Extensive Burns Research Articles

Reconstruction of Giant Defects Due to Electrical and Radiation Burns in the Lower Leg with Free Anterolateral Thigh Flaps

The purpose of this study was to introduce reconstruction of giant soft tissue defects of the lower leg caused by high-voltage electrical burns and radiation burns using the free anterolateral thigh (ALT) flap. From March 2017 to January 2018, 6 patients who sustained high-voltage electrical burns and 2 patients who sustained ulcerated radiation burns were reconstructed using the free ALT flap. The mean size of the defects was 19cm×32cm (range, 18cm×22cm to 30cm×36cm). The mean size of the flaps was 22cm×34cm (range, 20cm×24cm to 32cm×38cm). All flaps survived completely. The mean preoperative Functional Analysis Technique Evaluation score was 62 (range, 43 to 74). The mean follow-up period was 16 months (range, 12 to 18 months). At the final follow-up, the mean postoperative score was 90 (range, 86 to 94). The mean improvement was 33% (range, 17% to 54%) with 4 excellent and 4 good results. For extensive, high-voltage electrical, and radiation burns encompassing the lower leg, early treating the giant soft tissue defects with a free ALT flap produces good functional outcomes without significant complications.

A Case of Extensive Burn Complicated by a Necrotizing Soft Tissue Infection Caused by Aeromonas hydrophila

A Case of Extensive Burn Complicated by a Necrotizing Soft Tissue Infection Caused by<i> Aeromonas hydrophila</i>

Prayer burns

Introduction: In Indian culture, it is considered auspicious to conduct prayers before beginning one's day or even before starting to celebrate any of the festivals. The variations in conducting the prayers are numerous, but one thing which is constant is fire, which in the form of diya or candle or incense stick is always present. This many a times becomes the source of clothes catching fire leading to burns. The flame burns can cause serious complications depending on the age and the percentage of the body involved. Herein, we are presenting an article regarding the same. Methods: All burns which occurred while praying from September 2019 to September 2021 were included in the case series. Results: In our study, the patients above 60 all had comorbid conditions, and 5 out of 8 (five out of eight) patients expired that is 62.5% of the study group. These patients had the accident at home while praying where the flame from diya which is lit on the temple floor near the idol of god caught fire to the clothes. Indian females prefer to wear clothes with flairs such as chaniya choli, long Indian skirt, or saree which increases the chances of contact with diyas or source of flame leading to accidental burns. Considering that 5 (five) patients were more than 50 years of age, they survived for mean days of 16.2 days and then expired, the three younger patients recovered with an average stay of 47.3 days. Even with extensive burns due to younger age the patients recovered and did require skin grafting in the course of their treatment. Discussion: Diminished alertness of the senses, impaired mentation, slower reaction time, reduced mobility, and decreased ability of elderly people to identify the severity or risk of a situation as well as their capacity to escape from harm, puts them at higher risk of sustaining burn injury. These circumstances will also lead to larger increased total body surface area (TBSA) and deeper burns; moreover, there is an increased risk for the development of inhalation injury. These factors are closely related to a higher mortality rate. Conclusion: Age plays an important role in treatment response in a major trauma like burns. Increased age with associated co morbidities add to the severity of the burns. Younger age group however have better survival chances, though even they required prolonged hospital stay in our study considering the higher percentage of burns involved.

An ideal postgraduate student in anaesthesia.

An ideal postgraduate student in anaesthesia.

Burn reconstruction

Burn injuries are severe traumatic events with a range of local and systemic repercussions. Various complications may occur in the early and late stages of burn injuries depending on the causative agent, duration of contact, degree of burn, and extent of the harm. Long after their burn scars have healed, many patients still struggle with issues related to their burn injuries. Burn scars, hypertrophic scars, keloid, contractures, heterotopic ossifications, chronic ulcerations, and marginal ulcers are late-onset complications that hurt the quality of life and result in lost productivity. Escharotomy, fasciotomy, repeated debridement, and primary wound management can lower mortality and potential complications. Complex burns should ideally be treated in specialized burn centers supervised by plastic surgeons and a multidisciplinary team of experts who treat patients holistically. This case report presents a contracture that occurred following an extensive burn to the neck, arm, and finger joints, which was successfully treated with surgery and healed without complications.

Prognostic and Predictive Factors of Mortality in Burn Patients at dr. Cipto Mangunkusumo General Hospital, Indonesia

Introduction. Some prognostic– and predictive factors in burn have never been investigated in Indonesian specific characteristics, which is delayed treatment. A study was conducted to determine prognostic and predictive factors in this specific characteristic. Method. A retrospective cohort focused on burn mortality in extensive burns managed in CMGH from 1998–2010. Some known prognostic– and predictive factors and unknown ones were the variables of interest. Bivariate and multivariate using logistic regression analysis proceeded to find out these factors. Results. Out of all factors investigated, the variables that showed a significant correlation were: TBSA, inhalation injury, Baux score, revised Baux score, serum albumin, blood urea, serum creatinine, haemoconcentration, base excess, serum lactate, international normalized ratio, and random blood glucose. Conclusion. In the study, Baux score, revised Baux score, serum creatinine, haemoconcentration, base excess, and INR as predictive factors for mortality in the extensive burn.

Trapezius fasciocutaneous flap for burn reconstruction.

This case involves a 30-year-old female who suffered extensive facial burns as an outcome of a horrific assault. The patient subsequently underwent 2 surgeries with the ultimate goal of reducing the cosmetic, physical, and thus mental burden the assault caused. The technique of choice was the novel trapezius fasciocutaneous flap for burn reconstruction of the neck. It is discussed that while this technique is still deemed a novel procedure, its unique characteristics make it an excellent choice for cases similar to this one. While this approach has not been widely popularized in the treatment of patients with burn contracture requiring reconstruction, the donor site characteristics and ideal functionality make the trapezius fasciocutaneous flap such an excellent choice. This particular type of graft yields a hidden donor site, contains rich vascularity with physical qualities similar to those of facial skin, specifically in regard to thickness, color, and texture, and ultimately produces the most ideal cometic outcome. Further, the wide arc of rotation unique to this flap allows for better manipulation and mobility at the transplanted location. While the anatomic implications are very relevant to head and neck surgery, this method also produces exemplary cosmetic outcomes when compared to other graft procedures.

Fractional CO2 laser therapy of hypertrophic scars - evaluation of efficacy and treatment protocol optimization.

Hypertrophic scars are an unwanted and mutilating consequence of deep burns, and are further exacerbated by extensive burn injuries. Fractional CO2 laser therapy is one of the methods for complex treatment of hypertrophic scars, it has been used since 2007 [1]. Although its effectiveness has been objectively proven in clinical practice, the optimal settings parameters have not been determined. To evaluate the effect of laser therapy, previously designed evaluation tools are used, which evaluate the quality of scars well, but fail to capture specific changes for the performed laser therapy. Fractional CO2 laser therapy of hypertrophic scars is performed at the Department of Plastic and Esthetic Surgery, University Hospital Olomouc, since 2017 and the systematic study took place in 2019-2020. In common, 25 hypertrophic scars were treated in 13 patients; each scar was treated by fractional CO2 laser therapy more than once. Statistical analysis detected statistically significant improvement of the texture of the scars and the improvement of overall functional and esthetic result. We found significant reduction of the height under 2 mm (62,5% of scars) in scars with the height &gt; 2 mm before the initiation of laser therapy. Correlation analysis detected astatistically significant positive correlation between the energy of laser beam and the reduction volume of the scar protruding above the niveau of healthy surrounding tissue. Fractional CO2 laser therapy showed statistically significant efficacy in the reduction of the risks associated with full-format CO2 laser-therapy. Fractional treatment was very well tolerated by the patients. Topical 5% lidocaine gel was effective in 24 out of 25 patients. Further healing was without complications in all patients. Fractional CO2 laser therapy has achieved statistically significant improvement of the texture and reduction of hypertrophic scars and overall improvement of functional and esthetic result in our study.

Application of Multifunctional Intelligent Suspension Treatment Beds in Nursing Care of Patients with Extensive Burns.

The nursing care of patients with extensive burns by using multifunctional intelligent suspension treatment beds was studied. 40 patients, including 30 males and 10 females, with extensive burns were nursed using multifunctional intelligent suspension treatment beds. First of all, the patients were given psychological care, which was patiently explained, so that they can overcome their fears and be treated with peace of mind. Second, the room temperature and bed temperature were closely monitored. Finally, special attention was paid to the adjustment of rehydration volume, regular detection of plasma electrolytes, prevention of electrolyte disorder, and dehydration. Besides, disinfection and isolation should be performed when using. The results showed that 4 cases (20%) were positive in group A and 8 cases (40%) were positive in group B on the 10th day after injury (X2=4.005), and the incidence of wound infection in group A was significantly lower than that in group B. The use of suspension beds in patients with extensive burns makes them safe and comfortable, and the whole body wound scabs healed faster, as well as the infection was minimized. A suspended bed is especially suitable for the clinical treatment of patients with extensive burns. The advantages of suspended bed can be fully realized by summarizing clinical experience.

Analysis of Underwear Used with Protective Clothing Worn by Metallurgy Workers and Welders – Research Survey

Employees of the metallurgy industry and welders are constantly exposed to a hot factors and hot microclimate in working environment. Difficult working conditions associated with expose employees to hot factors occurring in the form of flame, contact heat, convective heat, and splashes of molten metal may consequently lead to extensive body burns and even death. Scientific publications have proven that the temperature of the working environment is an important factor affecting human safety and performance. Improved comfort and safety can be achieved by using properly selected clothing and underwear/undergarment, meeting the requirements for a specific occupational group. In order to obtain information regarding underwear/undergarments usually used under protective clothing as well as to get acquainted with expectations regarding the subject matter, questionnaire surveys were conducted among two professional groups, namely employees of the metallurgy and welders, who are constantly exposed to a hot factors and hot microclimate.

Practical Approach to the Pathologic Diagnosis of Mixed Filamentous Fungal Infections in Burn Wounds: A Case Series

Abstract Introduction/Objective Opportunistic infections by fungi are a major source of morbidity and mortality in patients suffering from extensive burn wounds. Here we review a series of cases of infections by multiple fungi in burn wounds as diagnosed by histopathology and outline the key features for the pathologist to include in the report. Methods/Case Report Biopsies from patients with more than one fungal species identified in the laboratory in a concurrent culture or by PCR were included in this study. Three cases are presented with multiple fungi identified. Each case had yeast and at least one different hyaline mold species present on pathology; two cases additionally had mucormycetes present, with angioinvasion in one case. All organisms requiried microbiologic cultures and variably required molecular testing for full identification. Results (if a Case Study enter NA) N/A Conclusion Pathologists should be aware of the possibility of infection by multiple fungal species in burn wounds. Fungal morphology in tissue sections should allow for detection and distinction of mucormyctes and other hyaline molds. Histopathologic correlation with culture and/or PCR results is essential to distinguish potential contaminants from true infection.

Resurfacing in Facial Burn Sequelae Using Parascapular Free Flap: A Long-Term Experience.

It is difficult to treat large postburn sequelae (scars and defects) over the face. Available methods include skin grafts, local flaps, tissue expansion, and free flaps. These surgical options should be chosen wisely, depending on individual patient requirements and the area involved. In patients with large postburn scars and defects in which the surrounding tissue is also involved, use of free tissue transfer is extremely useful. A retrospective analysis was done between 2011 and 2019 of 52 cases with extensive facial burn deformities in whom secondary reconstruction was done with free parascapular flap cover in our department. Outcome was assessed by a direct questionnaire. There was no complete flap loss in the series. Two cases were re-explored for venous insufficiency and suffered partial marginal necrosis. Twenty patients had to undergo further debulking procedure. Forty-seven patients were satisfied by the final outcome. Postburn facial deformities are difficult to treat; in many cases, there are no local options, and tissue from different regions is to be used for reconstruction. Free parascapular flaps can be used as an effective method in such cases with a high level of patient satisfaction.

Research advances on skin sweat gland regeneration induced by stem cells and tissue engineering

As the largest organ in mammals, skin is the first protective barrier against external stimuli. Sweat glands are one of the important cutaneous appendages and play an important role in maintaining electrolyte balance and regulating body temperature. Patients with extensive deep burns usually suffer from damage to deep dermis or the entire skin layer. The damaged sweat glands are difficult to repair and even unable to regenerate, which seriously affects patients' sweating and thermo-regulation function, reduces patients' quality of lives. How to achieve the functionalization of sweat glands has become one of the important researches in regenerative medicine of damaged skin. This review summarizes the translational and application technology of sweat gland regeneration and repair using stem cells and tissue engineering, in order to provide a theoretical basis for the research of sweat gland regeneration.

Patterns and Outcomes of High-Voltage vs Low-Voltage Pediatric Electrical Injuries: An 8-Year Retrospective Analysis of a Tertiary-Level Burn Center.

Although electrical injuries (EIs) are rare traumas in the pediatric age group, they are considered one of the most devastating injuries. We aimed to evaluate the patterns and outcomes of pediatric high-voltage injuries (HVIs) vs low-voltage injuries (LVIs), admitted to the burn center within the efforts of determining evidence-based data for contributing to burn prevention strategies. A retrospective study was conducted on children with EIs hospitalized in the Burn Center of Adana City Training and Research Hospital for 8 years (2013-2020). Data including the patients' clinical and demographic characteristics, the percentage of total body surface area with burns (%TBSA), length of hospital stay, exposure place, electrical current type, and treatment results were collected and analyzed. EIs were detected in 57 (2.5%) of 2243 acute pediatric burn injury admissions. EIs were most frequently observed in the form of HVIs, among children within the age range of 13 to 18 years, mostly in residential outdoor environments, where the high-power lines still passing close to the home roofs and balconies, resulting from contact with them. Besides, to a lesser extent in LVIs, in the home environment among children younger than 5 years, which was caused by connection with substandard electrical cords/poor-quality electrical devices and inserting an object into the electric sockets. Concerning the mean of %TBSA, HVIs suffered more extensive burns than LVIs. The most frequently affected anatomical regions among HVIs and LVIs were the upper limb, followed by the lower limb. While superficial partial- and deep partial-thickness burns were significantly more common among the LVIs, full-thickness burns were more prevalent among the HVIs. The amputation rate was 12% of which only one of them was major amputation (forearm above the elbow joint). HVIs had more elevated creatine kinase (CK) and CK-myocardial band (CK-MB) levels than LVIs but were not correlated with electrocardiography findings. Only one death (caused by HVI) was observed, with a mortality rate of 1.8%. Pediatric EIs are less common than scald or fire flame-related burns in this age group but can cause significant morbidity and even mortality, especially in severe burns. It is possible to prevent possible morbidity and mortality by strengthening compliance with safety precautions, especially with parental education and raising social awareness. In this context, taking necessary precautions for passing high-voltage power lines under the ground, the standardization of electrical cables by the relevant legal regulations, the use of socket covers in homes, promoting the widespread use of residual current relays, and arrangements to be taken against the use of illegal electricity are among measures for the prevention strategy.

Therapeutic Efficacy of Artificial Skin Produced by 3D Bioprinting.

The skin protects the body from external barriers. Certain limitations exist in the development of technologies to rapidly prepare skin substitutes that are therapeutically effective in surgeries involving extensive burns and skin transplantation. Herein, we fabricated a structure similar to the skin layer by using skin-derived decellularized extracellular matrix (dECM) with bioink, keratinocytes, and fibroblasts using 3D-printing technology. The therapeutic effects of the produced skin were analyzed using a chimney model that mimicked the human wound-healing process. The 3D-printed skin substitutes exhibited rapid re-epithelialization and superior tissue regeneration effects compared to the control group. These results are expected to aid the development of technologies that can provide customized skin-replacement tissues produced easily and quickly via 3D-printing technology to patients.

Досвід використання пробіотичних штамів Lactobacillus acidophilus R0052 та Lactobacillus rhamnosus R0011 у дітей з опіковою травмою

На сьогодні опіки посідають друге місце серед усіх травм дітей. Основною причиною летальних наслідків у випадку виражених та глибоких опіків є інфекція, що виникає у 23–82 % усіх випадків опіків. Раціональна антибактеріальна терапія має велике значення в боротьбі з генералізованою інфекцією. Метою цього дослідження було ретельне вивчення епідеміології та характеристики антибіотик-асоційованої діареї (ААД) у хворих дітей з опіками, а також можливість запобігання цій діареї, що виникала внаслідок антибактеріальної терапії в пацієнтів Обласного опікового відділення м. Запоріжжя. Протягом 2012–2015 років ми спостерігали 438 дітей з опіковими травмами, які приймали антибіотики. У цих госпіталізованих дітей було знайдено специфічні для ААД Clostridium difficile токсини А + В у фекаліях. Це дозволило діагностувати Clostridium difficile-ентероколіт, пов’язаний з прийомом хворими антимікробних препаратів (A4.07, МКБ‑10). Розроблено профілактичні методи AAД, а саме призначення з перших годин перебування в стаціонарі per os пробіотичного засобу Lactobacillus acidophilus R0052 і Lactobacillus rhamnosus R0011 у складі препарату Lacidofil®. Використання пробіотичних штамів з антитоксичною активністю щодо Clostridium difficile скорочує в 3,4 раза число випадків антибіотик-асоційованої діареї в дітей з опіками та зменшує тяжкість її симптомів.

Influence of electron beam irradiation on extracellular matrix of the human allogeneic skin grafts.

The nonviable allogeneic human skin grafts might be considered as the most suitable skin substitutes in the treatment of extensive and deep burns. However, in accordance to biological security such grafts require the final sterilization prior to clinical application. The aim of the study was to verify the influence of electron beam irradiation of three selected doses: 18, 25, and 35 kGy on the extracellular matrix of human skin. Prior to sterilization, the microbiological tests were conducted and revealed contamination in all examined cases. Individual groups were subjected to single electron beam radiation sterilization at proposed doses and then subjected to microbiological tests again. The results of microbiological testing performed for all irradiation doses used were negative. Only in the control group was a growth of microorganisms observed. The FTIR spectrometry tests were conducted followed by the histological evaluation and mechanical tests. In addition, cost analysis of radiation sterilization of individual doses was performed. The results of spectroscopic analysis, mechanical tests, and histological staining showed no significant changes in composition and characteristics of tested tissues after their irradiation, in comparison to control samples. The cost analysis has shown that irradiation with 18 kGy is the most cost-effective and 35 kGy is the least favorable. However, according to biological risk reduction, the recommended sterilization dose is 35 kGy, despite the higher price compared to the other doses tested.

Surviving Nonsurvivable Injuries: Patients Who Elude the ‘Lethal’ Abbreviated Injury Scale Score of Six

The Abbreviated Injury Scale (AIS) score is used widely to quantify injury severity by body region. The maximal AIS score is 6, which defines a nonsurvivable injury. This study was undertaken to define mortality after AIS-6 injuries in order to determine if they are uniformly lethal and, if not, if differences between survivors and nonsurvivors exist which may aid in prognostication or refinement of the current AIS system. All patients in the National Trauma Data Bank (2007-2017) with ≥1 AIS-6 injury were included. Exclusions were age <16 years, AIS-6 coding in the face/extremities (i.e., coding errors, as there are no AIS-6 injuries in these regions), and missing data. In-hospital mortality defined study groups, i.e., survivors vs. nonsurvivors. Univariable analysis compared clinical/injury data and outcomes. Multivariable analysis examined independent factors associated with mortality. 19,247 patients met inclusion/exclusion criteria. Of these, 25% (n=4,886) survived to hospital discharge and 75% (n=14,361) died. The most common discharge destination among survivors was home (n=2,187,45%) Nonsurvivors had significantly worse GCS in the field (3 vs. 14, p<0.001) and ED (3 vs. 15, p<0.001). Median AIS was higher among nonsurvivors in the Head (5 vs. 3, p<0.001), Abdomen (3 vs. 2, p<0.001), and External regions (1 vs. 1, p<0.001). Median time to death was 0.65h, with maximum time to death 8.76h. Multivariable analysis revealed External AIS-6 injuries were associated with greatest odds of mortality (OR 34.002, p<0.001) followed by Head AIS-6 (OR 10.501, p<0.001). AIS-6 injuries are not uniformly fatal, with 25% of such patients surviving to hospital discharge. Therefore, AIS-6 injuries may not be as catastrophic as previously considered. External and Head AIS-6, i.e. extensive burns and severe traumatic brain injuries, were associated with greatest odds of mortality. When death occurs after AIS-6 injury, it occurs rapidly, with all mortalities in this series occurring <9h after arrival. We suggest that the AIS-6 verbiage be revised to remove 'nonsurvivable'.

Interference in platelet count due to microspherocytosis related to extensive burn injury

Not applicable.

A prospective study of the effect and mechanism of autologous platelet-rich plasma combined with Meek microskin grafts in repairing the wounds of limbs in severely burned patients

Objective: To observe the effect of autologous platelet-rich plasma (PRP) combined with Meek microskin grafts in repairing the wounds of limbs in severely burned patients, and to explore the mechanism. Methods: The prospective controlled research method was used. From September 2016 to January 2020, 16 patients aged 18-69 years, with extensive deep burns, including 9 males and 7 females, who met the selection criteria were admitted to the Department of Burns and Plastic Surgery of the 909th Hospital of the Joint Logistic Support Force of PLA. The bilateral limbs with similar injury in 8 patients were divided into Meek skin grafting+PRP group and Meek skin grafting alone group according to the random number table; in the other 8 patients, the limbs with severer injury were included in Meek skin grafting+PRP group, and the limbs on the other side were included in Meek skin grafting alone group. The wounds of affected limbs in the two groups were treated correspondingly. On post surgery day (PSD) 10, the survival and fusion of Meek microskin grafts were observed and the survival rate and fusion rate were calculated; the histological morphology and the angiogenesis of the basal tissue of Meek microskin graft were observed by hematoxylin-eosin staining and immunohistochemical staining, respectively, with the microvessels being counted. Data were statistically analyzed with paired sample t test. Results: On PSD 10, the wounds of affected limbs in Meek skin grafting+PRP group were dry, and most of the transplanted skin grafts were closely adhered to the basal tissue; while a small amount of exudate could be found in the wounds of affected limbs in Meek skin grafting alone group, and a small part of the transplanted microskin grafts fell off or poorly attached to the basal tissue. On PSD 10, the survival rate and the fusion rate of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group were (94±3)% and (86±4)%, which were significantly higher than (89±4)% and (79±4)% of Meek skin grafting alone group, respectively (t=3.633, 4.229, P<0.01). On PSD 10, the basal epidermis was closely connected with dermis of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group, with more inflammatory cell infiltration and active microvascular hyperplasia, while the basal epidermis was less closely connected with dermis of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting alone group, with obvious degeneration of collagen fibers under the dermis, less inflammatory cell infiltration, and slightly poor microvascular hyperplasia. On PSD 10, the distribution of microvessels in basal tissue of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group were densely clustered, while the distribution of microvessels in Meek skin grafting alone group were scattered, sparse, and dotted. On PSD 10, the number of microvessels in basal tissue of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group was 36±6 in each 400-fold visual field, which was significantly more than 29±7 of Meek skin grafting alone group (t=2.671, P<0.05). Conclusions: Autologous PRP can effectively promote the survival rate and fusion rate of Meek microskin grafts in the wounds of limbs after escharectomy in severely burned patients by promoting angiogenesis at the base of Meek microskin grafts.