History Of Burns Research Articles

A 5-year-old Girl with Scarring

A 5-year-old Girl with Scarring

Nose and Eyebrow Reconstruction Following Electrical Injury

Electrical injuries occur world wide and constitute 5 to 10% of all occupational fatalities.1 Factors that determine the type and extent of electrical injuries include voltage and current flow.1,2 Neurologic complications secondary to electrical injury can manifest themselves either early or late including delayed peripheral neuropathy; lower motor neuron syndrome.3 Patients with head wounds seem to be most at risk for development of cataracts.4 We describe a 24 year old male with a history of electrical burns to the face and neck causing full thickness and underlying soft tissue loss of the left eyebrow, left frontal area, most of the nose and posterior neck. The patient was surgically reconstructed in several stages: 1) Nasal reconstruction was accomplished using an anterior neck tubed flap for the columella, bilateral nasolabial flaps with rib cartilage as an intervening structure for the septum and a scalp forehead flap to substitute the skin of entire nose, and eye brow reconstruction. 2) Forehead reconstruction was carried with use of a tissue expander.

Perforator-Based Reverse Radial Forearm Flap to Reconstruct Multiple Third-Degree Burn Defects of the Fingers

Adequate soft-tissue coverage is a cornerstone for successful hand reconstruction in burn patients allowing for hand mobilization and rehabilitation. Multiple finger injuries that involve separate soft-tissue defects with complex wounds challenge the reconstruction dilemma. In this case report, a modified application of reverse radial forearm flap for the simultaneous reconstruction of multiple separate finger defects for burn cases is presented. A 23-year-old heavy industry worker is presented with a history of third-degree electrical burn of left index and middle fingers. The proximal interphalangeal (PIP) joint of the both fingers were exposed. A distally based radial forearm flap with a dimension 7.5 x 6 cm was planned. The flap was transposed to the distal defect and splitted. The bilobed flap was inset. A tendon graft is used to span the gap of extensor apparatus before insetting the flaps in both fingers. The donor defect was closed primarily. A satisfactory coverage is observed in the recipient areas. Finger functions including full range of motion of the metacarpophalangeal and PIP joints of the index and PIP and distal interphalangeal joints of long fingers were observed. The technique presented here is advantageous as it is easy to perform, covers multiple finger defects simultaneously, avoids long-term immobilization, saves the operative time, avoids microsurgery. Donor site is closed primarily and finally this approach ensures a simultaneous repair of complex wounds with multiple vital anatomical structures i.e. bone, tendon, joint, and soft tissue.

A survey on 30 months electrical burns in Shiraz University of Medical Sciences Burn Hospital

Electrical burn is less common nowadays but still has complications and requires therapeutic interventions especially in developing countries. It occurs more in males and in industrial sites. The importance of electrical burn led us to study a 30 months history of electrical burn in Shiraz, Southern Iran. In a cross-sectional retrospective study, 1352 patients were surveyed for 30 months in relation to the cause, time, demographic information, therapeutic measures and prognosis of the electrical burn. Among burn patients, 4.73% were due to electrical burns (mean age, 30.5 years) and 95.3% were male. The mean hospitalization period was 11.5 days and the mean burn extent was 27.5%. Half of the victims were employees and 59.3% of the electrical burns occurred at their work site. 67.2% of burns were due to high voltage electrical current (more than 1000 V) and 4.6% of the patients died due to the direct cause of electrical burn. The high prevalence of electrical burn in males and workers emphasizes on the essence of standardization of occupational areas and use of trained workers to prevent electrical burns.

From Fat of Old Pigs to Fenestrated Skin Grafts: A Fascinating History of Burn’s Treatment (1)

From Fat of Old Pigs to Fenestrated Skin Grafts: A Fascinating History of Burn’s Treatment (1)

Thermal burn and electric shock injuries among electric utility workers

Electrical burns are devastating, posing development of multiple injuries with high morbidity and mortality. Electrical burn management benefits from a multidisciplinary, multispecialty collaborative approach to improve outcomes.To highlight the clinical spectrum of electrical burns in the developing world, including common etiologies, presentation, intervention, associated injuries, and complications.A prospective study was conducted from January 2010 to December 2015 that included 78 patients (75 men and 3 women), who presented with a history of electrical burns. Patients were interviewed for detailed clinical history and physical examination.The study comprised 78 patients (high-voltage group: 38.46% and low-voltage group: 61.54%). The most affected age group was the 21–40 year age group. High-voltage injuries were more devastating. The most common complication was septicemia in 24.4% of the patients, which included 43.3% from the high-voltage group.Electrical burns affecting young adult men can impose a significant burden in developing countries. Electrical burns, especially due to high voltage, involve multiple organs benefitting from multidisciplinary management and have significant residual sequelae. Public awareness and education and proper training of industry workers remain the best way to minimize the prevalence of electric burns in the developing world.

Scalp necrosis: a rare complication of temporal arteritis

A 90-year-old woman presented to the emergency department complaining of a 3-month history of headache and recent blindness of her right eye. She also reported weakness and weight loss (5 kg during the last 3 months before her presentation) but no fever. She had been treated symptomatically with nonsteroidal antiinflammatory drugs without noting any significant relief. There was no history of trauma or burn. Her past medical history included diabetes mellitus type II and arterial hypertension. The physical examination on presentation was unremarkable except for a large area of scalp necrosis in the temporoparietal region bilaterally (Fig. 1). Routine laboratory testing on admission showed anemia (hematocrit=31,1%) and elevated erythrocyte sedimentation rate (ESR=120 mm/first hour). Serological tests for Varicella–Zoster virus (VZV) and herpes simplex virus 1 and 2 (HSV1 and HSV2) were negative. A computed tomography scan of the head was unremarkable. The patient underwent biopsy of the right temporal artery, which showed typical changes of temporal arteritis. She was given treatment with oral steroids (48 mg/day). After 2 months, the crusting area of the scalp diminished and the ESR normalized (ESR=20 mm/h). Scalp necrosis is a rare but severe complication of temporal arteritis. It is associated with a bad prognosis because it is usually a manifestation of severe, occlusive vasculitis or a result of delayed recognition of temporal arteritis [1]. Adequate corticosteroid therapy is mandatory [2].

H J Klasen, History of burns, Nieuwe Nederlandse Bijdragen tot de Geschiedenis der Geneeskunde en der Natuurwetenschappen, No. 62, Rotterdam, Erasmus Publishing, 2004, pp. 632, illus., €80.00, US$120.00 (hardback 90-5235-168-6).

H J Klasen, History of burns, Nieuwe Nederlandse Bijdragen tot de Geschiedenis der Geneeskunde en der Natuurwetenschappen, No. 62, Rotterdam, Erasmus Publishing, 2004, pp. 632, illus., €80.00, US$120.00 (hardback 90-5235-168-6). - Volume 50 Issue 1

Amputation in diabetic patients

Background: Foot ulcers and their complications are an important cause of morbidity and mortality in diabetes. The present study examines the amputation risk criterion and the long term outcome in terms of amputations and mortality in patients with diabetic foot. Methods: 27 patients with diabetic foot lesions were studied. There were 15 patients with early lesions and 10 with advanced lesions. 15 patients were managed conservatively including local amputations and 12 with lower extremity amputations. 80% patients were males in 45–59 years of age group and all patients had more than 6 years of poorly controlled diabetes. Results: Precipitating factors included walking barefoot, history of minor trauma, infection, callosities or burns in 86% of patients. Major lower limb amputations were common in irregularly treated, poorly controlled diabetics due to infection in a limb devitalized by angiopathy and desensitised by neuropathy. Conclusion: Diabetic foot ulcers are associated with high morbidity and mortality. Mortality was higher in ischaemic ulcers than neuropathic ulcers.

Connaissances, attitudes et comportements des adultes vis-à-vis du soleil en France

The number of new skin cancers has constantly increased in France over the past two decades. The role of sun exposure can partly explain this phenomenon and justifies the development of information and prevention campaigns to change peoples' attitude towards sun bathing. To be effective, we need to know how much information and what attitudes the population currently has with regard to the sun. Although several studies in France have targeted children, little data is available regarding adults. This trial was aimed at pinpointing the knowledge, attitude and behavior of adults regarding sun exposure. Data were collected during a randomized multicenter study on the prevention and early diagnosis of cutaneous tumors, conducted in 26 Health Centers from 1998 to 2000. Standardized questionnaires were handed to those consulting to assess their knowledge, attitudes and behavior towards sun bathing. The population was composed of 41 143 adults aged over 30, consulting one of the 26 Health Check-up units. Analysis of the data was made using SAS v 6.12 and STATA 7.0 software. Logistic regression identified the explicative factors of knowledge and behavior. All the statistical analyses were considered significant above a threshold of alpha<5%. A total of 33 021 persons filled-in the self-questionnaire. Forty-nine percent were women and 51% were men, with a mean age of 50 years. Geographically, 25% lived in the North-East, 16% in the North-West, 25 p.cent in the South-East and 34% in the South-West. Thirty percent claimed that they tanned without burning and 2% of the population studied had often suffered from sun burn, generally when they were adult. The risks related to sun burn were known, because 92% knew that the sun increased the risk of skin aging and 89% knew that it increased the risk of skin cancer. Regarding sun screens, knowledge was not so good; 42% thought that all products were the same and 53% that they allowed one to sun bathe longer. This knowledge was better in those with fair skins, in those who had a history of sun burn, in women and in those who lived in the northern areas of France. Conversely, knowledge decreased with age and was limited in those aged over 60. Regarding behavior, those with fair skin and who reddened under the sun without tanning, protected themselves more. The women declared they protected themselves more than the men, but they used less sun protective measures (clothing, hats...), other than sun screens, than men. Subjects aged over 60 protected themselves more than younger subjects. Lastly, a personal cutaneous history increased protective behavior, and those from northern France protected themselves more than those from the South. This analysis of 33 021 adults aged over 30 shows the good global knowledge of the consequences of sun bathing, but also the lack of knowledge on the interest of using external sun protection and the role of physical means of protection. Attitudes varied depending on gender, age and phototype and also depending on the area where they lived. Despite good knowledge, the most frequent behavior of adults aged over 30 is still not appropriate with differences depending on age, gender and area, which must prompt more appropriate targeting of prevention campaigns according to the populations concerned.

Successful treatment with topical 0.5% fluorouracil and imiquimod 5% cream in the treatment of a patient with actinic keratosis and squamous cell carcinoma

Actinic keratosis (AK) lesions are dysplastic epidermal lesions commonly identified in fair-skinned patients who have had excessive sun exposure. Compelling evidence of their premalignant status, underlines the need for close monitoring and early treatment of these lesions. Treatment of AK lesions with topical 0.5% fluorouracil is effective and may be most appropriate for patients with widespread actinic damage. A 60-year-old white male with Fitzpatrick skin type II presented with a history of squamous cell carcinoma and multiple AK lesions and reported a childhood history of numerous burns and blistering eruptions. The patient is bald, and as a result, frequently develops AK lesions and squamous cell carcinoma on the scalp. Previous treatment included cryosurgery on numerous occasions with limited success and frequent recurrences. Clinical examination revealed over 30 hypertrophic AK lesions on the scalp and a large squamous cell carcinoma measuring 1.2 cm by 1.2 cm. Due to the diffuse nature of the AK and squamous cell carcinoma, topical treatment with imiquimod 5% cream, once daily at bedtime was implemented. Following 10 days of therapy, no response was observed. At that time, topical 0.5% fluorouracil cream applied once daily was added to the treatment regimen. Concomitant treatment with both topical 0.5% fluorouracil cream (applied at bedtime) and imiquimod 5% cream (applied in the morning) continued for 2 weeks during which the patient developed a painful exuberant reaction that resulted in thickcrusted lesions and edema. Following compression of the area and application of petroleum jelly, the patient healed completely without sequelae and experienced no recurrences of lesions 1 year following treatment.

Factors associated with positive HIV serostatus among women who use drugs: continued evidence for expanding factors of influence.

To identify risk factors associated with positive HIV serostatus among African American women who smoke crack and/or inject drugs and who are not enrolled in drug treatment or another institutional setting. Baseline interviews were conducted from June 1998 to June 2000 with 379 heterosexually active women (ages 18 to 59) who had been recruited for potential enrollment into an HIV intervention trial. Adjusted for age and drug using status, women who expressed more difficulty saying no to sex with male partners were more likely to be HIV-positive (adjusted odds ratio [aOR]=3.08, 95% confidence interval [CI] 2.02, 4.83). Similarly, those who indicated greater communication with casual sex partner(s) were less likely to test positive (aOR=0.29, 95% CI 0.10, 0.89). Lower HIV internal control and a history of cuts or burns on lips due to crack smoking were also associated with positive serostatus, and were important confounders in the final multivariate model. A higher level of internal control was associated with a decreased likelihood of positive serostatus, while a history of cuts or burns on the lips was associated with an increased likelihood of HIV antibodies, even after controlling for the amount of oral sex. A broad array of factors may promote or avert infection with HIV. The degree to which personal attributes and beliefs, and relationship characteristics contribute to the likelihood of infection must continue to be addressed. The importance of oral sex and presence of oral sores and their potential role in transmission was suggested.

Phenotypical characteristics, lifestyle, social class and uveal melanoma

PURPOSE To investigate potential risk factors of uveal melanoma, including phenotypical characteristics, eye burns, social class, smoking and alcohol consumption. METHODS A hospital-based and population-based case-control study of uveal melanoma was carried out from 1995 through 1998 and the results pooled. A total of 118 patients (59 men and 59 women) with uveal melanoma and 475 controls matching on sex, age and study regions were interviewed. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS There was an elevated risk for blue or grey iris color (OR = 3.0, 95% CI 1.5–6.0). Red or blond hair color at age 20 was slightly associated with an increased risk for uveal melanoma (OR = 1.5, 95% CI 0.9–2.4). There was no elevated risk for a history of eye burns (OR = 1.1, 95% CI 0.5–2.4). CONCLUSIONS Among the potential risk factors studied, only the phenotypical characteristics showed an association with the risk of uveal melanoma.

Autologous limbal grafting combined with deep lamellar keratoplasty in unilateral eye with severe chemical or thermal burn at late stage

Purpose To evaluate the efficacy of autologous limbal transplantation (ALT) combined with deep lamellar keratoplasty (DLK) for ocular surface reconstruction and corneal clarity recovery in eyes with severe late-stage chemical or thermal burns. Design Retrospective, noncomparative, interventional case series. Participants Thirty-nine eyes of 39 patients with a history of severe chemical or thermal burns over 6 months (mean, 47 ± 28.7 months) exhibiting corneal vascularization, conjunctivalization, and heavy corneal scarring were treated at two university hospitals. Methods Surgical procedures included excising epibulbar fibrous tissue, clearing the fibrovascular membrane over the cornea, deep removal of corneal stroma 7.5 to 8.0 mm in diameter, exposing Descemet’s membrane in the pupillary area, grafting a corneal button, transplanting autologous limbal and conjunctival epithelial grafts, and making a temporary tarsorrhaphy. Main outcome measures Integrity of ocular surface recovery, postoperative corneal epithelial stability, optical corneal clarity, and best-corrected visual acuity were the outcome measurements. Results Thirty-four of 39 eyes that received ALT combined with DLK met the criteria of the study. Of 34 operated eyes, full corneal epithelialization was achieved in 19 eyes (55.9%) within 5 days and in 32 eyes (94.1%) within 7 days after surgery. Delayed epithelial healing occurred in two eyes (5.9%). The reconstructed corneal surface remained stable, and the renewed epithelium was characterized cytologically by nonkeratinized squamous cells without goblet cells. After surgery in 11 of 34 eyes, fluid was identified between Descemet’s membrane and the donor corneal graft, resulting in a pseudochamber that completely resolved in 10 eyes within 30 days. In one patient, a persistent pseudochamber was present for 28 months. After surgery, transparent cornea especially in the pupillary area was accomplished in 29 eyes, whereas mild cornea clouding, nebulomacular corneal opacity, and heavy corneal scarring were observed, respectively, in three eyes. In addition, corneal endothelial decompensation was identified in two eyes and demonstrated persistent corneal epithelial and stromal edema. Remarkable improvement of postoperative vision was achieved in 30 eyes. Four eyes without postoperative improvement in vision were regrafted by penetrating keratoplasty at least 6 months after the original ALT and DLK surgery. Conclusions Autologous limbal grafting combined with DLK simultaneously can restore a normal and stable ocular surface, create clear central cornea, and remarkably enhance visual acuity after severe chemical or thermal burns.

Cornea and heart valve donation in the regional organization of organ procurement in Germany

Burns are one of the major health issues that considerably affect variable groups of the population, varying in age and severity. Despite advances in burn surgical and non-surgical treatments, patient's appearance still represents public health issue. In regards to surgical treatment of burns, skin grafting is still considered the gold standard. One of the major burdens in the burn surgical treatments is the availability of the skin for grafting. As for the non-surgical treatment different modalities of skin dressings or substitutes are still available as an option.A validated questionnaire based study was utilized to acquire assessment of the overall general population knowledge, awareness and attitude toward skin donation. In addition, it surveyed community personal willingness to donate their skin to a skin bank after being deceased, to help solve skin shortages due to the lack of skin banks in Saudi Arabia.A total of 698 individuals completed the questionnaire over the period of 5 months, from February 2018 till June 2018. Married, postgraduate females, with a history of burn in close family members or similar individuals showed a positive attitude toward skin donation. However, 22% of the participants did not agree to donate their skin due to religious reasons.The study concluded that the majority of participants were willing to donate their skin, and they were aware of the concept of skin donation and its crucial importance in surgical burn management. The current study showed the majority of participants were aware of skin donation and skin use for burn treatment, in addition to having positive attitude toward skin donation. Men were more aware than the women of skin donation. Religious concern was a major reason for participants’ skin donation refusal, an issue that can be addressed by contacting Islamic scholars to issue a Fatwa approving the cause.

Socioeconomic and cultural influence in the causation of burns in the urban children of Bangladesh.

This prospective case-control study was conducted on 105 consecutive cases admitted to the burn units of Dhaka Shishu Hospital and Dhaka Medical College Hospital. The same number of controls were selected randomly from the community and matched with respect to age group, sex, and location of residence within the defined metropolitan area during the period January to September 1997. Both the controls and cases were divided into three age groups. Group A (19 controls and 19 cases) included neonates and infants, group B included children from 1 to 4 years, and group C included children from 4 to 12 years. The mean age of the controls in group A was 8.42+/-3.86 months and in group B and C was 5.72+/-4.05 years. The mean age of cases in group A was 4.79+/-4.05 months and in group B and C was 5.08+/-2.87 years. A scoring system was used to analyze 14 socioeconomic and cultural factors, which indicated highly significant differences between controls and cases (P < 0.001), and also between male (P < 0.001) and female (P < 0.001) controls and cases. There were significant differences between controls and cases in group A (P < 0.001), group B (P < 0.01), and group C (P < 0.001). Differences were not significant between males and females within groups A, B, and C for cases or controls (P > 0.05). Regression analysis of the total scores for cases and controls indicated a negative correlation between burns and the socioeconomic variables included in the study. There were highly significant associations between burns and lack of alertness to burns among parents (P < 0.001), clothing of manmade fabrics (P < 0.001), and cooking equipment in the kitchen within reach of children (P < 0.001). There was a significant association between burns and illiteracy of the mother (P < 0.01), housing located in slums and congested areas (P < 0.01), illiteracy of the father (P < 0.02), presence of preexisting impairment in children (P < 0.05), presence of a history of burns among siblings (P < 0.05), and low economic status of the parents (P < 0.05). No significant associations were indicated between controls and cases with respect to number of children in the family (P > 0.1), family pattern (P > 0.1), conjugal bonding between parents (P > 0.5), and sibling's death and disability from burns (P > 0.5). It is evident that an increase in alertness to burns, easy availability of clothing of natural fabrics, keeping cooking equipment beyond the reach of the children, increased literacy among parents and children, and improvement in family income might decrease the incidence of burns in children.

Post-burn hallux varus: a case report and management of a rare deformity

Post-burn hallux varus is an extremely rare condition. A 22-year-old male, with a history of campfire burns in childhood, presented with secondary hallux varus of the left great toe. Surgical correction included medial soft tissue release, metatarsophalangeal joint arthrodesis, two-pin fixation of bones, metatarsophalangeal joint capsulorrhaphy, and coverage of the skin defect with a “Z” plasty of the skin and split thickness skin grafting. Follow up 20 months later showed satisfactory results.

Unusual intermediate-term outcome in three cases of limbal autograft transplantation

Objective To report an unusual intermediate-term outcome after limbal autograft transplantation for unilateral, severe chemical burns. Design Case reports of three consecutive cases. Participants Three patients with a history of chemical burns. The fellow eye was clinically uninvolved in all patients. Surgery was indicated for conjunctivalization (cases 1 and 3) and persistent epithelial defect (case 2). Intervention Three (cases 2 and 3) or four (case 1) 1.25-clock-hour-wide limbal grafts were harvested from the fellow eye and transplanted to the limbus in the affected eye. Surface re-epithelialization, improvement in visual acuity, and maintenance of surface stability were monitored. Results Limbal grafts were effective in re-epithelialization of the corneal surface within 4 weeks in all cases. Symptomatic relief and improvement in visual acuity were noted during early follow-up. However, a progressive conjunctival ingrowth that tended to override the grafts and encroach the visual axis was noted over the course of a year in all three recipient eyes. Conclusions Limbal autograft transplantation is an effective method for surface re-epithelialization in strictly unilateral chemical burns. Caution should be exercised in case selection. The authors’ experience suggests a variable degree of attenuation in viability of transplanted limbus. Close follow-up of operated eyes is necessary to determine the long-term efficacy of limbal transplants as a source of corneal phenotypic cells.

Use of macrophage colony-stimulating factor in the treatment of fungal infections.

Management of fungal infections is a major medical problem. The risk of developing a fungal infection is higher for patients who are undergoing dose-intensive therapy, are immunocompromised, have neutropenia, are receiving prophylactic antibiotics, have other infections, have invasive catheters, or have a history of severe trauma or burns. Survival is decreased among patients who develop fungal infection in these situations. In view of the high morbidity and mortality associated with fungal infections in transplant recipients, cytokines that enhance cell function, such as macrophage colony-stimulating factor (M-CSF), have been investigated. M-CSF enhances cytotoxicity, superoxide production, phagocytosis, chemotaxis, and secondary cytokine production in monocytes and macrophages. Animal models and clinical data suggest efficacy of M-CSF in controlling fungal infection.

Respiratory symptoms, spirometry and chronic occupational paraquat exposure

A cross-sectional study was conducted to evaluate the relationship between respiratory health and paraquat exposure. The study population was selected from among workers at 15 Nicaraguan banana plantations which relied on paraquat for the control of weeds. All the workers were interviewed after they received their job assignment for the day of the survey, and all who reported never having applied paraquat and all who reported more than 2 years of cumulative exposure as applicators of paraquat with knapsack sprayers were invited for medical evaluation. One hundred and thirty-four exposed workers and 152 unexposed workers were administered a questionnaire interview asking about exposure and respiratory symptoms, and they underwent spirometric testing of forced expiratory volume in 1 s (FEV1.0) and forced vital capacity (FVC). In the exposed group 53% reported having experienced a skin rash or burn resulting from paraquat exposure, 25% reported epistaxis, 58% nail damage, and 42% paraquat splashed in the eyes. There was a consistent dose-response relationship between intensity of exposure (as indicated by a history of skin rash or burn) and the prevalence of dyspnea. This relationship was more marked for more severe dyspnea. There was a 3-fold increase in episodic wheezing accompanied by shortness of breath among the more intensely exposed workers. There was no relationship between exposure and FEV1.0 or FVC. The high prevalence of respiratory symptoms associated with exposure, in the absence of spirometric abnormalities associated with exposure, could be a result of unmeasured gas exchange abnormalities among workers with long-term exposure to paraquat.