Large Burns Research Articles

The influence of Muscle Wasting on Patient Outcomes among Burn Patients: A Burn Care Quality Platform Study.

The hypermetabolism that occurs after large burns leads to muscle wasting that can result in weakness, difficulty fighting infections, and other challenges to healing. Overall, rates of muscle wasting are not well established across burn centers. The Burn Care Quality Platform (BCQP), the largest available dataset on burn patients globally, was used to explore the rate of Muscle Wasting using data collected from more than 100 burn centers. "Muscle Wasting" was defined from relevant ICD codes (sarcopenia, muscle cachexia, protein malnutrition). Binomial and logistic regression were used to analyze the role of Muscle Wasting in burn mortality and other outcomes after controlling for demographic and comorbid characteristics. In total, the BCQP provided data from 84,438 adult and pediatric burn patients injured between 2000-2018. Only 2.6% (N=2,159) of the patients in the BCQP were diagnosed with having Muscle Wasting at some point during their admission. While Muscle Wasting was not associated with a statistically significant impact on mortality, it remained an independent predictor of inability to discharge to independent living, longer inpatient days, as well as an average of 10 additional surgical procedures (P<0.001 for all) as compared to patients who did not have Muscle Wasting. Muscle Wasting is an independent risk factor for several adverse outcomes in burn patients, but not mortality in the BCQP. Confidence in these findings would be improved with more accurate data collection, as the diagnosis of Muscle Wasting is likely under-reported, under-diagnosed, or both.

HOUSING TEMPERATURE ALTERS BURN INDUCED HYPERMETABOLISM IN MICE.

Mice used in biomedical research are typically housed at ambient temperatures (22-24 °C) below thermoneutrality (26-31 °C). This chronic cold stress triggers a hypermetabolic response that may limit the utility of mice in modeling hypermetabolism in response to burns. To evaluate the effect of housing temperature on burn-induced hypermetabolism, mice were randomly assigned to receive sham, small, or large scald burns. Mice recovered for 21 days in metabolic phenotyping cages at 24 °C or 30 °C. Regardless of sex or sham/burn treatment, mice housed at 24 °C had greater total energy expenditure (TEE, P < 0.001), which was largely attributable to greater basal energy expenditure (BEE) when compared to mice housed at 30 °C (P < 0.001). Thermoneutral housing (30 °C) altered adipose tissue mass in a sex-dependent manner. Compared to sham and small burn groups, large burns resulted in greater water vapor loss, regardless of housing temperature (P < 0.01). Compared to sham, large burns resulted in greater BEE and TEE in mice housed at 24 °C, however, this hypermetabolic response to large burns was blunted in female mice housed at 30 °C, and absent in male mice housed at 30 °C. Locomotion was significantly reduced in mice with large burns compared to sham and small burn groups, irrespective of sex or housing temperature (P < 0.05). Housing at 30 °C revealed sexual dimorphism in terms of the impact of burns on body mass and composition, where males with large burns displayed marked cachexia, whereas females did not. Collectively, this study demonstrates a sex-dependent role for housing temperature in influencing energetics and body composition in a rodent model of burn trauma.

Factors associated with delayed admission to the burn unit: A major burn center’s experience

BackgroundTimely admission to the burn unit is crucial. Ideal burn care requires prompt interventions such as wound and body temperature management, infection control, and fluid resuscitation to prevent complications like burn progression and infection. In this study, we identify specific factors and outcomes associated with delayed admission to a regional burn center. MethodsPatients admitted to a large urban burn center from January 2015 to December 2023 were retrospectively queried, with subsequent collection of demographic and outcome variables from chart review. Descriptive statistics, Welch’s t-tests of unequal variances, and Chi-square analysis were performed. Multiple logistic regression was performed to explore the association between delayed admission and ICU stay, ventilator requirements, and mortality. ResultsA total of 3137 patients were included in the study. Approximately 63.4 % of patients were admitted within 24 h, while 36.6 % had a significant delay in care of over 24 h after injury. Male patients were likely to experience delayed admission (39.0 vs. 31.8 %, p < 0.001). There was no significant difference in age between the two cohorts (38.6 vs. 39.7 years, p = 0.199). There was no significant difference in time to admission by racial background (p = 0.061). Total body surface area burned (TBSA) varied between the delayed and control cohorts (15.5±18.7 % vs. 8.2±12.9 %, p < 0.001). Patients who were single (p < 0.001) and lived alone (p = 0.011) were more likely to experience a delay in burn unit admission. Homelessness (p < 0.001), substance abuse disorder (p < 0.001), and uninsured status (p < 0.001) were also associated with delayed admission. In regression analysis when controlling for TBSA, delay in care was significantly associated with a greater requirement for ICU stay (p < 0.001) and mechanical ventilation (p = 0.021) but was not associated with increased mortality (p = 0.232). ConclusionSociodemographic variables such as homelessness, lack of social support, and substance abuse are associated with delayed burn unit admission. Knowledge of these factors can inform future interventions to improve outcomes for vulnerable patients, promoting better recovery and long-term outcomes after burn injury.

Evaluation of a National Sample of 16,671 Pediatric Burn Admissions: Identifying Predictors of Non-accidental Pediatric Burns

BackgroundBurn injuries remain one of the leading causes of injury and death in children. Studies have demonstrated a higher mortality for pediatric burns associated with non-accidental injury. Using data from a burn registry, our study aimed to discern potential factors associated with non-accidental burn injuries. MethodsWe utilized the American Burn Association database from 2016 to 2018, which collects data from over one hundred burn centers across the United States, to evaluate a large pediatric burn population. Patients aged ≤14 years were analyzed. The population was then divided into suspected non-accidental versus accidental burn injuries. A multivariable logistic regression model was utilized to evaluate for predictors of burn injuries. Additional models were used to assess the relationship between suspected non-accidental burn injury and mortality, intensive care unit (ICU) stay, and hospital length of stay. Results16,671 pediatric patients were included. Of those, 1228 (7.4%) patients suffered non-accidental burn injury. A majority of children who sustained non-accidental burn injury were younger, non-white, and sustained scald burns. The regression model demonstrated predictors for non-accidental burn injuries included younger age, Black race, chemical/corrosion burns, government insurance, and increased total body surface area (TBSA) burn. Overall mortality for the population was 0.5%. ConclusionThis evaluation of a national burn registry reveals differences in pediatric patients sustaining non-accidental burns compared to accidental burns. The findings in this study identify pediatric populations at risk for suspected non-accidental burn injuries which may assist in preparing the families for expectations after admission for a burn injury. Level of EvidenceIII.

Mapping PM2.5 Sources and Emission Management Options for Bishkek, Kyrgyzstan

Harsh winters, aging infrastructure, and the demand for modern amenities are major factors contributing to the deteriorating air quality in Bishkek. The city meets its winter heating energy needs through coal combustion at the central heating plant, heat-only boilers, and in situ heating equipment, while diesel and petrol fuel its transportation. Additional pollution sources include 30 km2 of industrial area, 16 large open combustion brick kilns, a vehicle fleet with an average age of more than 10 years, 7.5 km2 of quarries, and a landfill. The annual PM2.5 emission load for the airshed is approximately 5500 tons, resulting in an annual average concentration of 48 μg/m3. Wintertime daily averages range from 200 to 300 μg/m3. The meteorological and pollution modeling was conducted using a WRF–CAMx system to evaluate PM2.5 source contributions and to support scenario analysis. Proposed emissions management policies include shifting to clean fuels like gas and electricity for heating, restricting secondhand vehicle imports while promoting newer standard vehicles, enhancing public transport with newer buses, doubling waste collection efficiency, improving landfill management, encouraging greening, and maintaining road infrastructure to control dust emissions. Implementing these measures is expected to reduce PM2.5 levels by 50–70% in the mid- to long-term. A comprehensive plan for Bishkek should expand the ambient monitoring network with reference-grade and low-cost sensors to track air quality management progress and enhance public awareness.

Predictive analysis of lactate clearance on the prognosis of patients with large burns

Aims: To examine burn shock monitoring and the connection between lactate clearance and shock prognosis in individuals with severe burns. Materials and methods: This retrospective analysis comprised 100 patients with significant burns treated in our hospital between August 2017 and August 2021. The patients were split into two groups based on whether they survived or not: 50 cases each in the survival and death groups. Both groups had their blood lactate levels, partial pressure of oxygen, and other relevant indices tested. Analysis was done on the correlation between lactate level, lactate clearance, and death as well as the association between lactate clearance and prognosis at each time and point. Results: The lactate clearance rates at 6 h, 12 h, 24 h and 24 h in the survival group were greater than those in the death group, and the differences were significant (p &lt; 0.05). The lactate clearance rates at each time point were compared at a cut-off of 20%, and patients with 6 h and 12 h blood lactate clearance rates ≥20.0% had lower prognostic morbidity and mortality rates than those &lt;20.0%, with a significant difference (p &lt; 0.05). Conclusion: Lactate clearance is directly correlated with the prognosis of patients with severe burns, and survivors also have a high clearance rate. As a result, in patients with severe burns, lactate clearance monitoring during the shock phase can improve prognostic prediction and enable early treatment plan modification based on outcomes.

PANORAMA DA FISIOTERAPIA OFERTADA A PACIENTES COM SEQUELAS DE QUEIMADURA

Introduction: Burns are thermal, electrical, chemical or radioactive traumas that damage body tissues and can lead to death. Objective: To analyze the data and information collected in the system, referring to the quantity of physiotherapeutic care offered, by the SUS, to patients with burn sequelae, in Brazil, in the last 10 years. Materials and methods: Data were obtained from the DATASUS database. The collected data was organized in an Excel spreadsheet, displayed in graphs and analyzed based on scientific literature. Result: In Brazil, in the last 10 years, 97,685 physiotherapeutic services were offered to medium and large burn patients, through the SUS. The largest number of care for medium and large burn patients was concentrated in the northeast region of Brazil and the smallest number in the Central-West region. Conclusion: The study provided a broad overview of the physiotherapeutic care provided to patients with burns in Brazil over the last ten years.

Dioxin concentrations and congener distribution in biomass ash from small to large scale biomass combustion plants.

Biomass plays a pivotal role in global energy production, with a significant share allocated for industrial heat and power generation. The combustion of biomass generates biomass ash, which is widely utilized as a fertiliser. However, concerns arise regarding the presence of dioxins in biomass ash, which may limit its continued use. Dioxins are toxic compounds listed under the Stockholm Convention due to their persistence and detrimental effects on human health and the environment. This study investigates the dioxin content in biomass ashes produced in various combustion plants with a capacity of 1-50MWth in Estonia, where biomass is widely used for heating and power production. The research encompassed samples from nine biomass combustion plants with varying technical parameters considering both bottom and fly ash. Dioxin concentrations were determined for 7 polychlorinated dibenzo-p-dioxins (PCDDs), 10 polychlorinated dibenzofurans (PCDFs), and 12 dioxin-like PCBs (PCBs). The results indicate that dioxin TEQ content in all samples was well below the European Union's (EU) POP Regulation limit of 5µg TEQ/kg, with most values being at least tenfold lower. However, some samples failed to meet the EU Fertilising Products Regulation's threshold of 20ng TEQ/kg. Notably, fly ash exhibited higher dioxin concentrations than bottom ash. While PCBs were in significant concentrations, PCDDs dominated the overall dioxin TEQ content. This study provides essential insights into the dioxin content in biomass ash and its correlation with current EU regulatory limits. It also highlights the complex distribution of dioxin congeners, particularly PCBs, within biomass ash, emphasizing the continued research's importance.

The influence of fire mosaics on mammal occurrence in north-western Australia

BackgroundUnderstanding the relationship between fire and species habitat preferences is critical in an era of rapid environmental change. In northern Australia, large, intense, and frequent fires are thought to be a primary cause of mammal population declines, particularly through their influence on habitat suitability. Here, we used a large species presence database in combination with satellite-derived fire history data to assess the influence of fire attributes, including burn extent, frequency, and pyrodiversity, on the likelihood of occurrence of eight mammal species in north-west Western Australia.ResultsThe likelihood of occurrence declined for some species with an increasing proportion of recently burnt habitat and increased for most species with an increasing proportion of long unburnt habitat. The occurrence of six species was negatively correlated with increasing fire frequency, while the occurrence of four species was positively correlated with increasing pyrodiversity.ConclusionsOur results indicate that fire likely plays an important role in influencing mammal occurrence in the Pilbara and support previous research indicating that frequent large-scale burns have a mostly negative impact on small to medium-sized mammals in northern Australia. To improve mammal habitat suitability, land managers should aim to reduce the extent of large late dry season burns and increase the availability of mature spinifex grasslands.

Exercise and Heat Stress in Well-Healed Burn Survivors: Effects of Cooling Modalities on Thermal and Perceptual Responses.

Burn injuries that require grafting impair thermoregulation, which may dissuade individuals with such injuries from being physically active. We tested the hypothesis that cooling modalities attenuate core temperature elevations and perceptions of heat stress during physical activity in the heat among adults with well-healed burn injuries. Adults with no burn injuries (non-burned), 20-40% body surface area burn injuries (moderate burn), and > 40% body surface area burn injuries (large burn) performed 1 hour of moderate intensity exercise (2.5 ± 0.2 mph and 2% grade) on four different occasions in two environmental conditions (30 °C & 39 °C, 40% relative humidity). Within each environmental condition, we applied one of the following cooling modalities, random assigned, for each visit: no cooling (control), fan at 4 m/s (fan), water spray every 5 min (water spray; scaled to burn area size), or a combination of water spray + fan. In 30 °C, perceptual strain index (PeSI) was reduced in the non-burned and moderate burn groups with water spray + fan, whereas PeSI was reduced with all cooling modalities in the large burn group. The cooling modalities did not affect core temperature responses. In the 39 °C environment, water spray and water spray + fan attenuated the elevation in core temperature (p ≤ 0.007) only in the large burn group. In the moderate burn group, PeSI was decreased with water spray + fan (p = 0.017). In the large burn group, both water spray alone and water spray + fan (p ≤ 0.041) lowered PeSI. For both environments across burn groups, the applied cooling modalities were generally more effective at reducing indices of perceptual strain relative to indices of thermal strain (e.g., core temperature).

On the Analysis of Scale Effects of Flame Stabilization in Scramjet Combustors

Scale effects of flame stabilization in scramjet combustors at Mach 2.52 are investigated through experiments and numerical simulations based on two geometrically similar combustors. As the equivalence ratio increases, the combustion mode will change from Scram to Dual to Ram. However, the larger combustor has a delayed mode transition. The scale effects of flame stabilization are also reflected in the changes of heat release, precombustion shock train length, jet penetration depth, and reaction zone location. The combustion flowfields of different-scale combustors exhibit numerous differences under different combustion modes. However, after shortening the isolator of the proportionally scaled small-scale combustor, the combustion flowfield is closer to that of the large-scale combustor. Further analysis reveals the reason for the inconsistent scale effects of flame stabilization under different combustion modes. The probable reason is that the boundary layer, which does not change proportionally with the combustor scale, has different effects on the combustion under the three modes. Compared with the Scram and Ram modes, the scale effect in the Dual mode is the most significant because the strong interaction between heat release and the boundary layer amplifies the slight difference in the relative thickness of the boundary layer.

Effect of Low-Temperature Argon Plasma and Ultrasonic Cavitation on the Course of Burn Wound Healing

Background: Various physical phenomena come into use in medicine; however, to date, universal physical methods have not been developed to optimize the course of the wound healing at all treatment stages. In combustiology, the first stage of burn treatment is debridement; then it is important to create an optimal biological environment, normalize blood circulation, suppress pathogenic flora, and stimulate proliferative processes in the wound.Objective: To determine the effectiveness of low-temperature argon plasma (LTAP) and ultrasonic cavitation in deep burn wound treatment based on clinical observations and cytological findings.Materials and methods: We studied impression smears from burn wounds of 36 patients with deep burns of various etiologies who were treated using LTAP and ultrasonic cavitation in the Thermal Injuries Unit at the Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine (Saint Petersburg, Russian Federation) between 2022 and 2023.Results: We found that cytogram findings in the study area changed from the inflammatory type to the regenerative-inflammatory one on day 3-7 when LTAP and ultrasonic cavitation were used, while such change in the control area was observed only after 10 days of treatment. Thanks to the use of LTAP and ultrasound after necrosectomy for deep dermal burns, the wound preparation for autologous skin grafting takes less time than it does with standard methods of local burn wound care. Ultrasonic cavitation should be used in cases of severe exudation and slough, whereas LTAP should be used when reparative processes in a burn wound slow down.Conclusions: Burn wound treatment using ultrasonic cavitation and LTAP enables to prepare the wound surface for autologous skin grafting with a high engraftment rate. The procedure allows to effectively and atraumatically debride the wound and suppress pathogenic microflora. Further research is planned in patients with large deep burn wounds.

The Myofibroblast Fate of Therapeutic Mesenchymal Stromal Cells: Regeneration, Repair, or Despair?

Mesenchymal stromal cells (MSCs) can be isolated from various tissues of healthy or patient donors to be retransplanted in cell therapies. Because the number of MSCs obtained from biopsies is typically too low for direct clinical application, MSC expansion in cell culture is required. However, ex vivo amplification often reduces the desired MSC regenerative potential and enhances undesired traits, such as activation into fibrogenic myofibroblasts. Transiently activated myofibroblasts restore tissue integrity after organ injury by producing and contracting extracellular matrix into scar tissue. In contrast, persistent myofibroblasts cause excessive scarring-called fibrosis-that destroys organ function. In this review, we focus on the relevance and molecular mechanisms of myofibroblast activation upon contact with stiff cell culture plastic or recipient scar tissue, such as hypertrophic scars of large skin burns. We discuss cell mechanoperception mechanisms such as integrins and stretch-activated channels, mechanotransduction through the contractile actin cytoskeleton, and conversion of mechanical signals into transcriptional programs via mechanosensitive co-transcription factors, such as YAP, TAZ, and MRTF. We further elaborate how prolonged mechanical stress can create persistent myofibroblast memory by direct mechanotransduction to the nucleus that can evoke lasting epigenetic modifications at the DNA level, such as histone methylation and acetylation. We conclude by projecting how cell culture mechanics can be modulated to generate MSCs, which epigenetically protected against myofibroblast activation and transport desired regeneration potential to the recipient tissue environment in clinical therapies.

Scale effects on rotating detonation rocket engine operation

Rotating detonation rocket engines are propulsive devices employing detonation waves moving circumferentially around an annular channel that consume axially fed propellants. Theoretically, this provides benefits with respect to combustion pressure gain and thermodynamic efficiency when compared to deflagration-based combustors. To facilitate size scaling of these devices, the relationships between geometric parameters, performance, and wave dynamics have been investigated with gaseous methane-oxygen propellant. Empirical relations were derived between combustor geometry, fueling conditions, and engine operation, as well as correlation to thermodynamic parameters calculated with chemical kinetics codes. The radius of curvature effects were explored in annular combustors having outer diameters of 25 mm, 51 mm, and 76 mm with a fixed gap width of 5 mm. The injectors were scaled to have same oxidizer-to-fuel injector port area ratio, impingement distance, and injector-to-gap area ratio. Larger combustors had higher wave counts during operation at a given mass flux and equivalence ratio. Combustor axial pressures were found to be more dependent on propellant mass flux and equivalence ratio than geometry. Mass flux and the inner-to-outer radius ratio, the latter of which was related to other geometric ratios, dictated the operating mode transition thresholds and the number of resulting waves, respectively.

Effect of Passive Pre-chamber Igniting Position on the Large Bore Natural Gas Engine Combustion Characteristics

Effect of Passive Pre-chamber Igniting Position on the Large Bore Natural Gas Engine Combustion Characteristics

Case report of pharmacokinetic analysis of continuous intravenous infusion of fentanyl in a patient with severe burn: burn shock stage complicates pain management

BackgroundFentanyl is widely used as an analgesic and sedative for patients with severe burn injuries in intensive care units. However, pharmacokinetic (PK) data for fentanyl, particularly for continuous intravenous infusion during the acute phase of burn injuries, are limited. Here, we report the clinical course and changes in blood fentanyl concentrations during the acute phase in a patient with severe burns treated with continuous intravenous infusion of fentanyl.Case presentationA woman in her 40s, with burns caused by a gas cylinder explosion, was transported to our hospital. The patient had burn wounds on face, neck, shoulders, and all four extremities, with a total burn area of 39.0%. For pain relief, the patient received a continuous infusion of 0.01 mg/mL fentanyl (20–30 µg/h) with a target blood concentration of 1.0–1.5 ng/mL, but continued to suffer from pain due to burning during the acute phase. We measured the blood fentanyl concentrations and found that all concentrations obtained during the acute phase were subtherapeutic. Notably, during the burn shock stage, blood concentrations of fentanyl were 0.50 ng/mL on day 1 and 0.66 ng/mL on day 2, indicating that the blood concentration did not rise sufficiently for the dosage. From days 0 to 2, the patient was administered a massive fluid load for burn shock. After the burn shock stage resolved, fentanyl concentrations gradually approached the target range, and the pain rating scale improved, even though the fentanyl administration rate remained unchanged (30 µg/h).ConclusionsMajor changes in the fluid volumes of body compartments that occur with large burns might increase the volume of fentanyl distribution, thereby lowering its concentration when a standard dose is administered. Our findings indicate that the PK of fentanyl in patients with severe burns can be substantially affected, especially during the shock phase, implying the importance of titrating analgesics for clinical efficacy in the acute phase.

Selective enzymatic debridement and modified Meek technique in the treatment of extensive burns: Preliminary observations.

Selective bromelain-based enzymatic debridement (BED) has emerged as a valid alternative for the treatment of extensive burns, with Total Body Surface Area (TBSA) > 20%. Autologous skin grafting represents the procedure of choice but the scarcity of donor sites remains the main reconstructive challenge. The modified Meek micro-grafting technique may represent a valid strategy to optimize the final outcome. A single-cohort retrospective analysis was performed, involving nine burn patients (TBSA > 20%) who underwent both BED and subsequently modified Meek technique. Demographic and clinical data (mechanism of injury, surgical treatment, complications, necessity of re-grafting, further surgery and esthetic outcome) were collected. All patients had large burns of mixed and deep dermal thickness (first, second, and third degree). All burns were enzymatically debrided postadmission and covered by the modified Meek technique. Local infection due to poor general conditions was the main complication for all patients. All but two patients survived. The selectiveness of the enzymatic debridement and dermal preservation seemed to improve the quality of scars resulting from micro-grafting. Evaluations performed at 12 ± 2 months postburn showed superior scar quality compared to areas treated with traditional (sheet/mesh) grafts. Combined BED and Meek techniques may provide an effective synergic combination for the treatment of extensive burns.

Pathophysiology of the gastrointestinal tract in burn disease

The review of foreign publications resulted in a generalisation of medical reports on the pathological changes of the gastrointestinal tract in burn disease. Burn disease produces an immediate reaction in all organs and systems, which are not always able to maintain homeostasis and frequently suffer pathophysiological and morphological damage. One of those target systems is the gastrointestinal tract. Only in very rare cases do severe (mainly electrical) burns cause direct injury to the abdominal cavity organs, thus resulting in a very severe clinical course and high mortality. Patients of all ages who have experienced a burn injury have an increased overall risk of developing gastrointestinal diseases, which include pathology of the esophagus, stomach, and intestines, as well as lesions of the gallbladder, biliary tract, and pancreas. With a burn area of 40—95%, 5.7% of the victims were diagnosed with pathology of the abdominal organs. Among them, 26.0% had an abdominal catastrophe (infarction or perforation), 37.0% had bleeding from the upper parts of the gastrointestinal tract, 32.0% had paralytic intestinal obstruction, and 5.0% developed pancreatitis and acute necrotizing cholecystitis. Large burns are usually associated with a significant decrease in splanchnic perfusion. After severe burns, intestinal ischemia and hypoxia disrupt the intestinal epithelial barrier and enteric bacterial translocation, leading to serious complications such as systemic inflammatory response syndrome, sepsis, and multiple organ failure. Peritonitis or gastrointestinal bleeding accounted for 88.2% of deaths among patients with gastrointestinal dysfunction. In general, gastrointestinal dysfunction was more common in patients with inhalation injuries, burn shock, large burn areas, and high analgesic requirements.

Cultured Skin in the Modern Era and the Impact of Infrastructure Volatility on Learning Curves: A 33-Year Institutional Review

Abstract Finding a perfect epidermal transplant remains a holy grail of burn surgery. The epidermis is a site of stem cells that allows for the epithelial regeneration. The use of CEA for the treatment of major burns was first reported in 1981. CEA requires specialized skills; thus, reports from different burn-centers have shown mixed results. Comparing our modern data with past data shows how this field has advanced while maintaining institutional control. We performed a retrospective analysis of all patients admitted between 01/01/1988-12/31/2021 for massive burns that were managed with CEA. Patients were divided into pre-defined groups: G1(early-era)=1988-1999, G2(pre-modern-era)=2000-2010, and G3(modern-era)=2011-2021. We compared demographics, %TBSA, presence of inhalation-injury, LOS, complications, and mortality. We treated 52 patients with CEA during the study period. In the modern-era, we found 11 patients; in the pre-modern-era, 10; and in the early-era, 31. Injury characteristics, including %TBSA and the presence of inhalation-injury, were not significantly different between the groups. We observed lower mortality rates in G1 and G3 (G1:20% vs. G2:42% vs. G3:27%, p&amp;lt;0.05), although the predicted mortality was not significantly different between the groups (G1:50% vs. G2:47% vs. G3:49%, NS). Patients in G1 also had a shorter hospital LOS, in days, (G1:90 vs. G2:127 vs. G3:205, p&amp;lt;0.05). Finally, the surface-area grafted per patient was the highest in G2 (G1:2,000cm2 vs. G2:4,187cm2 vs. G3:4,090cm2, p&amp;lt;0.01). CEA has not gained popularity despite proven positive outcomes. Our retrospective analysis showed that CEA should be considered as a treatment option for patients with large burns, given proper training and infrastructure.

Effectiveness of Autologous Skin Cell Suspension in Large Total Body Surface Area Burns: Analysis of Clinical Outcomes and Patient Charges

Abstract Autologous skin cell suspension (ASCS) is an adjunct to conventional split-thickness skin grafts (STSG) for acute burns, enhancing healing and reducing donor site requirements. This study validates ASCS’s predictive benefits in hospital stay reduction and cost savings by analyzing outcomes and real-world charges post-ASCS implementation at a single institution. A retrospective study (2018-2022) included burn patients with ≥10% TBSA. The study population comprised 2 groups: burns treated either with a combination of ASCS ± STSG or with STSG alone. Outcomes included LOS, surgeries, infection, complications, days on antibiotics, and adjusted charge per TBSA. The ASCS ± STSG group demonstrated significantly shorter LOS (Mdn: 16.0 days, IQR: 10-26) than the STSG group (Mdn: 20.0 days, IQR: 14-36; P = .017), and fewer surgeries (Mdn: 1.0, IQR: 1-2) versus the STSG group (Mdn: 1.0, IQR: 1-4; P = .020). Postoperative complications were significantly lower in ASCS ± STSG (11% vs. 36%; P &amp;lt; .001). The STSG group had a longer distribution of antibiotic days (IQR: 0-7.0, min–max: 0-76) than the ASCS ± STSG group (IQR: 0-0, min–max: 0-37; P = .014). Wound infection incidence did not differ (P = .843). ASCS ± STSG showed a lower distribution of adjusted charge per TBSA (IQR: $10 788.5-$28 332.6) compared to the STSG group (IQR: $12 336.8-$29 507.3; P = .602) with a lower mean adjusted charge per TBSA ($20 995.0 vs. $24 882.3), although this was not statistically significant. ASCS ± STSG utilization demonstrated significant reductions in LOS, surgeries, postoperative complications, antibiotics, and potential cost savings. These findings underscore the practicality of integrating ASCS in burn management, offering substantial benefits to patients and healthcare institutions.