Burn Surgery Research Articles

Investigation on Potential of Novel Carrier System Containing Silver and Gold Nanoparticles for Burn Surgery: Evaluation in Rat Model

The main aim of the study was to optimization and evaluation of a suitable dosage form i.e., tropical gel containing silver and gold nanoparticles which are synthesized by green synthesis as this is the rapid and better alternative to chemical synthesis. For burn injury systemic route of administration is not suitable due to damaged skin hence tropical route selected to provide controlled effects, low systemic toxicity and easy application. Silver nanoparticles were synthesized by green synthesis by use of neem leaves and gold nanoparticles by Aloe vera. Characterization was done by UV spectroscopy, particle size distribution, TEM and zeta potential. Gel was formulated by simple mixing and stirring method and evaluated for color, homogeneity, Spreadability, viscosity, in vitro release, antimicrobial study and in vivo study. In this study, the combination of Carbopol 934 P and HPMC (ratio 1:3) was found to be ideal formulation (Formulation F5) with optimum viscosity and Spread-ability i.e., 4459 cP and 5.7 gmcm/sec resp. in vitro release was found to be 98.66% in 12 hours. in vitro antimicrobial study and in vivo study on rat showed maximum effects than standard formulations. From this study it can be concluded that, tropical gel is the superior dosage form containing silver and gold nanoparticles which acts as the antimicrobial agents and is effective in treatment of burn surgery.

Current nursing practices for managing children with burn injuries: Thesis Abstract

Burns are one of the most common forms of trauma in children. Providing adequate care for burnt children properly is the most important contribution to the successful management. Aim: This study aimed to describe the current nursing practice provided for managing children with burn injuries and to identify the most common causes of burn injuries among children. Method: A descriptive exploratory research design was utilized in the study. The study was carried out in burn unit at Plastic, Reconstructive and Burn Surgery Center and Mansoura International Hospital at Mansoura city on a convenient sample of 56 nurses and 100 pediatric patients. Tools: Data were collected by using three tools. Current nursing practices for managing children with burn injury structure questionnaire sheet, Burn care observation checklist and clinical data sheet for children with burn injury. Results: The most common cause of burn was boiling water, more than three quarter of studied nurses had poor knowledge about burn and its management, two fifth of them had competent practice about wound dressing, more than two third of studied nurses had competent practice about pain and there was statistical significance difference between severities of burn and children death . Conclusion: The present study indicated that, the nurses' knowledge regarding burn was poor and were incompetent in the care practice regarding burn injuries. Recommendations: There is a need for burn training program that should be provided to nurses in order to improve their knowledge and practices regarding burn management.

Indocyanine Green Angiography Precise Marking for Indeterminate Burn Excision: A Prospective, Multi-centered, Double-blinded Study.

Background:During burn excision, the clinical judgment whether to excise or not excise the area with indeterminate burn depth is difficult. Indocyanine green angiography (ICGA) has been reported to provide high accuracy in diagnosing indeterminate burns. This study aims to evaluate the complete wound closures in both short-term and long-term outcomes after using ICGA precise marking to guide indeterminate burn excision.Methods:This was a prospective, multi-centered, double-blinded, experimental study. The participants were admitted to the hospital with indeterminate burn wounds. ICGA precise marking was performed. The deep second-degree burn was painted, excised, and subsequently covered with skin grafts and measured on day 5. The superficial burns were measured on day 21. All wounds were followed-up at two months.Results:Thirty indeterminate burn sites were included in this study. Using ICGA precise marking, the overall rate of short-term complete wound closure, which combined superficial and deep burns, was found to be as high as 96.7% (29/30). The long-term complete wound closures at two months confirmed the short-term result and yielded 100.0% of complete wound closure. The complete wound closures between the short-term and long-term measurements were not significantly different (P > 0.999).Conclusions:Using ICGA precise marking to guide indeterminate burn excision resulted in an excellent rate of complete wound closure and an insignificant difference between short-term and long-term wound outcomes. ICGA is a competent method to aid decision-making in burn surgery of the indeterminate area.

Survey of plastic surgery trainee attitudes to a career as a burns surgeon: A potential workforce dilemma

Aim and methodThe aim of this study was to gain insight into potential pitfalls in workforce planning for future consultant burns surgeons. An anonymous online survey was sent to current plastic surgery registrars in the UK to assess their subspecialty career choices, the perceived barriers to a career in burns surgery and possible solutions to these. ResultsThe response rate was 33%. Of 44 respondents, burns surgery was the primary subspecialty of choice for 2% (n = 1) and the secondary choice for 9% (n = 4). Reasons given for not selecting burns surgery included a lack of exposure to the subspecialty, a perceived narrow scope of clinical practice and a concern about the potential negative impact on personal lifestyle. Discussion and conclusionOur results may be extrapolated to demonstrate a potential shortfall in the workforce for burns surgery in the future. To address the perceived barriers highlighted by trainees, a coordinated response at a national and international level is most likely to be successful through the cooperation of burns associations. Possible solutions include increasing burns subspecialty exposure during training, incorporating experience in intensive care into surgical training, and highlighting the numerous research opportunities in burns surgery.

665 Blood Loss in Burn Surgeries: Prediction and Its Related Factors

Abstract Introduction Blood loss is a common and important problem in burn surgery, and patients often require blood transfusions. Preparation of estimated blood transfusions needed prior to surgery is essential. Some studies have devised formulas that can predict blood loss during burn surgery. However, there were many different factors in each study that may influence the amount of blood loss, which were not included in the formulas. Until today, there is no standardized formula that is widely used. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE database for cohort and trial studies that investigate blood loss in burn surgeries. Studies should have clear quantitative blood loss outcome. Results We included 15 studies from 1982 to 2018, 13 of which are cohort studies and 2 RCTs, with a total of 1613 subjects; all studies calculated blood loss and assessed possible relating factors, four of them proposed formulas to predict the volume of blood loss, 13 studies mentioned efforts used to reduce blood loss, and 6 studies assessed the timing of surgery. We found trends of blood loss within each variable and summarized them in tables. Conclusions From the studies included, there were a variety of results in the amount of blood loss and its related factors. This was due to confounding factors and dissimilarities between studies. However, several studies proposed blood loss prediction formulas, which pose promising benefits to betterment in burn surgeries.

57 Safety and Cost Effectiveness of Outpatient Surgery in Acute Burn Care

Abstract Introduction Outpatient burn surgery is increasingly utilized for delivery of acute burn care. Reports of its safety and efficacy are limited. The purpose of our study was to evaluate the safety and cost reduction associated with outpatient burn surgery and to describe our centre’s experience. Methods This was a single centre, retrospective cohort study of consecutive patients who underwent outpatient acute burn surgery requiring split thickness skin graft or dermal regenerative template from January 2010 - December 2018. Patients with insufficient follow up to evaluate operative site healing were excluded. Patient demographics, comorbidities, burn etiologies, operative data and postoperative care were reviewed. The primary outcome is complication involving major graft loss requiring reoperation. Results 165 patients and 173 procedures met the inclusion criteria. The average age was 44 years and 60.6% (100/165) were male. The number of annual outpatient procedures increased 48% from 23 to 34 cases over the 9-year period. The mean grafted total body surface area was 1.0 ± 0.9%. Rate of major graft loss requiring reoperation was 5.2% (9/172). Greater than 95% graft take was achieved in 80.9% of patients. Age, sex, co-morbidities, total body surface area, and procedure types were not significantly associated with postoperative complication rate. Outpatient burn surgery model was estimated to save CA$7,875 per patient from inpatient costs. This extrapolates to a total of over CA$1.36 million in savings over the 9-year study period. Conclusions Acute burn care at our centre is increasingly being delivered through an outpatient day surgery model. Our demonstration of its safety and considerable cost savings is compelling for further utilization. Our experience found the adoption of improved dressing care, appropriate patient selection, increased patient education, adequate pain control, and regimented outpatient multidisciplinary care to be fundamental for effective outpatient surgical burn care.

625 The Impact of COVID-19 on Burn Care at a Regional Burn Center

IntroductionThe COVID-19 pandemic has had a profound global impact, not least on hospital functioning. Institutions have all had to prepare and adapt to a large number of admissions, and the influence on elective and emergency surgical services, including burn care, has been significant; it may be some time before we know the full extent of this. While many centers were able to commence more normal activities for a while, we are now seeing an exponential rise in cases again, with potentially catastrophic consequences for the provision of burn care.MethodsA review of all admissions, operative cases and clinic visits between 1 April and 31 August 2020 was undertaken at an American Burn Association verified burn center. These data were compared with the same five-month period in the preceding two years.ResultsSelected data highlights are tabulated (Table 1). During the five months in question, fewer patients were admitted than the previous two years (N=81 versus 121). The mean total body surface area was slightly higher this year (13.7%), and the mean length of hospital stay longer (18 days). The male-to-female ratio of admitted patients was greater during the five months of 2020, at 2.9:1, compared to 1.7:1. No significant differences in terms of etiology were detected, however. As expected, clinic visits reduced dramatically from a mean of 160 patient visits per month to just 81 per month, with the majority conducted virtually. During 2020 the operative cases were similar in number to previous years (N=176), but the mean duration was significantly longer (190 minutes). The total time utilised for burn surgery was similar to previous years (572 hours). Table 1. Selected burn center data comparing 2020 with 2019 and 2018.ConclusionsThis study demonstrates that although total admissions were slightly reduced, the demands on Burn ICU bed resources and burn operating time were similar. The data supports the notion that removing scheduled operating time for our service resulted in less efficient execution of acute burn surgeries and longer hospital stays. Although formal clinic visits were significantly reduced and were mainly conducted virtually, several patients were satisfied by a novel and user-friendly email service conducted by our clinic nurse specialist.

664 “Minimally Invasive” Skin Grafting with Enzymatic Debridement and Autologous Skin Cell Spray

Abstract Introduction Minimally invasive surgery is increasingly becoming standard of care across numerous subspecialties. However, burn surgery has lagged behind; as the mainstay of reconstruction still involves wound excision with a knife, a commensurately sized skin graft, and a painful donor site. In recent years, several new technologies have the potential to be used synergistically to perform “minimally invasive” skin grafts. Enzymatic debridement with bromelain and autologous skin cell spray (ASCS) have independently been shown to reduce the need for split-thickness skin graft (STSG) and decrease the donor site size when grafting is performed. Bromelain is more likely to preserve healthy dermis and ASCS allows an 80:1 expansion. Due to constraints regarding the temporal course of these products only being available via studies before one was FDA approved, these two therapies have not been utilized together in the US until recently. A paucity of literature regarding their use in combination currently exists. Methods This study is a single site review of patients treated the continued access study protocol for bromelain-based enzymatic debridement and with ASCS per the FDA-approved instructions for use. Enzymatic debridement was performed over a 4-hour period with appropriate analgesia. Deep partial-thickness burns with residual dermis were treated with ASCS after enzymatic debridement and superficial dermabrasion. Wounds were dressed with a small pore non-adherent film and layered gauze. Full-thickness burn injuries were treated with conventional STSG. Results Two patients were treated over a 2 week period. One was a 51 yr old male with 17% TBSA superficial and deep partial thickness flame burns, of which 11% were deemed deep enough to warrant treatment with enzymatic debridement. 15% TBSA was treated with ASCS including the arms, back, and posterior neck with a 24 sq cm donor site. Wound closure was noted post-operative day 7 with complete re-epithelialization. The second patient was a 21-year-old male with several comorbidities impairing wound healing (diabetes [HgbA1c of 9.9], scurvy, and zinc deficiency. He had deep-partial and full-thickness burns to bilateral feet. The dorsum of the right foot was reconstructed with ASCS only and a 6 sq cm donor site, and the left foot was treated with a 3:1 meshed STSG and ASCS overspray with 100% take. Conclusions Enzymatic debridement and ASCS can be utilized to treat deep partial-thickness burns with a “minimally invasive” reconstruction. The donor sites in both patients were much smaller than had they been treated with a conventional meshed STSG. Further study is needed to determine which subsets of patients and burn wound characteristics are optimal for this combination of technologies. More data regarding outcomes such as length of stay, costs, and scar formation compared to standard of care is also warranted.

666 Autologous Skin Cell Therapy After Dermal Matrix with STSG in a 5-year-old African-American Female - How Adjunct Therapies are Refining the Dogmatic Treatment Approach to Burns

Abstract Introduction Split-thickness skin grafting (STSG) is the standard of care for the treatment of full thickness skin injuries. Skin grafts are associated with long-term morbidity including graft loss, adjacent structural injury, anesthetic complications, scarring, and scar contractures. Large surface area burns are additionally challenging due to limited donor site availability. Autologous skin cell suspension (ASCS) is a new adjunct for STSG using device that provides a suspension of non-cultured, autologous skin cells applied overtop of STSG. Dermal matrix templates are placed on wounds after burn excision and induces dermal regeneration in preparation for STSG, allowing for a thinner graft to be harvested and applied. This technique has been shown to require both smaller areas of donor skin as well as thinner skin harvest which improves both healing time and aesthetic outcomes of donor sites, enhancing the time-tested and well accepted technique of STSG. Methods We present the case of a 5-year-old African American female who suffered 18% TBSA deep partial thickness burns and full thickness burns to her abdomen, trunk and left back after her shirt was accidentally lit on fire at home. She was transferred from a local hospital to our burn center for further evaluation. She was evaluated by both the burn surgery and pediatric teams and admitted for wound cares and surgical planning. Results On hospital day five she underwent burn excision and placement of acellular dermal regeneration template. She returned to the operating room on hospital day 22 after daily wound cares for autografting with autologous skin cell suspension application to anterior and posterior torso and left arm, as well as to back and thigh donor sites. Her takedown on hospital day 29 showed excellent graft take. She was ultimately discharged on hospital day 47. She continued to undergo wound care in the outpatient burn clinic and daily physical and occupational therapy. Conclusions This case illustrates the use of dermal matrix and ASCS on a large burn with excellent aesthetic outcomes and improved healing time. This case is unique in highlighting the versatility of this therapy in a darker skinned patient. There are significant challenges with long term morbidity from STSG and the use of both dermal regenerative matrix and ASCS may provide surgeons with new approaches to decreasing depth and size of donor sites, as well as improving the length of hospital stay and overall aesthetic outcomes of donor and graft sites, specifically in darker skinned patients.

Impact of COVID-19 on Patient Trends and Outcome: Results from a Tertiary Care Burn and Plastic Unit in Northern India.

Background Burn and trauma injuries need emergency care and resuscitation, which required uninterrupted delivery of inpatient care services during the coronavirus disease 2019 (COVID-19) pandemic. Burn patients are physiologically immunocompromised, increasing the risk of COVID-19 infection in them. This study analyzes the impact of COVID-19 pandemic on patient trends in a burn and plastic unit and assesses the effect of COVID-19 infection in burns. Methods This single-center, retrospective observational case–control study was conducted in the Department of Burns, Plastic and Maxillofacial Surgery of a tertiary care hospital in New Delhi, India. Patient data was collected from April 1, 2019 to August 10, 2019 and from April 1, 2020 to August 10, 2020. All data of burns and trauma patients collected was analyzed and compared. Results There were total 350 admissions during COVID time period and 562 admissions during non-COVID time period. The admission rate, type of burn injury, and death rate did not vary significantly during the two time periods. Thermal burn was the most common type of burn injury. There were total 18 cases diagnosed to be COVID-19 positive during the pandemic. There were two deaths among COVID-19 positive burn cases. Conclusion This study finds no difference in patient patterns during COVID and non-COVID time period. Amongst burn patients, no increased risk of COVID-19 infection is seen with larger body surface area of burns. No increase in mortality is seen in burn patients infected with COVID-19.

Early tangential excision with guidance of gentian violate application

Background: Uses of gentian violet as a marker to determine burn depth, to facilitate early tangential excision.Patient and Method: A prospective study conducted on eighteen burned patients, they were admitted to Burns and Plastic Surgery Hospital in Sulaimani, with deep second and third degree burn, and they underwent early tangential excision with the guidance of gentian violet and grafting. Incisional biopsy was taken from two patients and sent for histopathology, they resulted in staining of dead tissues and preservation of normal tissues.Results: The mean age of the patients was (23.25) years. (77.7%) were with flame burn and (22.3%) were with scald burn. With the use of our method (55.5%) of patients needed one session and (44.5%) of patients needed more than one session of excision and grafting. The mean of excised and grafted area was (9.97%) TBSA. (77.7%) of patients with good graft take (90-100%), (16.6%) of patients with moderate graft take (50-89%), (5.5%) of patients with poor graft take (

46 Increased Concomitant Burn and Trauma Injuries Follows an Increase in Overall Trauma Volume: A Descriptive Analysis

Abstract Introduction Concomitant traumatic injury in the burn patient complicates care coordination and increases morbidity and mortality. The incidence of concomitant injury, however, is uncommon and reported to range from 5–7%. In May 2020, our level 1 trauma center began seeing 40% more patients per month that the 12 months prior. We sought to determine the incidence of concomitant injury in burn patients during this time of increased trauma volume and to examine the associated traumatic injuries in this group. Methods The burn registry at a single ABA-verified burn center was examined from 5/20–9/20. Patients with concomitant burn and traumatic injury were examined with respect to: %TBSA burn, mechanism of injury, operative interventions, associated traumatic injuries, and length of hospital stay. Continuous data was presented as mean (standard deviation). Results Eighty-nine burn patients were admitted during this period, of whom 24 (26.9%) had concomitant traumatic injuries. The cohort was young and mostly male; the mean TBSA was 16% () (Table 1). The most common mechanism of injury was motor vehicle collision (12 or 50%), followed by fall after high voltage electrical injury (6 or 25%) and motorcycle collisions (5 or 21%). The most common associated injuries were: pulmonary contusions 29.1% (7/24); long bone fractures 25% (6/24); pelvic/acetabular fractures 20.8% (5/24); femur fractures 16.6% (4/24); and solid organ injury: 16.6% (4/24). Twenty patients (83.3%) required burn or trauma operative intervention during hospital stay. Of the 20 patients who required operative intervention, 85% underwent burn surgery and 55% underwent trauma surgery (solid organ or orthopedic). Forty percent of these patients required operation for both burn and traumatic injury. In looking specifically at the electric injury group, all six patients required operative intervention for burn injuries, and four required extremity fasciotomy. Patients with electrical injury had a significantly longer hospital stay relative to their TBSA (p< 0.04). Conclusions Concomitant trauma and burn injuries are infrequent yet present a major clinical challenge. Our recent increase in overall trauma volume was paralleled by an increase in patients with concomitant burn injuries. The associated traumatic injuries require a multi-disciplinary approach to minimize morbidity and restore function.

600 Social Determinants and Their Impact on Burn Surgery Outcomes

Abstract Introduction To our knowledge, no studies have been conducted assessing the social determinants of health and the impact on the outcomes for burn patients. Such studies are needed considering burn injuries are associated with high costs, severe psychological impact, and a high burden placed on the healthcare systems. The burden is hypothesized to be aggravated by the increasing amount of diabetes and obesity seen in the general population which put patients at increased risk for developing chronic wounds. Studies have shown that several socioeconomic status (SES) factors are associated with increased risk of burns, but none have documented the outcomes of burn patients based on their social determinants of health. In our study, we will be comparing patients in the burn ICU (BICU) to patients in the surgical ICU (SICU). The purpose of this comparison is to evaluate whether the same social determinants of health have similar influences in both groups. Methods We performed a retrospective analysis of population group data from patients admitted to the BICU and SICU from January 1, 2016, to November 18, 2019. The primary outcomes were length-of-stay (LOS), mortality, 30-day-readmission, and hospital charges. Pearson’s chi-square test for categorical variables and t-test for continuous variables were used to compare population health groups. Results We analyzed a total of 487 burn and 510 surgical patients. When comparing BICU and SICU patients, we observed significantly higher mean hospital charges and LOS in burn patients with a history of mental health (mean difference: $42,756.04, p=0.013 and 7.12 days, p=0.0085), ESRD ($57,8124.7, p=0.0047 and 78.62 days, p=0.0104), sepsis ($168,825.19, p=< 0.001 and 20.68 days, p=0.0043), and VTE ($63,9924.1, p=< 0.001 and 72.9 days, p=0.002). Also, higher mortality was observed in burn patients with ESRD, STEMI, sepsis, VTE, and diabetes mellitus. Burn patients with a history of mental health, drug dependence, heart failure, and diabetes mellitus also had greater 30-day-readmissions rates. Conclusions This study sheds new knowledge on the considerable variability that exists between the different population health groups in terms of outcomes for each cohort of critically ill patients. It demonstrates the impacts of population health group on outcomes. These population groups and social determinants have different effects on BICU versus SICU patients and this study provides supporting evidence for the need to identify and develop new strategies to decrease overspending in healthcare. Further research to develop relevant and timely interventions that can improve these outcomes.

633 Use of an ICU Rounding Tool Enhances Critical Care Learning for Trainees on a Burn Surgery Rotation

Abstract Introduction An institutional Burn Intensive Care Unit (ICU) Rounding Tool was implemented for both quality improvement data collection and trainee education. Forms are completed by trainee team members daily for all critically ill patients prior to teaching rounds. Gathered data are structured to facilitate evaluation of patient volume status, sepsis risk and ventilator management. The forms are then used to guide discussion among students, residents, mid-level providers, fellows, attending surgeons and other members of the multi-disciplinary rounding team. We conducted a series of interviews with trainees regarding their user experience to assess the tool’s educational utility. Methods A convenience sample of residents who had recently completed their Burn Surgery rotation were interviewed in a structured format. Questions focused on the form’s ease of use and comprehensibility. Emphasis was placed on the extent to which it stimulates learning while rounding. Additional feedback was sought for the purpose of improving the tool for continued use. Results Participants were post-graduate year one or two resident physicians training in General Surgery, Urology, Emergency Medicine or Anesthesia. Prior experience and comfort with ICU level care ranged from very little to moderate. All interviewees found the tool helpful in their patient assessments, though the current layout of the form was a frustration for many. Overall, they unanimously found the forms beneficial for preparation of patient presentations and felt that utilization during rounds facilitated learning. Conclusions Interviews with trainees on their burn surgery rotation demonstrate that implementation of an ICU Rounding Tool has provided educational benefit, particularly for those less experienced in intensive care. Feedback from this cohort will be used to improve the tool’s usability. Our next steps will include a more formal survey of all trainees involved since the inception of this project.

547 Face Escharotomy in an Acute Deep Facial Burn

Abstract Introduction Escharotomy is the relaxation of the eschar through longitudinal or horizontal incisions in order to protect the region’s deep perfusion. The pressure that it will create in the peripheral areas such as hard eschar limb, trunk, and neck causes the circulatory disorder in the limb and the risk of limb loss, inadequate thoracic expansion in the thorax and vital perfusion and oxygenation problems in the neck. It is one of the most basic rules of burn surgery to perform the determined escharotomy incisions very quickly and without hesitation to prevent complications. In this report, a case of facial subunit principles based escharotomy is presented. Methods 42-year-old man felt into hot sand while working in an iron and steel factory. Patient was transferred to our burn unit for corresponding 35% of the total body surface burns on the face, neck and upper extremities. The patient was consulted to plastic surgery after the initiation of fluid replacement therapy, insertion of a chest tube for hemothorax, and tracheostomy. The patient had massive edema in the face and neck (Figure 1). There was no capillary fill in the facial skin. Doppler ultrasound examination showed bilateral weak facial artery, temporal superficial artery, supraorbital and trochlear artery flow. Results A decision was made to perform escharotomy to relieve arterial traces at 10th hour of the injury. Bilateral nasolabial, infraorbital rim, superior glabellar, temporal incisions were performed from eschar to subcutaneous fat layer in accordance with aesthetic subunits (Figure 2). Relief of the base perfusion during escharotomy was observed and bleeding was observed at the base of the incision. Doppler examination was repeated after escharotomy. The facial edema rapidly regressed. Deepitelization and reepithelization was observed in the areas with hair roots within 10 days and the patient was operated on the 15th day of hospitalization for debridement and skin grafting. Eschars were debrided and covered with split thickness skin grafts according to aesthetic subunit principles. Post-operative image of the patient seen (Figure 3). Conclusions Face is not an area in which eschar formation commonly seen because of its robust vascular supply and protection reflex of the patients. Although descriptive drawings and guides for facial escharotomy has not been published yet, relaxation of axial arteries in terms of compression due to eschar formation may be needed. In this report, a case of facial subunit principles based escharotomy is presented and acceptable results were achieved.

Analgesia for the Change of Dressing in Burn Victims: A Comparison Between Oral Ketamine and Oral Dexmedetomidine

Objective: To compare the efficacy of oral ketamine with oral dexmedetomidine for providing adequate analgesia for change of dressing in burn patients in burn dressing room. Methods: This randomized controlled trial was carried out in Jinnah Burn and Reconstructive Surgery Center, Lahore, from April 2019 to September 2019 after getting the approval from the Ethical Committee of Jinnah Hospital / Allama Iqbal Medical College, Lahore. 80 patients between 20 to 50 years, with 1st and 2nd degree burns and 20 to 40% of total body surface area involved were allocated in two groups A and B. The patients in group A received oral ketamine at a dose of 5mg/kg in 15 ml of water 30 mins while those in group B received dexmedetomidine, 4 ug/kg orally, in 15 ml of water 30 mins before the start of dressing change. The change of dressing was carried out with continuous vital monitoring. Pain was assessed via visual analogue scale (VAS) and sedation via Ramsay sedation score. All the observations were recorded on the predesigned proforma. SPSS version 21 was used for data analysis. Result: The baseline mean VAS score of patients in group A was 7.67 + 0.55 and in group B was 7.70 + 0.57 (p value = 0.799). Significant decrease in pain score in both groups was noted after 30 mins of drugs administration (p=0.000). Also a significant difference in pain scores was seen between the two groups (p< 0.05), with the patients in group A having lower pain scores as compared to patients in group B. Conclusion: both ketamine and dexmedetomidine provide adequate analgesia for the change of burn dressing when administered orally with ketamine providing better analgesic state as compared to dexmedetomidine. Key Words: Burn, ketamine, dexmedetomidine, analgesia. How to cite: Sohail F., Bangash R.L., Azim W., Arshad F, Anwar A., Niazi K.A. Analgesia for the Change of Dressing in Burn Victims: A Comparison between Oral Ketamine and Oral Dexmedetomidine. Esulapio 2021;17(01):39-44

Expert consensus on the application of nitrous oxide and oxygen mixed inhalation for sedation and analgesia technology in burn surgery (2021 version)

The writing group of Expert consensus on the application of nitrous oxide and oxygen mixed inhalation for sedation and analgesia technology in burn surgery (2021 version) formulated the consensus through three face-to-face national multi-disciplinary expert meetings, combining theoretical and practical experience, and drawing lessons from application of nitrous oxide and oxygen mixed inhalation for sedation and analgesia technology in other disciplines at home and abroad. The consensus provided detailed descriptions on the indications, contraindications, possible side effects and corresponding first aid measures, application process, operation conditions, and training of the technology in burn surgery, and formulated the relevant plans.

Effects and mechanism of eleutheroside E on the growth of human hypertrophic scar fibroblasts

Objective: To investigate the effects and mechanism of Eleutheroside E on the growth of human hypertrophic scar fibroblasts (Fbs). Methods: The experimental research method was used. The hypertrophic scar tissue was collected from 6 patients with hypertrophic scar [1 male and 5 females, aged 20 to 51 (37±8) years] admitted to the Department of Burns and Plastic Surgery of General Hospital of Northern Theater Command, from October 2018 to March 2019. The third to seventh generations of human hypertrophic scar Fbs were cultured for the follow-up experiments. Cells were divided into normal saline group, 100 μmol/L Eleutheroside E group, 200 μmol/L Eleutheroside E group, and 400 μmol/L Eleutheroside E group, and 10 μL normal saline, Eleutheroside E at the final molarity of 100, 200, and 400 μmol/L were added to cells in the corresponding groups. Cells were divided into small interfering RNA (siRNA)-negative control alone group, siRNA-thrombospondin 1 (THBS1) alone group, siRNA-negative control+400 μmol/L Eleutheroside E group, and siRNA-THBS1+400 μmol/L Eleutheroside E group. Cells in siRNA-negative control alone group and siRNA-negative control+400 μmol/L Eleutheroside E group were transfected with siRNA-negative control, cells in siRNA-THBS1 alone group and siRNA-THBS1+400 μmol/L Eleutheroside E group were transfected with siRNA-THBS1. At 24 h after transfection, cells in siRNA-negative control alone group and siRNA-THBS1 alone group were added with 10 μL normal saline, cells in siRNA-negative control+400 μmol/L Eleutheroside E group and siRNA-THBS1+400 μmol/L Eleutheroside E group were added with Eleutheroside E at the final molarity of 400 μmol/L, respectively. At 0 (immediately), 12, 24, 36 and 48 h after treatment, the cell proliferation activity was detected by thiazolyl blue assay. Cells were divided into normal saline group, 200 μmol/L Eleutheroside E group, and 400 μmol/L Eleutheroside E group, siRNA-negative control alone group, siRNA-THBS1 alone group, siRNA-negative control+400 μmol/L Eleutheroside E group and siRNA-THBS1+400 μmol/L Eleutheroside E group. The corresponding treatments were the same as before. At 24 h after treatment, the apoptosis was observed by Hoechst 33258 staining. Cells were divided into normal saline group, 100 μmol/L Eleutheroside E group, 200 μmol/L Eleutheroside E group, and 400 μmol/L Eleutheroside E group, siRNA-negative control alone group, siRNA-THBS1 alone group, siRNA-negative control+400 μmol/L Eleutheroside E group, and siRNA-THBS1+400 μmol/L Eleutheroside E group. The corresponding treatments were the same as before. At 24 h after treatment, the protein expression level of THBS1 of cells was detected by Western blotting. The number of sample in each group at each time point was all 3. Data were statistically analyzed with analysis of variance for factorial design, one-way analysis of variance, independent sample t test, and Bonferroni correction. Results: At 0 h after treatment, the absorbance values of cells in normal saline group, 100 μmol/L Eleutheroside E group, 200 μmol/L Eleutheroside E group, and 400 μmol/L Eleutheroside E group were similar (P>0.05). At 12, 24, 36, and 48 h after treatment, the cell absorbance values of cells in 100 μmol/L Eleutheroside E group, 200 μmol/L Eleutheroside E group, and 400 μmol/L Eleutheroside E group were significantly lower than those of normal saline group (t=7.64, 28.94, 13.69, 5.87, 6.96, 22.83, 14.75, 11.52, 21.09, 20.15, 29.52, 23.12, P 0.05). At 12, 24, 36 and 48 h after treatment, the cell absorbance values of cells in siRNA-THBS1 alone group and siRNA-negative control+400 μmol/L Eleutheroside E group were significantly lower than those in siRNA-negative control alone group (t=7.14, 44.87, 20.67, 40.98, 9.26, 11.08, 15.33, 20.56, P 0.05). Compared with that in normal saline group, the number of apoptotic cells in 200 μmol/L Eleutheroside E group and 400 μmol/L Eleutheroside E group were increased at 24 h after treatment. At 24 h after treatment, compared with that in siRNA-negative control alone group, the numbers of apoptotic cells in siRNA-THBS1 alone group and siRNA-negative control+400 μmol/L Eleutheroside E group were increased, while the number of apoptotic cells in siRNA-THBS1 alone group, siRNA-negative control+400 μmol/L Eleutheroside E group, and siRNA-THBS1+400 μmol/L Eleutheroside E group were similar. At 24 h after treatment, the protein expression levels of THBS1 of cells in 100 μmol/L Eleutheroside E group, 200 μmol/L Eleutheroside E group, and 400 μmol/L Eleutheroside E group (0.87±0.12, 0.38±0.07, 0.20±0.09) were significantly lower than 1.83±0.17 in normal saline group (t=16.61, 16.17, 17.29, P 0.05). Conclusions: Eleutheroside E can inhibit the growth of human hypertrophic scar Fbs by down regulating the expression of THBS1.

Assessment of Nursing Care Provided to Hospitalized Children Burn Patients at Burn and Plastic Surgery Center at Kirkuk City

Background: Burns are the foremost important causes of a child’s injury that lead to a considerable healthproblem; social, functional, and psychological weakness. They are the leading reason of hospitalization andare associated with significant morbidity and mortality.Objectives: This study aimedto assess the quality of nursing management and to find outassociation betweennurses’ sociodemofigureic data and quality of nursing management provided to admitted children AzadiTeaching Hospital in Kirkuk city-Iraq.Method: A descriptive design (quantitative approach) was carried out from January 1st to 20th of October2020. A non-probability (purposive sample) sampling technique utilized to collect data from (48) nursesworking in burn and plastic surgery center in Azadi teaching hospital in Kirkuk city. A questionnaire wasdesigned and constructed for the purpose of the study. Statistical analysis was performed using (SPSS)software (V.26). Comparison was carried out using Chi-square (X2) and T test for determination of the P.value.Results: The study sample revealed that the majority of the sample were in age group (21-30) years oldrepresent (47.9 %), and (60.4 %) of the participants were female. The most striking results emerged fromthe data is that the majority of the participants have a good level of the practices in relation to nursingmanagement of major burns at admission (54.17%). The results also show a significant association betweenthe nurses’ practices at admission and their age, gender, number of courses training.Conclusion:Training courses have significant effects on nurses’ practices at admission. Further studies arerequired to find the effectiveness of intervention that involve nurses’ practices for children with burn injuries.

A Short History of Skin Grafting in Burns: From the Gold Standard of Autologous Skin Grafting to the Possibilities of Allogeneic Skin Grafting with Immunomodulatory Approaches.

Due to groundbreaking and pioneering developments in the last century, significant improvements in the care of burn patients have been achieved. In addition to the still valid therapeutic standard of autologous split-thickness skin grafting, various commercially available skin substitutes are currently available. Significant progress in the field of tissue engineering has led to the development of promising therapeutic approaches. However, scientific advances in the field of allografting and transplant immunology are of great importance. The achievement of various milestones over the past decades has provided thought-provoking impulses in the field of skin allotransplantation. Thus, biologically viable skin allotransplantation is still not a part of the clinical routine. The purpose of this article is to review the achievements in burn surgery with regards to skin allotransplantation in recent years.