn showing a strong correlation (r: 0.63) to TTRE. Most treatments were managed outpatient, evidenced by a negligible average hospital stay (0.96 days), with recorded no complications. Conclusions: Our findings endorse PHMB as a promising treatment for superficial second-degree burns in young patients, due to the observed stable and rapid wound closure without the association of increased risks. Continued exploration into the optimal application of prehospital interventions and the comprehensive benefits of PHMB in pediatric burn management is necessary. Future research should assess long-term outcomes, including functionality, scar quality, and patient satisfaction.

A Meta-Analysis of the Mortality and the Prevalence of Burn Complications in Western Populations.

Management of burn injuries is complex, with highly variable outcomes occurring among different populations. This meta-analysis aims to assess the outcomes of burn therapy in North American and European adults, specifically mortality and complications, to guide further therapeutic advances. A systematic review of PubMed, Web of Science, and Cochrane was performed. Random-effect meta-analysis of proportions was conducted to assess the overall prevalence of the defined outcomes. In total, 54 studies were included, pooling 60 269 adult patients. A total of 53 896 patients were in North America (NA, 89.4%), and 6373 were in Europe (10.6%). Both populations experienced similar outcomes. The overall pooled prevalence of mortality was 13% (95% CI, 8%-19%) for moderate burns, 20% (95% CI, 12%-29%) for severe burns in the NA region, and 22% (95% CI, 16%-28%) for severe burns in Europe. Infectious complications were the most common across both regions. European studies showed an infection rate for patients with moderate and severe burns at 8% and 76%, respectively, while NA studies had rates of 35% and 54%. Acute kidney injury (39% vs 37%) and shock (29% vs 35%) were the next most common complications in European and NA studies, respectively. The length of stay was 27.52 days for patients with severe burns in Europe and 31.02 days for patients with severe burns in NA. Burn outcomes are similar between Western populations. While outcomes are reasonably good overall, infectious complications remain high. These findings encourage the development of further therapeutic strategies disclosing respective costs to enable cost/efficiency evaluations in burn management.

A Systematic Review of Simulation in Burn Care: Education, Assessment, and Management.

Assessment and management of burns require nuanced, timely interventions in high-stake settings, creating challenges for trainees. Simulation-based education has become increasingly popular in surgical and nonsurgical subspecialties to supplement training without compromising patient safety. This study aimed to systematically review the literature on existing burn management-related simulations. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles describing burn-specific surgical and nonsurgical simulation models were included. The model type, study description, simulated skills, assessment methods, fidelity, cost, and outcomes were collected. Of 3,472 articles, 31 met inclusion criteria. The majority of simulations were high-fidelity (n=17, 54.8%). Most were immersive (n=17, 54.8%) and used synthetic benchtop models (n=13, 41.9%), whereas none were augmented/virtual reality. Simulations of acute and early surgical intervention techniques (n=16, 51.6%) and burn wound assessments (n=15, 48.4%) were the most common, whereas burn reconstruction was the least common (n=3, 9.7%). Technical skills were taught more often (n=29, 93.5%) than non-technical skills (n=15, 48.4%). Subjective assessments (n=18, 58.1%) were used more often than objective assessments (n=23, 74.2%). Of the studies that reported costs, 91.7% (n=11) reported low costs. This review identified the need to expand burn simulator options, especially for burn reconstruction, and highlighted the paucity of animal, cadavers, and augmented/virtual reality models. Developing validated, accessible burn simulations to supplement training may improve education, patient safety, and outcomes.

Acute Surgical and Rehabilitation Management of Complex Hand Burns in Combat Casualties

Burns are inevitable in modern warfare and have comprised between 5% and 20% of battlefield injuries. Involvement of the hands is the leading cause of postburn functional impairment. The purpose of this paper is to provide guidance on aspects of care necessary for the management of complex hand burns in a battlefield setting. Proper assessment and establishment of a comprehensive plan of care at the onset of injury help to ensure optimal functional outcomes in hand function. Basic treatment principles for the acutely burned hand include edema management; early wound coverage, including excision of the burn and skin grafting; early and aggressive hand therapy; and burn-scar contracture mitigation strategies.

Characterization of PM0.1 mass concentrations and elemental and organic carbon in upper Southeast Asia

Addressing the air pollution problem in upper Southeast Asia (USEA) becomes critical due to its serious impacts on human health and the environment. This study aims to investigate the characteristics of ultrafine carbonaceous particles (PM0.1; Dp <≤ 0.1 μm) in Chiang Mai, Thailand, and Tachileik, Myanmar. Carbon compositions, including elemental carbon (EC) and organic carbon (OC) in PM0.1, were determined by a carbon analyzer. The range of particle mass ranged from 3.2 to 18.4 μg/m3 with an average of 8.3 ± 4.4 μg/m3 and 5.4–20.8 μg/m3 with an average of 10.2 ± 4.3 μg/m3 in Thailand and Myanmar, respectively. The ratio of the EC, Char-EC/Soot-EC ratio, was found to be more applicable than the OC/EC ratio for identifying the sources of the emission. The char-EC/Soot-EC ratios in the PM0.1 were less than 1.0 in the rainy season. Vehicle exhaust had a significant impact on these samples. However, the higher Char-EC/Soot-EC ratios indicate that biomass burning was a major source. The correlation for PM0.1 with all carbon profiles was strong, especially during the dry season, suggesting that they were produced from the same emission source. The OC/EC vs. EC correlation for PM0.1 at the Chiang Mai and Tachileik sites appears to be affected by open biomass fires. Our findings suggest that biomass combustion is a probable source of PM0.1 in Thailand and Myanmar. Therefore, it is crucial to prioritize the management of open burning and traffic to mitigate PM0.1 pollution in this region.

Promoting Straw Recycling to Accelerate the Sustainable Development of Agriculture

Guided by Xi Jinping’s thought of socialism of the new era with Chinese characteristics in the 14th Five-Year Plan, the comprehensive utilization of straw is closely integrated with the annual key tasks of improving rural areas, by adhering to the priority of agricultural use, industry-oriented, multi-measures, and focusing on counties and municipalities with larger amounts of straw resources. Agricultural modernization requires that provincial policies focus on promoting the utilization of straw as fertilizer, feed, energy production, substrate, raw material, and so on while emphasizing the establishment of a complete straw collection, storage, and transportation system. In response to the problem of the open burning of straw in recent years, China has adopted a variety of policies and measures to control pollution and rationally utilize straw resources. The state and provinces have issued many policy documents on straw resource management, which are divided into the management of straw burning, comprehensive utilization of straw, planning of the straw energy industry, and financial subsidies. Rational utilization of straw not only solves the key issues of employment of farmers but also promotes ecological efficiency and rural economic development. The research results of straw recycling have also made important progress in improving the utilization rate and value of straw, promoting the resource utilization of agricultural waste, and providing important technical support for the sustainable development of China’s agriculture and rural environmental protection.

The Relationship between Waste Management Practices and Human Health: New Perspective and Consequences

Waste management, an integral aspect of modern life, exerts a profound influence on both public health and the environment. While existing research explores the environmental impact of various waste management practices, there is a paucity of studies investigating the direct health effects on humans from these practices. This article aims to address this gap by examining the intricate interplay between specific waste management strategies, such as open burning or landfill leachate management, and their potential to cause respiratory illnesses, birth defects, or other health problems in urban areas. Drawing from existing knowledge and recent research, it underscores the imperative of adopting an integrated waste management approach that harmonizes environmental preservation and health considerations. Furthermore, the review spotlights emerging technologies and innovative methodologies that hold promise in mitigating potential health hazards associated with conventional waste management practices. It accentuates the intricate connection between waste management and human health, underscoring the need for holistic strategies that encompass both community welfare and environmental sustainability. This paper advocates for sustainable waste management approaches that not only alleviate health concerns but also promote resource recovery and community engagement. Policymakers, urban planners, and stakeholders are encouraged to collaborate in the adoption of effective waste management methods that safeguard both the environment and human health. By recognizing the intrinsic link between environmental and health issues, a harmonized approach can be forged to address them.

The Effect of Stubble Burning and Residue Management on Soil Properties: A Review

The Effect of Stubble Burning and Residue Management on Soil Properties: A Review

802 Increase in Surgical Burn Management During the COVID-19 Pandemic

Abstract Introduction The COVID-19 pandemic has had a profound impact on healthcare systems worldwide. This study explores the consequences of the pandemic on pediatric burn management, specifically focusing on whether the pandemic contributed to a surge in the volume of pediatric burns requiring surgical interventions. Methods All surgical cases that had a post-operative ICD-10 diagnosis of a burn was collected from the National Surgical Quality Improvement Program Pediatric database. Patient demographics, procedure codes, and postoperative complications was collected. Results From 2018 to 2021, there was a total of 872 pediatric burns that required surgical intervention. The median age of the patients was 5.4 years. There was an 8.7% increase in volume of these cases from 2019 to 2020. The overall rate of complications was 8.4%. The predominant surgical approach employed in the majority of cases was the utilization of split-thickness autograft. Conclusions There was an increase in pediatric surgical burn treatment volume during the COVID-19 pandemic. Further investigation into the underlying causes and implications of this surge is warranted. Applicability of Research to Practice This analysis provides more information on the incidence of pediatric burns managed by surgical treatment and how it was affected by the COVID-19 pandemic.

573 Comparing ChatGPT and Google in Burn Injury Education: Answering Common Burn Injury and Management Questions

573 Comparing ChatGPT and Google in Burn Injury Education: Answering Common Burn Injury and Management Questions

Copper Ion-Inspired Dual Controllable Drug Release Hydrogels for Wound Management: Driven by Hydrogen Bonds.

Bacterial infections and inflammation progression yield huge trouble for the management of serious skin wounds and burns. However, some hydrogel dressing exhibit poor wound-healing capabilities. Additionally, little information is given on the molecular theory of hydrogel gelation mechanisms and drug release performance from drug-polymer network in the water environment. Herein, cationic guar gum (CG) is first mixed with dipotassium glycyrrhizinate (DG), and then crosslinked Cu2+ to strengthen the mechanical strength followed by encapsulating mussel adhesive protein (MAP) as composite dressings. Intriguingly, CG-Cu2+ 0.5-DG10 possessed proper rheological properties and mechanical strength predominantly driven by strong CG-H2O-Cu2+ and Cu2+-CG hydrogen bonding interaction. Weak DG-CG hydrogen bonding only controlled DG release in the initial 4 h, while strong hydrogen bonding is the main force regulating the sustained release of Cu2+ within 48 h. The incorporation of MAP further loosened the tight crosslinking of CG-Cu2+ 0.5-DG10. The screened CG-Cu2+ 0.5-DG10/MAP possessed excellent self-healing, injectability, antibacterial, anti-inflammatory, cell proliferation-promotion activities with high biocompatibility. Therefore, CG-Cu2+ 0.5-DG10/MAP hydrogel expedited wound closure on S. aureus-infected full-thickness skin wound model and lowered necrosis progression to the unburned interspaces on a rat burn model. The results highlight the promising translational potential of Cu2+-inspired hydrogels for the management of burns and infected wounds.

Wound Management of Pediatric Burns.

The goal for treating pediatric burns is to allow the patient to heal with as little scarring as possible. Compared to older children and adults, very small children have anatomic differences that alter their treatment. They have thinner skin that leads to a higher risk for full-thickness burns. Children also tend to freeze when touching a hot item, so that the prolonged contact also leads to deeper burns. Two healing strategies are needed to treat these wounds. One must optimize reepithelialization in superficial burns to reduce scarring. Deeper burns require skin grafting, but there are techniques, such as the use of "sheet" autograft skin that lead to excellent outcomes. Strategies to treat the massive pediatric burn will also be covered. Finally, there are instances where different strategies are needed to cover exposed bone or tendon. The ultimate goal is to return the skin to as normal a state as possible.

Initial Pediatric Burn Management: A Practical Guide.

Children have an imperative to explore their environment to grow and develop, which puts them at risk for sustaining burn injury. Burn injury remains the third leading cause of injury-related death worldwide. Plastic surgeons, as experts in the evaluation and management of cutaneous injuries, are frequently called upon to evaluate and treat children with burn injuries. This article focuses on the unique physiologic aspects of children and how they impact initial evaluation and management of burn injury. Children are not "little adults," and they have different airway, circulatory, and cutaneous systems. Understanding the signs of potential child abuse is important to avoid further child harm. Finally, recognition of the criteria for referral to a pediatric burn center is important to optimize both short- and long-term outcomes for patients and families.

Burn injuries and acute burn management in the rural areas in northern Bangladesh – A household survey

IntroductionBurn injuries pose a significant public health challenge, especially in low- and middle-income countries (LMICs). In Bangladesh, burn injuries are prevalent and often result in severe disability or death. However, knowledge regarding the causes of burn injuries, acute burn management, and barriers to seeking burn care in the riverine areas of northern Bangladesh is limited. MethodsWe conducted a questionnaire-based study in eight subunits and five selected districts in northern Bangladesh to determine the prevalence, causes, and management of burn injuries in these areas. A total of 210 individuals from different households were interviewed, which represented a population of 1020 persons. ResultsAmong the respondents, 55% reported that at least one member of their household suffered from a burn injury in the past. The most common causes of burn injuries were open fire (41%) and hot fluids (30%). More than 40% of burns were not rinsed with water directly after sustaining the injury. Additionally, almost 30% of respondents did not seek medical care immediately after the injury, with financial constraints being the most commonly cited reason. DiscussionWe found a low rate of adequate cooling and seeking medical care. The need for basic knowledge on prevention and treatment of burn injuries and improved access to affordable health care services in the region is high.

CERVICAL SCAR CONTRACTURES: EXPERIENCE OF THE PLASTIC SURGERY DEPARTMENT IN MARRAKECH

Deep cervical burns can lead to disabling sequelae, especially in cases of delayed, incorrect, or inadequate initial burn management. The aim of this study is to report the various epidemiological aspects of cervical contractures, analyze therapeutic modalities, and emphasize the importance of prevention. Our work is a retrospective study spanning a period of 10 years from July 2013 to July 2023, which includes 107 cases of cervical contractures followed at the Plastic and Reconstructive Surgery Department and Burn Unit of the Mohammed VI University Hospital Center in Marrakech. The average age of our patients is 20 years, ranging from 1 to 55 years. 68% of the studied population is female, with a sex ratio of 2.14. They mostly come from a low socioeconomic background. The most frequently found circumstances of the initial burn were domestic accidents, accounting for 80% of all accidents. The etiology of the initial burn is thermal in all patients in our series, 100%. In our study, the majority of cases were initially managed in non-specialized health centers or even at home through traditional practices. Initial treatment involved conventional treatment in 45.5% of cases, early excision with grafting in 22.7% of cases, and physiotherapy (compression therapy, massage) in 22.7% of cases. The topographic distribution of sequelae showed a predominance of anterior neck involvement in 96% of cases. Facial burn sequelae are most frequently associated (70%) with cervical contractures, followed by trunk sequelae (50%). The majority of patients (80.5%) present with deformation of the cervico-mental angle, as well as limitation of cervical extension. Severe cervical contractures (according to Achauers classification) are the most frequent, representing 44.6% of cases. Surgical treatment of these sequelae involves various methods, including skin grafts used in 50.6% of cases, local flaps used in 38.4% of cases, flaps used in 5.5% of cases, and skin expansion used in 5.5% of cases. Functional and aesthetic improvement is achieved in 85.9% of cases, while surgical revision was necessary in 5 patients. Cervical burn sequelae pose a major therapeutic challenge, despite the diversity of surgical procedures, hence the importance of prevention.

The Use of Oxandrolone in the Management of Severe Burns: A Multi-service Survey of Burns Centres and Units Across the United Kingdom.

Introduction Severe thermal burns are a catastrophic injury. Those surviving the initial insult are subject to life-long disability, prolonged hospital admission, nutritional issues and poor wound healing. Oxandrolone has been shown to reduce hospital duration and promote lean body mass. Despite not being licenced for use in burns trauma within the United Kingdom (UK), services across the country utilise Oxandrolone in the management of severe burns. We aim to analyse the use of Oxandrolone in major burns across burns services within the UK. Methods We conducted a survey across all burn centres and units across the UK. Any burns service provider with experience in patient management of patients sustaining burns with a total body surface area >15% was included. All services were identified using the British Burns Association website. We conducted a survey of all centres and units and contacted them via telephone through the trust's switchboard. Responses were accepted from any healthcare staff familiar with the day-to-day in-patient care of patients on the ward. Services with no in-patient services were excluded. Results A total of 24 burns centres and services responded to our survey. Twelve of the respondents were in a burns unit and 12 were in a burns centre. Eight respondents were paediatric facilities, and the remaining 16 dealt with adult burns. In total, 16/24 (66.6%) services reported using Oxandrolone. Conversely, 8/24 (33.3%) burns services denied using Oxandrolone. 7/12 (58.3%) burns units use Oxandrolone in the management of burns. 5/12 (42.7%) burns units do not use Oxandrolone in severe burns. 9/12 (75%) of burns centres described using Oxandrolone, whilst the remaining 3/12 (25%) did not. Discussion Oxandrolone is used varyingly across burns services across the UK. Burns centres were more likely to use Oxandrolone compared to units. We also find that more paediatric services used Oxandrolone in comparison to adult services. Studies have shown that the benefit of Oxandrolone is not age-dependent. Further work is required to assess the impact of this medication on patients with severe burns and national guidance would help further improve burns management across the UK.

Surgical Management of Diabetic Foot Burns Is Associated With Poor Outcomes: A Systematic Review and Meta-Analysis.

There is no consensus on the optimal management of diabetic foot burn injuries. Here, we systematically identify studies reporting on diabetic foot burns and evaluate outcomes among patients managed operatively vs nonoperatively. PubMed, Embase, and Web of Science were searched. Screening was performed by independent reviewers. Primary research studies with English full texts published between 1980 and 2023 that discussed outcomes of foot burns in adults with diabetes were included and critically appraised using validated tools. Results are presented using descriptive statistics of aggregated data. The search yielded 2402 nonduplicate papers, of which 35 met the inclusion criteria. Nine papers were included for meta-analysis, including 7 retrospective comparative analyses, 1 cross-sectional study, and 1 retrospective chart review. There were 1798 diabetic foot burn patients. The mean age was 58.2 years (SD 4.12), and 73.1% (n = 1314) were male. A total of 15.7% (n = 283) of patients were surgically managed, including debridement (3.7%, n = 66), grafting (8.2%, n = 147), flap (0.2%, n = 3), and primary amputation (7.1%, n = 127). The secondary amputation rate, defined as amputation following initial surgery, was 4.9% (n = 14). The overall amputation rate was 7.8% (n = 141). Other complications included infection (4.0%, n = 72), osteomyelitis (1.9%, n = 34), and graft failure (8.2%, n = 12). One study reported functional status at the last visit. Diabetic foot burns are highly morbid. The surgical management of these complex injuries is high risk, as amputation results in poorer quality of life and functional outcomes.

From Admission to Discharge-A Total Friction Burn Review from a Single Institution.

While most friction burns are adequately managed in an outpatient setting, many may require hospital admission, operative excision, and extended care. To this day, there is a wide variance in friction burn management. Our goal is to review the etiology, management, and outcomes of such burns warranting hospitalization. We conducted a retrospective review of all friction burns admitted to a single, American Burn Association-verified burn center from January 1, 2016 to December 31, 2020. A total of 28 (34%) patients required surgery for their friction burns and 15 (18%) ultimately required a split-thickness skin graft. The mean number of operations was 2.4 (95% CI 1.6-3.1). Overall, the operative group was younger (29.9 vs 38.3 years, P = .026), more likely to have a concomitant traumatic brain injury (25% vs 7%, P = .027), and had a longer hospital length of stay (17.5 vs 3.9 days, P < .001). Both groups had a similar overall TBSA (8.5% vs 10.0%, P = .35), but the operative group had a larger surface area comprised of third-degree burns (3.05% vs 0.2%, P < .001). Overall, friction burns resulting in hospital admission are associated with high-energy traumatic mechanisms and concomitant injuries. Patients who need operative intervention for their burns typically require multiple procedures often culminating in a split-thickness skin graft. While non-operative management of friction burns with topical agents has been found to be successful, patients with higher injury severity scores should be monitored very closely as they may require surgical excision.