Extensive Burns Research Articles

Burn injury due to smoking in bed: clinical features and treatment

Intention. To compare results of treatment among patients with burn injury associated with alcohol and smoking in bed vs general burn injuries. Methodology: The main study group included 60 patients with burns > 10 % TBSA, resulting from the ignition of the bed from an unfinished cigarette. The control group consisted of case histories of 330 patients with burns of similar area not associated with smoking in bed. Statistical data processing was performed using Microsoft Office Excel 2007 and IBM SPSS 20.0 using descriptive and non-parametric statistics. Results: Multifactorial injuries due smoking in bed combine deep burns, inhalation injury and poisoning with combustion products (so-called sofa injury) and are much more common in men (p = 0.002). Alcohol intoxication significantly increases the risk of such injuries (p = 0.001). “Sofa injuries” need longer (p = 0.001) and more expensive (p = 0.05) treatment than other burn categories. Early excision is preferable with one-stage skin graft. If the radical excision fails, then a vacuum dressing should be considered for temporary wound closure. Mortality in this group reaches 53 % and significantly exceeds that from any other type of thermal injury (p = 0.002). Conclusion: The so-called “sofa injury” is most common in middle-aged patients. Associated burn disease includes extensive deep burns of the trunk and upper extremities, usually with alcohol intoxication, inhalation injury and carbon monoxide poisoning. Most victims develop burn sepsis and multiple organ failure. Stratified excision is ineffective in most these patients. When excised to the fascia level, radical necrotomy can be achieved only in 60 % of cases. Taking these features into account helps to organize treatment correctly, optimize systemic therapy and create personalized surgical tactics, which should improve the results of treatment in patients with “sofa injury”. However, further clinical trials are necessary to confirm this theory.

533 Establishment and Effects of a Method for Wound Repair in Patients with Extensive Deep Burns Using Fresh Skin Allografts and Autologous Micrograft

Abstract Introduction This study was to establish a method for wound repair in patients with extensive deep burns using fresh allogeneic scalp combined with autologous micrograft. Methods Two patients with burn injuries involving 90% (3rd degree, 70%) and 97% (3rd degree, 85%) total body surface area (TBSA) respectively were treated with fresh scalp allografts donated by 32 males aged (31.5 ± 8.2) years or autologous micrografting. The bilateral limbs with third-degree burns were selected as treatment and control groups. Wounds in the treatment group were treated with fresh allogeneic scalp and autologous micrograft, while wound in the control group received MEEK grafting. Preoperatively, the surgical area on the extremities was calculated to estimate the necessary amount of allogeneic scalp and MEEK grafts. Fresh scalps (0.30 - 0.35 mm) were harvested from each donor to prepare a larger piece of skin allograft. Autologous micrografts were transported onto the epidermis of the skin allograft. The treatment and control group received grafting according to our protocol. The donors received follow-up visits after 3 months to see if there is alopecia and scar hypertrophy. The wound coverage rate was observed in both treatment and control groups on postoperative weeks 2, 3, 4 and 5. Results The donor sites in all allogeneic skin donors healed within 10 days postoperatively. The scalp recovered well without any alopecia or scar hypertrophy during the follow-up visits. The wound coverage rate of the treatment group was approximate to or higher than that of the control group. Conclusions Considering that allogeneic skin is scarce and expensive and the patient’s relatives are willing to help save the patient’s life by donating the scalp, this method may be a feasible clinical treatment option. Applicability of Research to Practice This study is a clinical study which is highly applicable in practice.

723 Should Allograft / Homograft Still Be Used for Small and Medium Size Burns?

Abstract Introduction There is no doubt that human cadaveric allograft has been invaluable for the temporary coverage of large and extensive burns. In such cases, allograft has important systemic effects with respect to fluid and heat loss, inflammation, and metabolism. The incidence of large burns, however, has decreased over time. Small and medium-sized burns remain constant and are often treated with allograft as a means to test and/or prepare a wound bed after excision. This allows for a conservative, staged approach to burn wound closure but it remains unclear if the use of allograft in this way is advantageous. Knowing the deleterious immunomodulatory effects of allogeneic transplantation and given current applications of negative pressure wound therapy (NPWT), is allografting still a valid option for temporary coverage of small and medium-size burns. Methods A patient with a 20% TBSA full-thickness flame burn underwent tangential excision of the left thigh down to the level of the subcutaneous tissue. A 3x3 cm square of freshly thawed, commercially available, human cadaveric allograft was applied to a portion of the wound and the entire would be placed into an NPWT dressing for 3 days. The dressing was removed in the OR and photos of the underlying wound bed were obtained. Results Macroscopically, the wound bed beneath the allograft appeared markedly less vascular (figure 1-2-3-A and B) than that of the control. Additionally, the wound bed beneath the allograft appeared to have more necrotic, or unhealthy appearing, adipose tissue. The wound bed beneath the allograft appeared desiccated while the control appeared healthy and vascular. Conclusions Allograft may not prevent desiccation, may not prepare a wound bed as well as NPWT, and may not be the best option for the staged treatment of small and medium-sized burns. Controlled trials are needed, as is an open and honest discussion regarding the potentially negative implications this may have on reimbursement. Applicability of Research to Practice Challenging the status quo in the surgical management of severe deep burns and the current reconstruction methods can be useful in order to make a change and improve patient safety and outcomes.

537 Transplantation of Fresh Scalp Allograft in Repairing Extensive Deep Burn Wounds in Children

Abstract Introduction It is difficult to treat pediatric extensive burns, which contribute to high mortality rates, partly because of the lack of large allogeneic skin to close wound in China. Therefore, we innovatively used fresh scalp as thin split thickness skin allografts to cover the burn wounds of pediatric patients. Methods Fresh scalp allografts were harvested from voluntary donors who were patients’ relatives. The median total burn area in the major burns was of 40% TBSA, in depth of deep second to third degree. The fresh scalp allografts were transplanted on the wounds post tangential excision or escharectomy in the way of mere fresh scalp allografts coverage or mixed coverage with autografts and fresh scalp allografts. Results All the patients survived without serious complications during the treatment period. The median healing time was 47 days; the average healing time of the donors’ scalps was (7.6±1.08) days with no scar formation, alopecia areata or folliculitis post operation. Conclusions The use of fresh scalp allografts in the treatment of pediatric major burns is an effective and feasible method in protecting wounds and promoting wound healing as well as in reducing scar formation in the donor sites of burned children. The high ratio of fresh scalp areas to pediatric burn wound areas ensures high efficiency of wound coverage; and healthy relative skin donors have more initiatives and favorable healing results. Applicability of Research to Practice This is a clinical research which is highly applicable in practice.

853 Microblading in Patients with Facial Burn Injuries

Abstract Introduction The experience of a burn injury is devastating. Physical and emotional recovery can be lengthy and often difficult. Many patients tire of constant surgical interventions required to achieve optimal functional and cosmetic outcomes. Identifying non-invasive interventions for patients with extensive facial burns that positively affect quality of life is appealing. Microblading, semi-permanent eyebrow tattooing, is one such option. Little research exists on the durability and longevity of microblading in burns, or its impact on body-image and self-esteem. The purpose of this case review is to identify possible benefits microblading may have physically and psychologically. Methods Case report looking at the impact of microblading on a young adult female over 18 years, who sustained a facial burn injury at age one year. Following consultation with her plastic surgeon, she was referred to a licensed body art facility to assess the viability of microblading over scar tissue. First treatment occurred at the facility in March of 2019 with a second session in May, as is standard practice. Patient photos obtained before and after procedures assessed longevity of microblading over scar tissue. Self-reported patient outcomes obtained following the procedure addressed the impact on perceived self-esteem and body-image. Results Photos were taken pre-treatment, directly post-treatment, 2 months, and 6 months post-treatment. Comparisons of photos immediately post treatment to those 6 months out showed appearance of tattooing remains the same. Eyebrows did not fade with time and continue to hold the same color and shape. Assessment of psychological impact was conducted through patient interview and self-report. Patient reported satisfaction with the procedure and cosmetic appearance following initial treatment. Over time, patient noted feeling more positive about body image and improvement in self-esteem. Conclusions Eyebrows are a critically important part of facial expression, which can be lost following a devastating facial burn. Initial data demonstrate the effectiveness of tattooing in recreating the appearance and function of eyebrows over scar tissue. Over time, the eyebrows maintained color without fading and shape did not change, demonstrating durability and longevity in this patient population. Early reports of improved self-image also remained unchanged over time. Microblading presents a possible low risk, inexpensive, effective alternative to expensive or potentially ineffective cosmetic surgery. This case establishes a need for further research on efficacy of microblading over scar tissue, with the hope of incorporating it into burn reconstruction as an alternative therapy and advocate for insurance coverage for qualifying patients. Applicability of Research to Practice Research supports microblading as a potential non-invasive, inexpensive treatment modality for loss of eyebrows.

96 Treatment of Donor Sites in Large TBSA Burn Injuries with an Autologous Skin Cell Suspension Supports Early Reharvesting

Abstract Introduction Treatment of large TBSA burn injuries is often limited by donor site availability and requires reharvesting to obtain definitive closure. Patients with severe injuries may have delayed closure compared to uncompromised patients that typically have their donor sites healed in 7–14 days. Autologous skin cell suspension (ASCS) can be prepared to treat burn wounds at the point-of-care. The safety and effectiveness have not yet been established for use in the treatment of donor sites. This study presents the use of ASCS for the treatment of donor sites in patients with life-threatening burn injuries that were enrolled in a prospective uncontrolled observational study (IDE 15945—NCT02992249). Methods ASCS was applied to the donor site after harvesting of STSGs. Clinical outcomes out to one year were evaluated including percentage of re-epithelialization, long-term cosmetic outcomes, and adverse events. Results Ninety-six subjects from 22 burn centers had their donor sites treated with ASCS as part of their treatment regimen. The average subject age was 30.1 and the average TBSA injury was 53.7 ±17.3%. The mean Baux score was 89.2 with 36% of subjects having a score greater than 100. Collectively, 528 donor sites were individually treated. In this compromised patient population 37.5% were ≥95% re-epithelialized by week 1 (n=435), and by week 2, 82.7% of the donor sites were ≥95% re-epithelialized (n=434), regardless of how many times they were harvested. Approximately 19% of the donor sites treated with ACSC were reharvested multiple times following initial healing (15% two times, 2.3% three times, and 7 donor sites were harvested 4 times) and retreated. Of donor sites harvested more than once, 39.3% (n=84), 81% (n=79), and 85.7% (n=77) of sites were ≥ 95% re-epithelialized by week 1, 2 and 4, respectively. One-year data was available for 427 donor sites and the majority had matched or mildly mismatched color, pigment, and texture. Adverse events included one site with a hematoma, one patient with donor sites that had fragile skin loss secondary to traumatic friction, one patient with active bleeding, two patients with anemia secondary to donor site bleeding, one patient with delayed closure due to mild infection of staph species. All AEs were unlikely or unrelated to the device. Conclusions ASCS has been successfully used to achieve closure of donor site wounds without significant safety risk in patients with extensive burn injuries. Applicability of Research to Practice Application of ASCS for donor site healing may be particularly relevant for patients with large burn injuries requiring subsequent reharvesting to achieve definitive closure.

Clinical Applications of Allograft Skin in Burn Care.

Allograft skin has been widely used for wound management in burn centers. Functional as biologic dressing, it can not only provide ideal temporary wound coverage in extensive burns when autograft is not immediately available but also prepare the wound bed for definitive autografting. In this article, the up-to-date clinical application of allograft in burn care was reviewed, including coverage of extensive burn wounds, combined use with meshed autograft, template for delayed application of cultured epidermal autografts, and the use of human acellular dermal matrix. Although it has potential disadvantages of rejection and disease transmission, allograft skin remains a workhorse in treatment of severe burn wounds.

Reconstruction of burn contractures of the anterior neck with pre-expanded free anterolateral thigh flaps

Burn contractures of the anterior neck result in severe functional and aesthetic deformities. The release of wide contractures leads to defects that cannot be closed with local flaps. In these cases, tissue expansion of local tissues may be a solution. However, when local tissues are also burned or inadequate, microsurgical free tissue transfer may be necessary. In order to increase the surface are of the transferred flap, pre-expansion of the donor site can be combined with the procedure. Five patients with burn contractures of the anterior neck were treated using pre-expanded free anterolateral thigh (ALT) perforator flaps. The anterolateral thigh was dissected on top of the fascia lata in an avascular plane. The borders of the dissection were kept 2 cm lateral to the pre-identified perforators. A 1000cc rectangular tissue expander was placed. The time of expansion ranged from 4–11 months with a final over expanded volume of 1200cc. The defect sizes ranged from 10 × 21 cm to 20 × 27 cm. There were either one or two perforators included in the flaps. All flaps survived completely with good functional and aesthetic outcomes. Donor areas were closed primarily in one patient and with various amounts of skin grafts in five patients. Overall, pre-expansion decreased the amount of total skin grafted area in the donor site. Pre-expanded ALT perforator flap can be a good option in extensive burns with wide contractures where the regional donor areas are also affected. This technique has several advantages: 1) large flaps can be safely harvested, 2) the expanded skin thins out making it more aesthetically appropriate to resurface superficial defects, 3) expansion period of the thigh is well tolerated by the patients, 4) two teams can work simultaneously, decreasing the operating time, 5) the donor area can be closed either primarily or with minimal skin graft application, and 6) there is no functional loss in the donor area and the donor scar stays under the clothes.

Incidence and Prognostic Value of Acute Coagulopathy After Extensive Severe Burns.

Acute burn-induced coagulopathy (ABIC) occurs after severe burns. However, the incidence, prognostic value, and clinical significance of ABIC after an extensive severe burn remain inconclusive due to wide variances in burn severity and coagulation profile evaluation timings in previous studies. This retrospective study explored the incidence and clinical and prognostic significance of early phase ABIC in 129 adult patients with extensive burns (>50% total body surface area [TBSA]) admitted to the burn centers of two hospitals within 10 hours postburn injury during 2009-2017. Demographics (age and sex) and clinical data (burn severity, vital signs, prehospital fluid replacement volume, hemodynamic parameters, coagulation profile, blood gas, and blood biochemical indicators) were collected upon admission. The incidence of ABIC in patients with severe burns and its relationship with their survival and clinical significance were analyzed. The average postburn interval was 5.7 ± 2.7 hours, and the incidence of ABIC was 31% (40/129). A logistic regression analysis identified ABIC as an independent predictor of 4-week severe mortality due to severe burn. The incidence of ABIC was significantly associated with the total burn area, lactic acid levels upon admission, and postburn admission interval, but not with the prehospital fluid replacement volume. In conclusion, approximately 30% of patients with severe burns developed ABIC within 10 hours postburn, and this condition strongly predicts 4-week mortality. Although burn severity and tissue ischemia/hypoxia are main risk factors for ABIC, the pathogenesis is not fully understood and should be explored in future studies.

Inhibition of Lipolysis With Acipimox Attenuates Postburn White Adipose Tissue Browning and Hepatic Fat Infiltration.

Extensive burn injuries promote an increase in the lipolysis of white adipose tissue (WAT), a complication that enhances postburn hypermetabolism contributing to hyperlipidemia and hepatic steatosis. The systemic increase of free fatty acids (FFAs) due to burn-induced lipolysis and subsequent organ fatty infiltration may culminate in multiple organ dysfunction and, ultimately, death. Thus, reducing WAT lipolysis to diminish the mobilization of FFAs may render an effective means to improve outcomes postburn. Here, we investigated the metabolic effects of Acipimox, a clinically approved drug that suppresses lipolysis via inhibition of hormone-sensitive lipase (HSL). Using a murine model of thermal injury, we show that specific inhibition of HSL with Acipimox effectively suppresses burn-induced lipolysis in the inguinal WAT leading to lower levels of circulating FFAs at 7 days postburn (P < 0.05). The FFA substrate shortage indirectly repressed the thermogenic activation of adipose tissue after injury, reflected by the decrease in protein expression of key browning markers, UCP-1 (P < 0.001) and PGC-1α (P < 0.01). Importantly, reduction of FFA mobilization by Acipimox significantly decreased liver weight and intracellular fat accumulation (P < 0.05), suggesting that it may also improve organ function postburn. Our data validate the pharmacological inhibition of lipolysis as a potentially powerful therapeutic strategy to counteract the detrimental metabolic effects induced by burn.

EVALUATION OF PATIENTS WITH PATHOLOGY AT RISK FOR FOREARM AND HAND AMPUTATION

Forearm and hand pathologies, such as trauma, infections, tumors or extensive burns, represent a genuine challenge for the orthopedic surgeon, considering the fact that they have a major impact on the patient quality of life. Amputations at this level, though rare, are often a lifesaving procedure, which helps minimize the severe complications that may occur. We present a retrospective study made on a number of 3203 patients which were admitted to an Orthopedic clinic, from 2012 to 2014. We analyzed which is the most frequent cause for upper limb procedures, the distribution in both genders, the average hospitalization period of time and we determined which is the higher occurrence between lower and upper limb pathologies, aiming to determine the prevalence of forearm and hand amputations in the studied group.

Development of in situ gels of nano calcium oxide for healing of burns

Abstract Background Wound closure is the prime objective in the treatment of deep and extensive burns, where the dermis layer is partially or completely destroyed and the inherent capability of spontaneous re-epithelialization is greatly reduced or absent leading to high mortality rate. Scar formation as a result of burn wounds results in aesthetic and functional impairment, causing emotional distress in patients. Induced regeneration of skin could be a solution to improve the quality of life of burned patients. Materials and methods Nano calcium oxide (NCO) was prepared by thermal decomposition method. In situ gels (ISG) were formulated using micronized xanthan gum and NCO in different concentrations by geometric mixing. The formulations were evaluated for their particle size, surface morphology, elemental composition, clarity, pH, gelling and in vivo burn wound healing properties. Results The average particle size and polydispersity index of NCO was found to be 345.3 nm and 0.23 respectively. Three formulations were prepared, each containing varied concentrations of NCO (12.5, 25 and 50 ppm). The SEM analysis of the formulation exhibited particle sizes ranging from 1 nm to 468 nm and EDX characterization showed intense peaks of calcium and oxygen. The percentage of wound size reduction was significantly increased in wounds treated with prepared in situ gels in contrast to commercial product (calcium alginate dressing) and control (untreated) group. With an increase in concentration of NCO, the rate of healing also increased. In situ gels containing 50 ppm of NCO exhibited a better rate of wound healing in comparison to other formulations, within a period of 15 days. Histopathological analysis indicated that in situ gels had better wound healing properties. Conclusion In situ gels of NCO were developed as a formulation for effective treatment of burns and to aid in skin regeneration.

Burn management during the COVID-19 pandemic: recommendations and considerations.

ABSTRACTCoronavirus disease-2019 (COVID-19) is a respiratory disease, caused by a novel coronavirus (SARS-COV-2). This disease has been raising international public health concerns since its recent outbreak in December 2019. As the virus is easily transmitted by respiratory droplets, all hospital departments needed to change their practices in an attempt to control the spread of this virus. Burn units and clinics are particularly affected by this pandemic because of the larger risk of contamination for both patients and caregivers. Furthermore, cross-clinical aspects especially pain management and complications such as coagulopathy might be caused by both extensive burns and COVID-19 infections, which makes the management of these patients particularly challenging. That’s why we covered both main aspects in this review. In addition, we present briefly a synthesis of guidelines from several entities to help manage the health crisis and provide optimal care for all burn patients during this pandemic.

Major COVID-19-positive burns treated successfully

Extensive burns are severe form of trauma causing a great threat to life. Approximately 300,000 deaths is attributed to burns annually, majority (>95%) of which occur in developing countries. Survival rate of patients decreases as the rate of burn increases. Coronavirus disease (COVID-19) pandemic has affected all the communities worldwide. It has strong infectivity and high transmission rate. When treating corona-virus-infected burns patients, prevention of cross infection to health workers becomes of utmost importance. Here, authors present a case of extensive burns along with COVID-19 infection, the precautions taken to prevent infection among health workers and protocols followed for management. The patient was treated over a span of 75 days where the patient was cured of COVID-19 in 21 days and underwent two surgeries with homograft and autograft application. Multidisciplinary approach with strict protocols of safety and vigilant monitoring is key to successful management.

Progenitor Biological Bandages: An Authentic Swiss Tool for Safe Therapeutic Management of Burns, Ulcers, and Donor Site Grafts.

Clinical experience gathered over two decades around therapeutic use of primary human dermal progenitor fibroblasts in burn patient populations has been at the forefront of regenerative medicine in Switzerland. Relative technical simplicity, ease of extensive serial multitiered banking, and high stability are major advantages of such cell types, assorted to ease of safety and traceability demonstration. Stringent optimization of cell source selection and standardization of biobanking protocols enables the safe and efficient harnessing of the considerable allogenic therapeutic potential yielded by primary progenitor cells. Swiss legal and regulatory requirements have led to the procurement of fetal tissues within a devised Fetal Progenitor Cell Transplantation Program in the Lausanne University Hospital. Proprietary nonenzymatic isolation of primary musculoskeletal cell types and subsequent establishment of progeny tiered cell banks under cGMP standards have enabled safe and effective management of acute and chronic cutaneous affections in various patient populations. Direct off-the-freezer seeding of viable dermal progenitor fibroblasts on a CE marked equine collagen scaffold is the current standard for delivery of the therapeutic biological materials to patients suffering from extensive and deep burns. Diversification in the clinical indications and delivery methods for these progenitor cells has produced excellent results for treatment of persistent ulcers, autograft donor site wounds, or chronic cutaneous affections such as eczema. Herein we describe the standard operating procedures for preparation and therapeutic deployment of the progenitor biological bandages within our translational musculoskeletal regenerative medicine program, as they are routinely used as adjuvants in our Burn Center to treat critically ailing patients.

Burns in the Emergency Department: A One-Year Single Center Analysis on 355 Cases

Background: Burns are common reasons for emergency department presentations. While extensive or special burns require treatment in a specialized center, the majority are amenable to ambulatory treatment or hospitalization in a surgical ward. Romania has a national data collecting mechanism regarding all hospitalized patients, but there are no available statistics concerning non-hospitalized burn cases. This study aims to explore the amplitude of burn trauma by analyzing data from an Emergency Department at a major Romanian regional trauma center. Methods: This is a retrospective single-center 1-year study of all burn-related emergency department presentations at the trauma referral center for Romania's North-East region, in 2015. Included in the study were all cases of burns, indiscriminate of their etiology. Results: A total of 355 burn cases were analyzed. The average monthly number of cases was 29.58, with a maximum of 54 and a minimum of 18. There were 206 males and 149 females and 57.7% urban residents. Only 134 cases have been hospitalized during this period. Conclusions: Almost two-thirds of cases have not been hospitalized, thus missing from national statistics. Precise epidemiological data is paramount for a successful national burn management strategy. Creation of a national burn registry is suggested.

Regeneration of Functional, Full-Thickness Skin With Minimal Donor Site Contribution Using Autologous Homologous Skin Construct

Autologous skin grafts (autografts) remain the gold standard in the treatment of skin loss. For extensive wounds or burns, however, identifying adequate donor sites can be the limiting factor. Additionally, donor sites are associated with pain, risk of infection, and poor cosmetic outcomes. Many skin substitutes have been engineered as alternatives to traditional autografts. These substitutes, however, all leave something to be desired either functionally or cosmetically. This report describes the use of a new technology, autologous homologous skin constructs, to regenerate full-thickness skin grafts that maintain functional polarity, allowing important components of skin such as glands and hair follicles to regenerate. These grafts only require small samples of full-thickness skin from the patient, decreasing issues of donor site availability.

Use of epidermal cell suspension in burns wound management: A pilot study

Introduction: It is a standard practice to cover the burn wounds with skin grafts at the earliest. Deficiency of donor skin seriously limits timely cover of extensive burns. Studies have shown that these autologous cells enhance the wound-healing process by reducing the time needed for the host cells to invade the wound tissue and by early synthesis of new skin this technique of enzymatically digesting small skin grafts, centrifuging the suspended cells and spraying the epidermal cells over burn raw areas may allow early healing. Aims and Objective: The aim of this study is to assess feasibility and role of epidermal cell suspension as wound cover in burns. Materials and Methods: This study was conducted at the burn center of a tertiary Hospital in India over a period of 1 year. Patients with postburn raw areas were included. Similar size two sites were identified in the patients. On one site cell suspension was applied, while other areas were managed with conventional dressings. Small piece of split-skin graft (SSG) was used to make cell suspension. Under anesthesia, required size of SSG was harvested from healthy donor site. Trypsinization of graft was done; epidermis was separated from the dermis. The epidermis was cut into tiny pieces, and patient's serum was added and centrifuged. Epidermal cell suspension was made, and viability of cells is confirmed using an inverted microscope. Meanwhile, the wound is thoroughly cleaned by soda bicarbonate solution. The freshly prepared keratinocytes suspension was applied on day 1, 3, and 5. Similar standard dressing protocol was followed on the control side. Wound assessment was done based on the percentage of reepithelization on the 7th and 14th day. Results: Twenty-eight patients (18 males and 10 females with a mean age of 34 years) were included the study. Cell suspension was sprayed on 4735 cm2 area. Wound size reduced to 2247 cm2 and 923 cm2 on the 10th and 14th day, respectively. While, at control site wound reduced to 3882 cm2 and 2134 cm2 on the 7th and 14th day, respectively. The difference in cell suspension and control treated area was found to be significant. Conclusion: Keratinocytes cell suspension is feasible in burns and improves the healing of wounds. However, larger studies are required to standardize and validate its use in major burns.

Split-thickness scalp and allogenic acellular dermal matrix in repairing deep wounds of hands in patients with extremely extensive burns

Objective: To explore the clinical effects of split-thickness scalp and allogenic acellular dermal matrix (ADM) in repairing deep wounds of hands in patients with extremely extensive burns. Methods: Six patients with extremely extensive burns complicated by deep burn in hands were admitted to our department from December 2014 to December 2017, including 4 males and 2 females, aged 21 to 58 years. Their total burn areas were from 85% to 95% total body surface area (TBSA), and the sum of deep-partial thickness and full-thickness wounds was larger than 50% TBSA. Under general anesthesia, deep wounds of 10 dorsal hands were repaired by combined transplantation of split-thickness scalp and allogenic ADM in 4 to 6 weeks after injury. The skin grafting range was beyond the metacarpophalangeal joint, including partial dorsal digital deep wounds. Survival of skin grafts on dorsal hands, follow-up of hand shape and functional recovery were observed and recorded. Results: Six patients were successfully treated. There was no infection on the dorsal deep wounds of 10 hands after surgery, and the grafts survived well. During follow-up of 1 to 2 years after operation, there were no recurrent tension blisters or dorsal extension deformity of the metacarpophalangeal joints in 10 hands, the shape and function of hands recovered well, and hand Carroll scores were from 90 to 99 points, with functional levels of Ⅴ and Ⅵ. Conclusions: The combined transplantation of split-thickness scalp and allogenic ADM is a good method for repairing deep hand wounds in patients with extremely extensive burns, which can alleviate the cicatrix hyperplasia and contracture of healed hand wounds, and improve the shape and function of hands.

Epidemiology of electrical burns: a 10-year retrospective analysis of 376 cases at a burn centre in South China.

ObjectiveTo investigate the epidemiological profile and associated outcomes of electrical injuries at a major burn centre in southern China.MethodsThis retrospective study enrolled consecutive electrical burn patients admitted to the burn centre of the First Affiliated Hospital of Guangxi Medical University between 2008 and 2017. Demographic and clinical data and outcomes were recorded. Mann–Whitney U tests/Pearson’s chi-squared tests were used to examine the differences between low-voltage and high-voltage injuries.ResultsThere were 217 high-voltage injuries and 159 low-voltage injuries. High-voltage burns were frequently observed between March and August, and low-voltage burns peaked between June and September. Burn patients were mainly men. Most burns occurred in participants aged 21 to 50 years and in industrial workers and electricians at work or householders at home. Only one person with high-voltage burns died (a mortality rate of 0.46%). Amputation rates were 37.33% for high-voltage burns and 22.01% for low-voltage burns. High-voltage injuries were associated with more extensive burns, longer hospital stays, and more complications and amputations.ConclusionsMore attention should be paid to prevention of electrical burns in male adults. Particular focus is needed on industrial workers, incidents in the spring and summer, and high-voltage injuries.