Hot Burns Research Articles

Immediate impacts of fire on koala movement in a fragmented landscape

Hazard reduction burns could pose a significant conservation challenge to threatened habitat specialists, such as koalas Phascolarctos cinereus. This study examines the immediate effects of a medium to hot hazard reduction burn on a small number of koalas occupying a fragmented agricultural area. Three koalas being monitored using GPS telemetry were inadvertently exposed to fire in a small strip of roadside vegetation in an agricultural landscape, providing an unexpected opportunity to assess their immediate responses to the fire. Nearly 81% of available trees were burnt to some degree, with 31% of tree foliage scorched up to 10.2m above the ground. The koalas reduced their home range sizes by 20–54% post-fire, where two avoided burnt areas while one remained within them. These findings highlight the importance of maintaining unburnt patches and corridors in fragmented landscapes and developing comprehensive conservation plans to mitigate the adverse effects of fire on koalas and other arboreal fauna.

Has the energy poverty crisis fuelled a rise in hot water bottle burn injuries within the United Kingdom?

IntroductionThere are an estimated 10 million hot water bottles (HWB) currently in use within the United Kingdom (UK), and HWB related burn injuries represent a significant resource burden to UK Burns Services. These injuries can be caused through a variety of mechanisms including scalds sustained when filling the bottle or scalds from leaking or rupture. The fuel poverty crisis started in February 2022 leading to an estimated six-fold increase in alternative sources of heating, in particular hot water bottles. In this study, we wish to understand the impact that this may have had upon burn injuries sustained by these products. MethodsAll hot water bottle (HWB)-related injuries sustained January 2014 - February 2023 were retrieved from the UK International Burn Injury Database (IBID). Data were collected on patient demographics, injury mechanism, anatomical location, and clinical outcomes. The data were collated and analysed; statistical analysis was performed using R StudioTM. Patient levelling costs were also incorporated to enable translation of these data into healthcare costs. ResultsA total of 5944 HWB-related burn injuries were recorded in the IBID database in England and Wales, from 2014 to 2023, with a mean of 594 (SD 146.2) burn injuries annually, costing an estimated £ 12.7 million. There were 423 burn injuries sustained from HWB in winter 2022 compared to 295 in winter 2021, representing a 43.4 % increase over one year, with a corresponding increase of 43.1 % in the number of patients managed in an outpatient setting. The largest increase in burn incidence between winter 2021 and winter 2022 was seen in children (0–16 years old) and older adults (greater than 65 years old) with a rise of 60.3 % (n = 41) and 68.5 % (n = 37) respectively. ConclusionOur epidemiological study on hot water bottle (HWB)-related burn injuries within the United Kingdom has shown that the dramatic rise in fuel prices, which sparked the fuel poverty crises, has coincided with a 43.4 % increase in HWB burns incidence on the health service in that year alone. This alarming rise in HWB-related injuries highlights the continued need for targeted public awareness campaigns to ensure a safe and proper use of these devices.

Hot car seat thermal burn: A must sought for differential diagnosis in summers

Hot car seat thermal burn: A must sought for differential diagnosis in summers

Self-induced Hot Water Finger Burn Trying to Get Feeling Back after Ropivacaine Block

Summary: This case report is about a patient with self-induced hot water burns several hours after an infraclavicular block with ropivacaine for a scaphoid fracture operation. This patient was honest about what happened. However, some patients are too embarrassed to admit what they did to themselves. The injury may be misdiagnosed by the emergency department physician or by the surgeon because the history is incomplete. The resulting burn, which can lead to fingertip loss when severe, can be erroneously misdiagnosed as an ischemic injury after lidocaine with epinephrine local anesthesia. Most hand surgeons have seen ischemic finger injuries the morning after failed finger replantation. Acutely ischemic fingers from arterial insufficiency do not have parallel hot water burn lines, reactive hyperemia at the base of the burn, or burn blisters at the fingertips. The purpose of this article and its video is to help physicians and nurses recognize the three signs of self-induced hot water finger burns after local anesthesia: (1) a parallel hot water line in the fingers at the proximal burn level; (2) reactive hyperemia just proximal to the burn line; (3) burn blisters in the submerged fingertips. When seeing postoperative patients with these signs, the examining clinician may tactfully ask: “Did you try to get the feeling back in your fingers by warming them?” It is hoped that the patient may then reveal that he tried warming the finger in water, and that may lead to the truth that the water was indeed too hot.

Burnt out: A retrospective review of paediatric burns admissions at Chris Hani Baragwanath Academic Hospital 2015–2020

BackgroundBurn injuries in children in low- and middle-income countries are common, serious, and preventable. Despite the high burden of disease, there is a paucity of data on the profile of paediatric burns in South Africa. Such data are essential to local burn prevention strategies. MethodsA retrospective review of all recorded paediatric burns admissions to the paediatric burns unit at Chris Hani Baragwanath Academic Hospital was performed from 1 January 2015 – 31 December 2020. Ethical approval was obtained. Data extracted anonymously included patient age, sex, mechanism of injury, injury severity, date of injury and residential location. ResultsA total of 2980 admissions occurred during the study period. Infants ≤ 1 year accounted for 42.2 % (1259/2980), males 61.4 % (1689/2751), hot water burns 79.1 % (2357/2980), and major injury 40.1 % (1201/2980) of admissions. Most burn injuries occurred in winter (28.2 %, 842/2980), and most admitted patients lived in Soweto 45.5 % (1355/2980). ConclusionsMost burns admissions in the study period were characterised by male children less than one year of age, hot water burns, major burn injuries and admissions in the winter months. These results are similar to national and international data regarding age, sex, mechanism of injury and seasonality of paediatric burns. The results from the study have been utilised to inform Surgeons For Little Lives’ paediatric burns prevention campaigns in Soweto and Gauteng Province.

One disaster two traumas: Being under rubble and burn injuries in the 2023 Maraş, Turkey earthquakes

IntroductionOn February 6, 2023, two separate destructive earthquakes with magnitudes of 7.7 and 7.5 occurred in Kahramanmaraş, Türkiye. More than 50,000 people lost their lives, and over 100,000 were reported injured. In this study, patients referred to hospitals with burn diagnosis and management of burn wounds following the disaster were evaluated. Material and methodsInformation on burn injury admissions related to the earthquake was collected from all burn facilities in the country within 15 days after the earthquake. The patients' demographics, being under rubble, rescue times, burn causes, grafting procedures, and deaths were recorded. ResultsFollowing the earthquake, burn victims were transferred to the 13 Burn Treatment Centers located in 10 provinces. A total of 191 patients were burned. Among the burn patients, 101 (52.9%) were rescued from the rubble 2–60 h after the earthquake. Eight patients who were hospitalized at the burn centers died. Scalding and flame burns were the most common etiologies. Burned total body surface area, concomitant crush injury, hospitalization, and mortality was higher among the patients trapped under rubble (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). Victims who stayed longer time under the rubble required significantly more grafting procedures (p < 0.001). ConclusionIn a literature review, it was observed that there are a limited number of publications reporting earthquake-related burns. In the February, 6 Türkiye earthquake, flame burns were seen due to small fires that occurred in collapsed buildings during the earthquake. And also contact burns and hot liquid burns were seen in earthquake victims trapped under rubble. Bursting hot water pipes, overturned stoves, contact with hot central heating radiators, and heated construction irons caused scalding and contact burns. It is believed that prolonged entrapment may cause delays in burn treatment or lead to deeper burns due to prolonged contact with the burning agent, increasing hospitalization rates. This earthquake once again drew attention to burn injuries that could occur during and after earthquakes, including those that may occur under rubble.

Skin Grafting in Post burn contractures of Groin and perineum in patients

Background: Groin and perineal burn contracture is a rare postburn sequel. Such postburn contractures causes distressing symptoms to the patients and in the management of these contractures, both functional and cosmetic appearance should be the primary concern. Material and Methods: This is prospective and descriptive study conducted in the Department of Plastic Surgery at Tertiary Care Teaching Hospital over a period of 1 Year. First dressing was seen on third or fourth postoperative day and percentage of graft take/loss was noted. Complications, if any, were recorded. Indwelling urinary catheter drainage was instituted for 3 to 4 days postoperatively. Once the graft stabilized, patients were discharged and advised to wear compression garments. Results: In our study, 77.1% of the patients, post burn contractures of the groin and perineum were because of Open chulla. Other less common causes were hot water (14.3%) and flame burn (8.6%). Majority of the patients were brought with complaints of difficulty in squatting (80.0%) followed by limitation of movements of hip joints (71.4%) and (44.3%) impairment of walking. In our series of 70 patients two types of operative procedures were performed: (1) release of contracture with split thickness skin grafting; (2) release of contracture and closure by multiple Zplasties. Moreover, 30 (42.9%) patients having bilateral groin contractures underwent release of contracture with split thickness skin grafting. 29 (41.4%) patients underwent release of unilateral groin contracture with split thickness skin grafting and 4 (5.7%) patients underwent release of unilateral groin contracture and closure by multiple Zplasties.Conclusion: To conclude, recuperation from perineal burns, both in acute period and chronic phase in case contracture occurs, is a difficult challenge physically and mentally. The agony that a burn patientendures during treatment is evident even to an onlooker.

Investigation of Schottky bypass diodes from a faulty PV plant

Bypass diodes in photovoltaic modules are designed to prevent the solar cells and cell strings in the module from overheating if a module is operated incorrectly. Possible consequences of bypass diode failures are for example power loss, glass breakage or hot spot burns in PV modules. To avoid such situations, the key-role-playing bypass diode must be in good condition and the knowledge of the condition status is of high interest. For this reason, 36 Schottky diodes were randomly selected from the junction boxes of taken-back PV modules and examined using a variety of characterisation methods. These included electrical characterisation and imaging techniques. The investigation identified all three possible bypass diode states: (i) bypass diode functional and conducting in one direction and blocking in the other direction, (ii) bypass diode defective and conducting in both directions and (iii) bypass diode defective and no longer conducting in any direction. Defective bypass diodes that changed from failure state (ii) to failure state (iii) were found in different aged conditions. Conversely, only an abrupt transition was found for the state (i) to failure state (ii). The main objective of having a fast and suitable method for characterising Schottky bypass diodes in PV systems in the field, which is also in simple agreement with results from laboratory measurement technology, was found with the electrician’s multimeter.

Outcomes of complex burn injury patients managed at two primary and one tertiary level burns facilities in the Western Cape province of South Africa - a retrospective review.

This study aimed to compare factors contributing to a positive outcome of adult burn injury patients managed at two primary and one tertiary level Western Cape hospitals. These patients from the primary hospitals (PLHs) met the referral criteria for specialised care at the Tygerberg Hospital burns unit (TBU) but were not accepted or were accepted late. A total of 1034 adult burn injury patients seen at two primary level ("A" and "B") hospitals and the TBU between 2016 and 2019 were retrospectively analysed. One hundred and eleven (111) primary level patients ("A" 71, "B" 40) met the criteria for referral to the TBU. The outcomes and factors contributing to positive outcome of these patients were compared with the 859 patients treated at the TBU during the same period. Patients treated at the TBU showed longer theatre waiting times, more operations, and higher complication and death rates than their primary level counterparts. The PLHs showed no factors significantly contributing to hospital discharge. At TBU, pregnancy status, younger age, hot water burns, lower abbreviated burns severity index (ABSI) score, and longer time to theatre were associated with hospital discharge. A shortage of beds was the main reason for denial of admission to the TBU. The PLHs showed good outcomes in managing severe burn injuries, although no significant contributors to a positive outcome were identified. Patient- and facility-related factors contributed to positive outcomes at the TBU. Upgrading both the Western Cape's primary level capabilities and the TBU's accessibility and efficiency are necessary to improve burns services.

Higher operating theatre temperature during burn surgery increases physiological heat strain, subjective workload, and fatigue of surgical staff.

Raising the ambient temperature of the operating theatre is common practice during burn surgeries to maintain the patient's core body temperature; however, the effects of operating in the heat on cognitive performance, manual dexterity, and perceived workload of surgical staff have not been assessed in a real-world context. Therefore, the aim was to assess the real-time impact of heat during burn surgeries on staff's cognitive function, manual dexterity, and perceptual measures (workload, thermal sensation, thermal comfort, perceived exertion, and fatigue) and physiological parameters (core temperature, heart-rate, fluid loss, and dehydration). Ten burn surgery staff members were assessed in CON (24.0±1.1°C, 45±6% relative humidity [RH]) and HOT (30.8±1.6°C, 39±7% RH) burn surgeries (average 150 min duration). Cognitive performance, manual dexterity, and perceptual measures were recorded pre- and post-surgery, while physiological parameters were recorded throughout surgery. HOT conditions did not significantly affect manual dexterity or cognitive function (p > .05), however HOT resulted in heat strain (increased heart-rate, core temperature, and fluid loss: p < .05), and increased subjective workload, discomfort, perceived exertion, and fatigue compared to CON conditions (p < .05). Cognitive function and manual dexterity were maintained in hot conditions, suggesting that operating in approximately 31°C heat is a safe approach for patient treatment. However, job burnout, which is positively correlated with perceived workload, and the impact of cumulative fatigue on the mental health of surgery staff, must be considered in the context of supporting an effective health workforce.

Why is milk so dangerous in rural areas?

In this study, hot milk burns observed in paediatric patients were examined, and the results were compared with those obtained from other types of scalding burns. A 10-year retrospective study was conducted with paediatric patients hospitalised for hot milk burns at the Gazi Yaşargil Training and Research Hospital Burn Center, Turkey. Of the 87 patients included in the study, 49 (56.3%) were male and 38 (43.7%) were female, with a male/female ratio of 1.29:1. Patients were aged two months to 18 years, with a mean age of 3.62±2.82 years. The highest rate of burn injury was observed in patients aged 0-4 years (n=67, 77.0%). The upper (n=56, 64.4%) and lower extremities (n=75, 86.2%) were the most frequently affected areas. Of the total number of patients examined, 25 (28.7%) exhibited second-degree burns, while 62 (71.3%) exhibited third-degree major burns. The mean hospitalisation time was 6.28±5.04 days. None of the patients died or underwent amputation. Scalding is the most common cause of burns in the paediatric population in Turkey. Hot milk burns attract attention due to their higher infection rates and length of hospital stay.

75 Tranexamic Acid Reduces Burn Wound Conversion and Lung Inflammation in a Murine Comb Burn Model

Abstract Introduction Burn wound conversion is a process where superficial partial thickness burns convert into deep partial and even full thickness burn injuries. Unfortunately, the pathophysiology of this phenomenon is poorly understood. A therapeutic intervention that may prevent secondary progression and cell death in burn-injured tissue is desirable. Recent work by our group has established that tranexamic acid (TXA) has significant anti-inflammatory properties in addition to its well-known anti-fibrinolytic effects. This study investigates tranexamic acid as a novel therapeutic treatment to mitigate burn wound conversion and reduce systemic inflammation. Methods Sprague-Dawley rats were subjected to a hot comb burn contact injury using a 150-g brass comb preheated to 100°C, to create four rectangular burns, separated by three unburned interspaces. A subset of animals underwent the comb burn injury with an adjacent 30% TBSA contact injury using solid brass rods. The interspaces represent the ischemic zones simulating the zone of stasis. The treatment group received IP injection of TXA (100mg/kg) immediately after injury and once daily until sacrifice. Sham animals underwent an identical procedure, with application of a room temperature comb. Animals were sacrificed at 6hrs and 7-day time points post-injury. Photo images were obtained of the comb burn injury. Full-thickness biopsies from the ischemic zones and lung tissue were assessed with established histological and immunohistochemical (IHC) techniques. Results At 7-days post injury, the percentage of ischemic zones with necrosis was significantly reduced in the treatment group when compared with untreated burn controls by photographic image analysis. When compared with controls, the treatment groups had significantly less progression of ischemic zones to necrosis when assessed by standard microscopy. These findings were consistent in both the comb burn only and comb burn + 30%TBSA injury models. The TXA treatment group demonstrated significantly more expression of the regeneration marker (CTHRC-1) and a trend toward increased expression of the Ki-67 proliferation marker when compared to untreated burn group. At 6 hours post-injury, TXA significantly decreased infiltration of neutrophils in the lungs for the 30%TBSA burn injury model. Furthermore, systemic levels of mitochondrial DNA, IL-1α and TNFα were significantly lower in TXA treated animals when compared to untreated burn controls. Conclusions Animals treated with tranexamic acid demonstrated reduced burn wound conversion and decreased burn-induced SIRS response. Lung inflammation was also significantly reduced by administration of TXA after injury. Applicability of Research to Practice Tranexamic acid and agents with similar mechanisms of action may provide a treatment to reduce burn wound conversion. This therapy could be easily incorporated into standard acute burn care practices.

Occupational health and safety aspects in the handling of cryogenic materials in nuclear and radiological facilities

Cryogenic materials, widely used in industries and facilities associated with nuclear technology and science and radiological applications, pose occupational health and safety hazards owing to their unique properties. The major health hazards include cold burns, asphyxiation, hot burns, and major safety hazards are explosion, fire, and equipment failure. Risk assessment consistent with material safety data sheet and hazard analysis is essential to assess the potential dangers while using cryogenic materials. Safe handling of cryogenic materials in nuclear and radiological facilities requires special considerations to ensure the protection of personnel and the environment. Administrative measures such as access control, training, checklists, and engineering controls such as ventilation, gas detection systems, and purging techniques are applied to deal with cryogenic hazards. Many personal proactive equipments are available to protect users from cryogenic hazards. While some protective measures for cryogenic hazards could suffice for low radioactivity laboratories, additional personal protective equipments are required to protect workers from radiation exposure in workplaces with potentially significant radiation hazards. The formulation of preparedness plans for emergencies resulting from cryogenic hazards should essentially take into account the unique constraints and requirements of radiological facilities. Simultaneous occurrence of radiological and cryogenic emergencies presents complex challenges requiring special mitigative measures.

Epidemiological and Clinical Profile of Pediatric Burns in the COVID-19 Era: The Experience of a Reference Center.

Pediatric burns represent a significant public health problem. We analyzed the characteristics of pediatric burns in a reference center, in order to identify better strategies for prevention and care. Burn patients admitted to the pediatric departments of our hospital from January 2020 to June 2022 were retrospectively evaluated. Age, gender, the etiology of injuries, the total burn surface area (TBSA), the degree of burns, the length of hospital stay (LOS), concomitant SARS-CoV-2 infection, and burn surface microbial colonization were analyzed. Forty-seven patients were included in the analysis (M:F = 1:0.67). Most of the cases involved patients between 0 and 4 years of age (83%). Hot liquid burns accounted for 79% of cases, flame burns for 9%, thermal burns for 6%, scald burns for 4% and chemical burns for 2%. Mean TBSA was 14 ± 11%. A second-degree lesion was detected in 79% of patients and third-degree in 21%. Mean LOS was 17 days. No additional infection risks or major sequelae were reported in patients with SARS-CoV-2 infection. Fifteen different species of bacteria plus C. parapsilosis were isolated, while no anaerobic microorganisms were detected. In the light of our experience, we recommend a carefully planned and proactive management strategy, always multidisciplinary, to ensure the best care for the burned child.

Burn Admissions Across Low- and Middle-income Countries: A Repeated Cross-sectional Survey.

Burn injuries have decreased markedly in high-income countries while the incidence of burns remains high in Low- and Middle-Income Countries (LMICs) where more than 90% of burns are thought to occur. However, the cause of burns in LMIC is poorly documented. The aim was to document the causes of severe burns and the changes over time. A cross-sectional survey was completed for 2014 and 2019 in eight burn centers across Africa, Asia, and Latin America: Cairo, Nairobi, Ibadan, Johannesburg, Dhaka, Kathmandu, Sao Paulo, and Guadalajara. The information summarised included demographics of burn patients, location, cause, and outcomes of burns. In total, 15,344 patients were admitted across all centers, 37% of burns were women and 36% of burns were children. Burns occurred mostly in household settings (43-79%). In Dhaka and Kathmandu, occupational burns were also common (32 and 43%, respectively). Hot liquid and flame burns were most common while electric burns were also common in Dhaka and Sao Paulo. The type of flame burns varies by center and year, in Dhaka, 77% resulted from solid fuel in 2014 while 74% of burns resulted from Liquefied Petroleum Gas in 2019. In Nairobi, a large proportion (32%) of burns were intentional self-harm or assault. The average length of stay in hospitals decreased from 2014 to 2019. The percentage of deaths ranged from 5% to 24%. Our data provide important information on the causes of severe burns which can provide guidance in how to approach the development of burn injury prevention programs in LMIC.

A rare type of burn : Nylon burns.

In this study, it was aimed to examine nylon burns in paediatric patients and compare the results with other causes of hot object contact burns. A 10-year retrospective study was conducted on 77 paediatric patients hospitalized for hot body burns at Gazi Yaşargil Training and Research Hospital Burn Center. Of those patients with hot body burns, 72.7% (n= 56) were males and 27.3% (n= 21) were females. Male-to-female ratio was 2.67:1. Mean age of the patients was 4.79 (min= 1, max= 16) years. There were 42 patients who applied to our hospital on the day of their burn, while four patients applied one day after the burn, one patient applied two days after the burn, 13 patients applied three days after the burn and 17 patients applied five days after the burn. Most burns (79.3%) were third-degree burns, whereas 19.5% were seconddegree and 1.2% were fourth-degree burns. The most common causes of hot body burns were hot nylon and hot stoves, followed by hot ash and hot irons. The number of nylon burns was the highest in the summer and the highest number of hot stove burns occurred in the winter. Nylon burns were most common in the three to eight age group and then gradually decreased. The highest burn rate was observed in nylon burns. The most common cause of all burns in the Turkish paediatric population is scalding. Although nylon burns are rare, they draw attention due to their higher burn degrees.

Geriatric Burn Injuries Presenting to the Emergency Department of a Major Burn Center: Clinical Characteristics and Outcomes

BackgroundBurn injuries in geriatric patients are common and may have significant associated morbidity and mortality. Most research has focused on the care of hospitalized patients after admission to burn units. Little is known about the clinical characteristics of geriatric burn victims who present to the emergency department (ED) and their ED assessment and management. ObjectiveOur aim was to describe the clinical characteristics and outcomes of geriatric patients presenting to the ED with burn injuries. MethodsWe performed a comprehensive retrospective chart review on all patients 60 years and older with a burn injury presenting from January 2011 through September 2015 to a large, urban, academic ED in a hospital with a 20-bed burn center. ResultsA total of 459 patients 60 years and older were treated for burn injuries during the study period. Median age of burn patients was 71 years, 23.7% were 80 years and older, and 56.6% were female. The most common burn types were hot water scalds (43.6%) and flame burns (23.1%). Median burn size was 3% total body surface area (TBSA), 17.1% had burns > 10% TBSA, and 7.8% of patients had inhalation injuries. After initial evaluation, 46.4% of patients were discharged from the ED. Among patients discharged from the ED, only 1.9% were re-admitted for any reason within 30 days. Of the patients intubated in the ED, 7.1% were extubated during the first 2 days of admission, and 64.3% contracted ventilator-associated pneumonia. ConclusionsBetter understanding of ED care for geriatric burn injuries may identify areas in which to improve emergency care for these vulnerable patients.

Investigation of the relationship of growth hormone, insulin-like growth factor (IGF)-1, and IGF-binding protein-3 levels with graft viability in autograft-transplanted pediatric patients with major burns

BackgroundIn our study, we investigated graft viability, Growth Hormone (GH), Insulin-like growth factor (IGF)-1, and IGF-binding protein (IGFBP)-3 in autograft-transplanted pediatric major burn cases. MethodsThis descriptive study was conducted with the participation of pediatric patients with major burn wounds. The laboratory data and characteristics of the patients were accessed retrospectively, and the obtained data were recorded in the data form developed by the researchers. In the analysis of the data, descriptive statistical methods, chi-squared test, Wilcoxon signed-rank test, one-way ANOVA, and post hoc analyses were used. ResultsThe sample of our study consisted of 93 pediatric major burn patients with a total burnt body surface area of more than 20%. It was found that 65.59% of the patients were between the ages of 1 and 5, 63.43% of them were in the 41–55 percentile range, 58.06% had a hot liquid burn, 74.2% had a second-degree burn, 60.21% had a burn percentage in the range of 21–40 of their total body surface area. It was determined that the GH and IGF-1 levels of the patients who experienced loss after graft transplantation remained below the normal value in the first 14 days, and the differences in the GH and IGF-1 values between the patients with good functioning grafts and those with graft loss were statistically significant (p < 0.01). It was found that the IGFBP-3 value remained low on the 14th day in the patients with good functioning grafts, and the difference in the IGFBP-3 values between the patients with good functioning grafts and those with graft loss was statistically significant (p < 0.05). ConclusionToday, it is known that the parameters of GH, IGF-1, and IGFBP-3 are related to many problems. However, no study examining their relationships with graft viability in autograft-transplanted pediatric patients with major burns was encountered. Our study may be the first to determine that changes in these three laboratory parameters negatively affect the healing of burn wounds.

Aqueous-based Nanoemulsion Containing (-)-α-bisabolol for Topical Treatment of Skin Burns

Background: α-Bisabolol (BIS) is a sesquiterpene extracted from the chamomile flowers, whose use to topically treat burn skin has been reported. High lipophilicity of BIS, however, is a problem for both skin application and washing. Objective: The present study aimed to prepare and characterize a stable and safe aqueous-based nanoemulsion to incorporate BIS and favor skin penetration focusing on skin burns' topical treatment. Method: Oil-in-water nanoemulsions were obtained from a pseudo-ternary phase diagram. The selected nanoemulsion was characterized (droplet size, PDI, and zeta potential), and the stability was assessed for 60 days at 6ºC and room temperature. The irritability of the formulation was determined by HET-CAM. Skin permeation studies were carried out in vitro intact skin, hot wa-ter burn skin, and hot plate burn skin. Results: The nanoemulsion incorporated 1% (w/w) BIS, presented droplets' size of 14.0±0.8 nm (PDI= 0.13±0.02), the zeta potential of +7.5±1.9 mV, and was physically stable over 60 days. The HET-CAM did not show any irritability process provided by the nanoformulation. In the skin permeation experiments, when compared to an oily control solution of BIS, nanoemulsion increased 3.7-fold penetration of the drug in intact skin, likely because the nanoformulation act-ed as an absorption drug enhancer. On a hot water burn skin model, the increase in drug pene-tration was 1.7-fold, and in the hot plate burn skin, it was 2.3-fold. Conclusion: The nanoemulsion seems to be a promising alternative for skin burns' topical treatment using this natural active.

517 Outcomes of Patients with Burns Associated with Home Oxygen Therapy: An Institutional Retrospective Review

IntroductionHome oxygen therapy (HOT) is frequently prescribed for patients with pulmonary dysfunction, which predisposes them to a unique health hazard at home. Prior studies show that HOT burns carry high morbidity and mortality, in large part due to inhalational injury. A significant portion of HOT patients are active smokers, which is the most frequent cause of HOT ignition. We conducted a retrospective review of patients with HOT related burns at our institution to characterize demographics and outcomes in this patient population.MethodsAn IRB-approved single-institution retrospective review was conducted by querying our institutional burn registry for patients diagnosed with head and neck burns between July 2016 and January 2021. Patients with burns due to HOT ignition were included. Patients were separated into three groups: i) discharged from the emergency department (ED), ii) observed for less than 24 hours, and iii) admitted to the hospital. Demographic and clinical outcome data were compared between groups.ResultsWe identified 100 patients with HOT burns, who were evaluated from 2016-2021, during which time we treated 3606 patients with burn injuries. Mean age was 66.6 ± 9.3 years with a male to female ratio of 1.3:1 and median TBSA of 1%. In these patients, 97% were on HOT for COPD and smoking caused 87.3% of burns. Thirteen were discharged from the ED, 35 observed for less than 24 hours, and 52 admitted. For admitted patients, 69.2% were admitted to the ICU with a median ICU stay of 1.5 days, 37% required intubation for a median duration of 1 day, and 11.5% required debridement and grafting with an average of 2.6 ± 1.6 procedures. Inhalational injury was found in 26.9% of patients, 3.9% underwent tracheostomy, and 17.3% experienced hospital complications. In-hospital mortality was 9.6% and 7.7% discharged to hospice. Among those admitted, median length of stay was 4 days and 67.3% discharged home. After discharge, 13.5% required readmission within 30 days. Patients admitted to the hospital had significantly higher rates of admission to the ICU, intubation, and inhalational injury compared to those that were not admitted (p < .01).ConclusionsMost HOT-related burns are caused by smoking and these injuries can result in significant morbidity and mortality. Efforts to educate and encourage smoking cessation with more judicious HOT allocation would assist in preventing these unnecessary highly morbid injuries.