Cent Body Surface Area Burns Research Articles

A 3 year prospective audit of burns patients treated at the Western Regional Hospital of Nepal

Burns in Nepal cause an estimated 1700 deaths per year and much suffering. We carried out a prospective 3 year audit of 237 burns patients admitted. to the Western Regional Hospital in Pokhara. The aims were to assess the profile of burns injuries and what could be achieved in local conditions to guide colleagues in developing countries with limited medical facilities. The majority of burns occurred at home and were largely preventable. 61 per cent of patients were children under 15 years of age. There were more female patients and females had more severe burns. No patients with greater than 40 per cent body surface area burns of any age group survived. Public education on burns prevention is needed but poverty, ignorance and a fatalistic attitude are difficult underlying causes to change.

Early, fatal disseminated intravascular coagulation in a patient with 60 per cent burns

A 23-year-old, previously fit and healthy young man was admitted to the West Midlands Regional Burns Unit at the Birmingham Accident Hospital, with 60 per cent body surface area burns and smoke inhalation. On arrival, he was briskly tachycardiac, hypotensive and disorientated. He was admitted to the intensive care unit, intubated and started on intermittent positive pressure ventilation. Despite prompt commencement of resuscitation and the infusion of enormous volumes of colloids, the patient remained oliguric. He soon developed severe haemorrhage from his gastrointestinal, urinary and respiratory tracts. He required several units of blood, but was persistently hypotensive. His condition deteriorated rapidly despite intensive supportive measures. He developed metabolic acidosis, refractory hypotension and died anuric, 20 h later. The post-mortem examination showed the presence of disseminated intravascular coagulation and adult respiratory distress syndrome.

Successful management of a patient with 95 per cent body surface area burns

This report describes the medical treatment of a patient with 95 per cent total body surface area burns, with over 50 per cent full thickness skin loss who survived.

Osteomyelitis of the spine in a burn patient due to Candida albicans

A 38-year-old white-skinned male was burned in an ultralight plane crash and sustained a 59 per cent body surface area burn, mostly full thickness skin loss. A fracture of the first lumbar vertebra was noted at admission which was treated without surgery. Candida septicaemia was diagnosed and treated during the acute phase of injury. Extensive grafting was required. Following discharge, the patient began experiencing low-grade back pain which was aggravated on postburn day 277 by a fall down a flight of stairs. Spinal radiographs obtained following this fall revealed osteomyelitis at the level of the eighth and ninth vertebrae with an intervertebral abscess. Following evacuation of the disc space during surgery, the organism was identified as Candida albicans. Treatment with amphotericin B and later fluconazole was initiated. Recovery was uneventful. The infection, probably of a haematogenous origin, is the first such case reported in the literature to our knowledge.

Silver sulphadiazine-induced haemolytic anaemia in a glucose-6-phosphate dehydrogenase-deficient burn patient

A 20-year-old soldier sustained 35 per cent body surface area burns by open flames. He was treated with topical application of 1 per cent silver sulphadiazine (SSD) twice daily. Four days postburn he developed acute haemolytic anaemia. Withdrawal of SSD was followed by complete recovery. A glucose-6-phosphate dehydrogenase (G6PD) deficiency was proven by pathological Motulski tests. Although the hazards of SSD are well indicated by the manufacturers, there appear to be no written reports of haemolysis induced by this drug in G6PD-deficient patients.

Successful treatment of a 95 per cent body surface area burn

Survival after sustaining a 95 per cent body surface area burn is uncommon. We report the successful treatment of a 21-year-old patient who sustained such an extensive burn injury. This report stresses the importance of early aggressive excision of the burn eschar and early coverage with allografts (hormografts) and later coverage with autogenous keratinocytes.

Long-term experience with 1 per cent topical silver sulphadiazine cream in the management of burn wounds

Three hundred and forty-two patients with 10–50 per cent body surface area burns were studied prospectively over the 5-year period from 1982 to 1986 for the effectiveness of topical 1 per cent silver sulphadiazine. Various parameters were studied including: (i) healing time of deep partial skin thickness burns, (ii) eschar separation time, (iii) conversion rate of deep dermal burns to full skin thickness burns, (iv) burn wound surface bacterial flora and their changing pattern over the years, (v) incidence of invasive sepsis and (vi) overall mortality. There was a remarkable decrease in the time taken for the healing of deep dermal burns, and the conversion rate of deep dermal burns to full skin thickness was significantly reduced. Eschar separation was delayed considerably. There was a total change in the predominent surface micro-organisms from Staph. aureus, which was predominant in 1982, to pseudomonas species and klebsiella in 1986. Moreover, there was the emergence of a new variety of micro-organism within the last 2 years. The incidence of invasive infection and overall mortality was significantly reduced.

Mortality from burns in Kuwait

There were 96 deaths among 1433 burns patients admitted to the Plastic Surgery and Burns Unit at Ibn Sina Hospital and Plastic Surgery Unit at Mubarak AI-Kabeer Hospital from January 1982 to December 1987. This represents an overall mortality of 6.7 per cent 74 per cent of the patients who died had sustained more than 50 per cent body surface area (BSA) burns. A large number of deaths occurred in two age groups, 0–5 years (21 deaths) and 21–30 years (24 deaths). The male to female ratio of burn-induced deaths was 1.18: 1. Flame burns due to domestic accidents were the aetiological factors in the majority of patients; 84 (87.5 per cent) of those who died sustained flame burns, although flame burns were only responsible for 46.6 per cent of all burns cases admitted. The mean survival period was 16.8 days postburn, the longest period being 79 days for a patient with 60 per cent BSA burns. Forty-seven patients (49.9 per cent) died of septicaemia which, with its related complications, remains the most important cause of death in our burns patients.

Survival of an infant with massive thermal injury: A case report

Survival of infants with greater than 80 per cent body surface area burns has not been well documented. Survival of a 4-month-old infant with 80 per cent full skin thickness flame injury is reported. Data from the National Burn Information Exchange showed that there were 2266 infants under 8 months of age treated for burns in reporting hospitals. Only four children of the 2266 were treated for full skin thickness thermal injury covering more than 80 per cent TBSA and none survived except for the child reported here. It was felt that early aggressive excision of the burn eschar was an important factor leading to the survival of this infant. Complex rehabilitation issues related to developmental issues as well as physical and psychosocial needs were identified and addressed throughout her time in hospital by a multidisciplinary team to ensure the best possible quality of life.

Faecal fistula as the result of thermal injury to the abdominal wall

A 23-year-old male with an 87 per cent body surface area burn from a motor vehicle accident developed a left lower quadrant abdominal wall faecal fistula. This fistula presumably resulted from thermal injury to the level of the peritoneum. This case report describes the course and management of this unusual occurrence.

Acute renal failure in a burn patient: the advantages of continuous peritoneal dialysis

An 8-year-old girl sustained 65–70 per cent body surface area burns when her clothes caught fire. Two weeks later, she developed acute renal failure (ARF) and needed dialysis therapy. The extensive, infected burn area prevented the establishment of a safe vascular access for haemodialysis. Continuous peritoneal dialysis proved to be a valid alternative form of treatment and even had advantages over haemodialysis. Large amounts of fluids, calories and electrolytes could be administered via the peritoneal route. This facilitated the treatment of the catabolic state of the uraemic burn patient and served to correct the electrolyte losses via the skin. Peritoneal dialysis is a valuable adjunct to the treatment of acute renal failure in burn patients who need renal replacement therapy.

The role of surgery in chromic acid burns: Our experience with two patients

Two patients with chromic acid burns are described, one having a 10 per cent body surface area (BSA) burn, the other a 70 per cent BSA burn. Hexavalent chromium, being more mobile physiologically, is more toxic than trivalent chromium. Both, however, are readily absorbed through burned skin, and cause renal failure. For this reason, emergency excision of burned areas has been advocated as first line treatment. However, this is not always feasible as, for instance, when the size of the burn is large, and is of uncertain value when patients are referred late.

Effects of early hypnosis on the cardiovascular and renal physiology of burn patients

Sixteen patients with body surface area (BSA) burns of 4 per cent to 83 per cent, with whom single hypnotherapeutic interventions were attempted 5·3±3·4 h post burn, were compared to 16 matched controls. Ten physiological parameters related to fluid volume and haemodynamics were recorded on the first two post burn days. The only significant difference discovered was elevated urine output 0–48 h post burn in successfully hypnotized patients ( P=0·01). This difference was inversely related ( r=−0·94, P=0·009) to burn size from a 10 per cent BSA burn (3·9 litres/48 h) to a 35 per cent BSA burn (1·6 litres/48 h). A statistically suggestive ( P=0·13) increase in urine output occurred in patients in whom hypnotic trance induction was unsuccessfully attempted. Patients with BSA burn sizes ≥ 50 per cent, who presented with significant physiological stress and hypovolemia, were found not to be susceptible to hypnotic trance induction, and derived no physiological benefit. Attempted hypnotherapeutic intervention per se, with its psychotherapeutic component, may act only to reduce affective or psychological stress and anxiety. This psychological stress reduction apparently facilitates the loss of retained fluid in patients with small burns by a mechanism which is overwhelmed by the physiological stress of a major burn injury.

Pulmonary candidiasis complicating a severe burn treated with miconazole

A 3 3 4 -year-old boy received a 50 per cent body surface area burn in a house fire. On the eighteenth day post burn he was moribund and a diagnosis of pulmonary candidiasis was made following tracheal cultures and X-ray changes after a period of progressive deterioration during which he had received multiple antibiotics and assisted ventilation. Treatment of this pulmonary candidiasis was with intravenous miconazole. The child's clinical condition rapidly improved over the following 24–48 hours and the X-ray changes resolved. He was subsequently discharged fully healed.

An unusual case of low α1 antichymotrypsin in a burned patient

Measurement of the level of serum α 1 antitrypsin ( α 1AT) and α 1 antichymotrypsin ( α 1ACT) in a 31-year-old male with a 35 per cent body surface area burn showed the patient to have low levels of α 1ACT on admission to the Wessex Regional Burns Centre. The rise in the level of this protein was depressed by comparison with other patients sustaining comparable injuries and the level of the protein returned to about 50 per cent of the normal value. The α 1AT level was also depressed and it is possible that this patient has a genetic deficiency of both α 1AT and α 1ACT.

Myocardial function following thermal injury.

Several investigators have suggested that a defect in myocardial function occurs in the dog following severe thermal burn. A study was therefore undertaken in which myocardial contractility was measured before and after burn. The left ventricular function curve was used as an index of contractility. Ventricular function was measured immediately before and 30 minutes following 30 per cent body surface area burn in 25 dogs, and before and after a sham burn in 13 control dogs. It was found that the burn produced a significantly greater impairment of myocardial contractility than did the sham burn. The mechanism by which the burn produced this alteration in contractility was not apparent from the results of this study.