Management Of Burns Research Articles

Medical and Surgical Care of Critical Burn Patients: A Comprehensive Review of Current Evidence and Practice.

Critically ill burn patients pose several unique challenges to care providers. The concepts of fluid resuscitation, nutritional management, organ support and wound care are rapidly evolving. There is a pressing need to review emerging evidence and incorporate these into practice for the effective management of burn patients.We have searched the PubMed and Google Scholar databases to review the current evidence on the acute care management of adult as well as paediatric burn patients. The rationales for current practices have been integrated into the review. The management of critically ill burn patientsrequires an in-depth knowledge of the pathophysiology of burn injury, a tailored approach for timely resuscitation, timely diagnosis oforgan specific problems, andcomprehensive wound care. This review will help the doctors and healthcare providers involved in the management of critical burn patients in their day-to-day practice.

Effectiveness of Planed Teaching Program on knowledge regarding First Aid Management and emergency care of burn among the staff nurses working in selected hospital in Azamgarh, Uttar Pradesh, India.

The aim of the present study was to assess the knowledge of staff nurses regarding first aid management and emergency care of burn among 60 nurses by using quasi experimental design. The tool consist of two parts first was deal with demographic variable and the second was consist of 40 multiple choice questions selected emergencies among burn patients. In pre-test knowledge scores of nurses is 12.76 and standard deviation 1.935. In post test knowledge scores of nurses is mean 27.68 and standard deviation was 3.766. There was statistical improvement seen after planed teaching. Thus the study recommended that different educational session regarding emergency care of burn will be effective to promote the knowledge of nurses regarding.

The Accuracy of Prehospital Fluid Resuscitation of Burn Patients: A Systematic Review

Early management of burns is an essential component of achieving desirable patient outcomes. One of the earliest points of patient management in the case of burn injuries is in the prehospital setting. Unlike first aid, which can be provided by a non-healthcare worker, fluid resuscitation can be provided in the prehospital setting by emergency medical services personnel. This systematic review aims to investigate whether burn patients are receiving accurate fluid resuscitation in the prehospital setting. In addition, it will investigate if existing inaccuracies could impact patient outcomes negatively. This systematic review was completed in accordance with the guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search for eligible studies started by searching relevant databases (PubMed, Embase, Medline, and Google Scholar). The selected studies were screened, and data were extracted and analyzed using a narrative synthesis approach. Seven studies met the inclusion criteria of this review, with a total of 961 patients. All seven studies included in this review reported that the volume of fluids for resuscitation purposes received by burn patients in the prehospital setting was inaccurate. However, most reported that the patient outcomes were not affected. Most of the studies were rated as “good,” however, and further high-quality randomized control studies are required before strong recommendations can be made.

Management of Facial Second-Degree Burns with Nanocellulose-Based Dressing: A Case Series and Systematic Review.

Previous studies have evaluated the effectiveness of bacterial nanocellulose (BNC) for the treatment of thermal injuries, but the synergic effect of platelet-rich plasma (PRP) with BNC-based dressing for burns still requires further investigation. Herein, we evaluated the effectiveness of BNC dressings in the management of facial burns using PRP. Patients with second-degree facial burns were treated with BNC-based wound dressings after debridement. The burn's depth and epithelialization were evaluated by clinical assessment. Besides using the dressings, we injected PRP subcutaneously into the left-hemifacial burns. The right hemiface was only treated with the dressings. Scar quality was assessed using the Patient and Observer Scar Assessment Scale (POSAS). Eight patients were included with superficial second-degree burns in 75% of the cases and deep second-degree burns in 25%. Overall, dressings were placed 3.25 days after the initial insult. None of the patients presented with complications after dressing placement. Dressing changes were not required, and no further surgical management was necessary. The mean time for epithelialization was 11.4 days. During subgroup analysis, we did not find a significant difference in the epithelialization time when comparing BNC-based dressings (11.8 days) to BNC-based dressings + PRP (11 days, p = 0.429). The mean POSAS scores from a patient (17 vs. 12.3, p = 0.242) and surgeon (13.5 vs. 11.3, p = 0.26) standpoint were not significantly different using BNC-based dressings versus BNC-based dressings + PRP. Nanocellulose-based dressings are effective to treat second-degree facial burns. It enhances reepithelialization with optimal esthetic outcomes with or without PRP.

A nonsurgical approach in management of burns induced microstomia: a review

Burns of head and neck region causes skin contracture which will result in microstomia and loss of skin flaccidity. The prevention and management of microstomia contracture is an important aspect of facial burn. The goal of microstomia repair include the reconstruction of orbicularis sphincter for adequate lip functioning, obtaining lip symmetry and well positioned scar and adequate mouth opening. The standard treatment for the prevention and management of contracture includes compression therapy, grafting, mouth splinting, scar massage, excercise, patient education. These types of maxillofacial prosthetic appliances may be indicated, in conjunction with or without surgery these appliances can be use to improve the reduced mouth opening caused by burns or other traumatic injuries With proper education and motivation of operator and the patient use of these appliances will not only improve the reduced mouth opening but also improve form, function, esthetics, and also enhance the patient’s quality of life.

A stylized two-stage debridement strategy using an electric dermatome and a Versajet™ hydrosurgery system for deep axillary burns.

Treatment of axillary contracture after extensive deep burns is a serious clinical challenge. Various surgical intervention for releasing contracture using skin grafts, flaps and artificial skin have been used, but no consensus on the optimal treatment has been obtained. A standardized two-stage debridement strategy using an electric dermatome (for eschar) and the Versajet™ hydrosurgery system (for slough) can be an appropriate debridement strategy that provides reliable wound bed preparation in cases of for axillary deep burns. Using this approach focus on management of acute axillary burns, it is possible to avoid engraftment failure and prevent contracture caused by prolonged infection. This treatment strategy can be standardized and can be performed easily, even by non-experts.

The Effect of COVID-19 on Burn Management and Outcomes in a Resource-Limited Setting

The Effect of COVID-19 on Burn Management and Outcomes in a Resource-Limited Setting

Three-Dimensional Printed Cellulose for Wound Dressing Applications.

Wounds are skin tissue damage due to trauma. Many factors inhibit the wound healing phase (hemostasis, inflammation, proliferation, and alteration), such as oxygenation, contamination/infection, age, effects of injury, sex hormones, stress, diabetes, obesity, drugs, alcoholism, smoking, nutrition, hemostasis, debridement, and closing time. Cellulose is the most abundant biopolymer in nature which is promising as the main matrix of wound dressings because of its good structure and mechanical stability, moisturizes the area around the wound, absorbs excess exudate, can form elastic gels with the characteristics of bio-responsiveness, biocompatibility, low toxicity, biodegradability, and structural similarity with the extracellular matrix (ECM). The addition of active ingredients as a model drug helps accelerate wound healing through antimicrobial and antioxidant mechanisms. Three-dimensional (3D) bioprinting technology can print cellulose as a bioink to produce wound dressings with complex structures mimicking ECM. The 3D printed cellulose-based wound dressings are a promising application in modern wound care. This article reviews the use of 3D printed cellulose as an ideal wound dressing and their properties, including mechanical properties, permeability aspect, absorption ability, ability to retain and provide moisture, biodegradation, antimicrobial property, and biocompatibility. The applications of 3D printed cellulose in the management of chronic wounds, burns, and painful wounds are also discussed.

Amphiphilic Chitosan Porous Membranes as Potential Therapeutic Systems with Analgesic Effect for Burn Care.

Eliminating or at least lessening the pain is a crucial aspect of burns management, as pain can negatively affect mental health and quality of life, and it can also induce a delay on wound healing. In this context, new amphiphilic chitosan 3D porous membranes were developed and investigated as burns therapeutic systems with analgesic effect for delivery of lidocaine as local anesthetic. The highly porous morphology of the membranes and the structural modifications were evidenced by scanning electron microscopy (SEM), energy dispersive X-ray (EDX) analysis and infrared spectroscopy (FTIR). Improved compression mechanical properties, long-term hydrolytic degradation (28 days) evaluation and high swelling capacities (ranging from 8 to 22.6 g/g) indicate an increased capacity of the prepared membranes to absorb physiological fluids (burns exudate). Lidocaine in vitro release efficiency was favored by the decreased content of cross-linking agent (reaching maximum value of 95.24%) and the kinetic data modeling, indicating that lidocaine release occurs by quasi-Fickian diffusion. In addition to the in vitro evaluation of analgesic effect, lidocaine-loaded chitosan membranes were successfully investigated and proved antibacterial activity against most common pathogens in burns infections: Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus.

The Impact of Different Oxygen Delivery Methods on Corneal Epithelial Repair after Injury.

The hyperbaric oxygen therapy is often used in the management of acid and base burns of the eyes. However, oxygen is rarely supplied locally through goggles or face mask in ophthalmology. Therefore, in this study, we aim to investigate how oxygen delivery affects eye recovery after injury. We used a rabbit model with corneal epithelial injury to examine the effects of local oxygen supply via goggles or face mask on the recovery of cornea. A total of 75 healthy New Zealand white rabbits were randomly divided into three groups, A, B, and C, with 25 rabbits in each group. Then, on each rabbit eye (150 eyes in total), a circle of corneal epithelium with 5 mm in diameter was scraped off from the center of the cornea with a corneal epithelial scraper. Group A was given oxygen goggles every day (the oxygen flow rate was 3 L/min, once a day, 2 hours each time); group B was given nasal inhalation of oxygen every day (the oxygen flow rate was 3 L/min, once a day, 2 hours each time); and group C did not receive any treatment and was healed naturally. We found that the group A, which received oxygen supply via goggles, showed the best eye recovery. Transmission electron microscopy showed that the cornea with local oxygen supply via goggles or face mask exhibited intact capillary structure and obvious desmosome/hemidesmosome connections between cells. Moreover, the protein and RNA levels of hypoxia-related genes were lower in group A and B, suggesting that the hypoxia factor is a sensitive and early regulator in the low oxygen environment.

WITHDRAWN: Acute management of deep periorbital burns – A 10 year review of experience

• Deep periorbital burns account for three-fourths (74.8%) of hospitalized deep facial burns, i.e. for 10.9% of all inpatient burns. • Groups at risk are toddlers of 1– 3 years and men within the age of 30-45 years. • The prevailing amount of surgery is done before the 10 th day post-injury. • Timely and judicious acute treatment reduces initial damage and late sequelae. • Preservation of vision is a determining factor for the effectiveness of treatment. Deep periorbital burns are an important issue mainly due to the presence of the eyes in the region, and the crucial importance of preservation of vision. There is no consensus regarding their treatment. A retrospective analysis of the treatment and outcome of 446 patients with deep burns of the periorbital region admitted in the Department of Burns and Plastic Surgery of St George’s University Hospital in Plovdiv, Bulgaria over 10 years was conducted. The study covers 446 patients, 162 female (36.5 %) and 284 - male (63.5 %) aged from 5 months to 92 years. Deep periorbital burns accounted for three-fourths (74.8%) of hospitalized deep facial burns, i.e. for 10.9% of all inpatient burns. The age break down shows peak values for toddlers (1-3 years) and adults over 45 years Most frequent burn agents were hot liquids and flames. The mean total body surface area affected was 19.6% (min 0.5%, max 80.0%). Concomitant ocular pathology was diagnosed in 14% (n=63) of the patients. An early, staged and precised surgical approach was preferred aimed at fast wound closure without sacrificing survived tissues. Follow up time ranged from 3 months to 5 years, median 37 months. Late ocular sequelae occurred in 7.4% (n=33) of the patients. There was no incidence of secondary corneal perforation or definitive loss of vision. Timely and adequate treatment during the acute period can minimize initial damage and late sequelae. Favor is given to the early, balanced surgical approach aimed at rapid wound closure between day 2 and 10 post burn. Preservation of vision is a determining factor for the significance of trauma and the effectiveness of treatment.

Chlorhexidine chemical burn in hand surgery: A case review and recommendations for prevention

Chlorhexidine gluconate (CHG) is one of the most commonly used antiseptic agents for pre-procedural skin preparation and is generally considered safe; however, there are reports that, under certain circumstances, CHG can cause chemical burns. This case report highlights the occurrence and management of a CHG chemical burn in a pediatric patient undergoing upper extremity surgery with a tourniquet despite the use of routine protective measures.

Medicinal herbs in the management of Common Skin disease – Ethno Botanical Approach

The acceptance and appreciation of herbal medicine is rising day by day. One of the significant reasons in growing this significance is the alertness of normal remedies being additional efficient and less dangerous than synthetic drugs. Skin health is imperative aspect of primary health care among many communities, because of the enhance challenge of HIV-AIDS, skin conditions being among the common opportunistic diseases in immune-compromised individuals. India has a rich myths of therapeutic plant on healthcare. A huge number of formulations have been used in India for management of cuts, wounds, burns and various skin disorders. The present review attempts to investigate the ethno botanical information foundation for dealing of various skin diseases. The medicinal plants used in this review are arranged alphabetically followed by family name; parts used and explained the Siddha herbs completely used in the skin disease with references.

Initial Pain Assessment and Management in Pediatric Burn Patients Presenting to a Major Trauma Center in Saudi Arabia.

Pediatric burn injury is a traumatic experience for affected children and their families. Burn pain is frequently undertreated and may adversely affect patient experience and outcomes. The aim of this study was to investigate the current practice of initial pediatric burn pain assessment and management at a major trauma center in Riyadh, Kingdom of Saudi Arabia. We conducted a retrospective cohort study that included children 14 years and younger who visited King Saud Medical City in the Kingdom of Saudi Arabia with a presenting complaint of burn injury from January 01, 2017 to August 30, 2018. Variables were reported using descriptive statistics as appropriate. The 309 patients who were analyzed were classified into 3 age groups ranging from 0 to younger than 3 years (61%), 3 to 7 years (24%), and older than 7 years (15%). They included 145 (47%) female and 164 (53%) male patients. Pain levels of 182 patients (59%) were documented using an age-appropriate tool. In 75 children (24%), pain levels were documented using an alternate tool, and the tool used was not defined for 44 children (14%). Pain assessment was not documented for 8 children. Of those with an age-appropriate tool, the median initial pain score was 4 (interquartile range [IQR], 2-4). Analgesia was recorded to have been administered to 139 patients (45%), within a median time of 50 minutes (IQR, 17-154 minutes) to first analgesia. Among patients who had appropriate assessment of pain, 92 (50.3%) received analgesia compared with 52 (41.3%) who did not have appropriate assessment (P = 0.12). Among patients who had appropriate pain assessment, time to analgesia was 42 minutes (IQR, 15-132 minutes) compared with 53 minutes (IQR, 17-189 minutes) among patients who did not have appropriate assessment (P = 0.48). Most pediatric patients presenting with burns had pain assessment, but a substantial proportion of children were not managed using recommended age-specific tools. The use of age-specific tools was not necessarily associated with delivery of analgesia. For pediatric burns, prompt delivery of analgesia should be prioritized with pain assessment using age-appropriate tools being recommended, but optional.

Nanolipogel Loaded with Tea Tree Oil for the Management of Burn: GC-MS Analysis, In Vitro and In Vivo Evaluation.

The GC-MS analysis of tea tree oil (TTO) revealed 38 volatile components with sesquiterpene hydrocarbons (43.56%) and alcohols (41.03%) as major detected classes. TTO efficacy is masked by its hydrophobicity; nanoencapsulation can address this drawback. The results showed that TTO-loaded solid lipid nanoparticles (SLN1), composed of glyceryl monostearate (2% w/w) and Poloxamer188 (5% w/w), was spherical in shape with a core-shell microstructure. TTO-SLN1 showed a high entrapment efficiency (96.26 ± 2.3%), small particle size (235.0 ± 20.4 nm), low polydispersity index (0.31 ± 0.01), and high negative Zeta potential (−32 mV). Moreover, it exhibited a faster active agent release (almost complete within 4 h) compared to other formulated TTO-SLNs as well as the plain oil. TTO-SLN1 was then incorporated into cellulose nanofibers gel, isolated from sugarcane bagasse, to form the ‘TTO-loaded nanolipogel’ which had a shear-thinning behavior. Second-degree thermal injuries were induced in Wistar rats, then the burned skin areas were treated daily for 7 days with the TTO-loaded nanolipogel compared to the unmedicated nanolipogel, the TTO-loaded conventional gel, and the normal saline (control). The measurement of burn contraction proved that TTO-loaded nanolipogel exhibited a significantly accelerated skin healing, this was confirmed by histopathological examination as well as quantitative assessment of inflammatory infiltrate. This study highlighted the success of the proposed nanotechnology approach in improving the efficacy of TTO used for the repair of skin damage induced by burns.

Burns of oral mucosa – A review

The objective of this review is to understand burns of oral mucosae as a type of injury, the different etiologies, clinical features and management of these oral burns in clinical practice. This review aims to aid dentists to evaluate and assess patients sustaining burn injuries in a better way and to understand the varied treatment protocols for particular types of burns in order to help patients restore their oral health.Articles from PubMed and Google Scholar (from1991 to 2019) were reviewed. All articles relevant to the topic, case reports and literature reviews were included in this review. No articles were excluded.All included articles suggested that burns are a type of tissue injury that can produce localized or diffuse areas of tissue damage depending on the severity and extent of the insult. Burns of the oral mucosa may be caused by thermal, mechanical, chemical, electrical or radiation injury. Thermal burns are usually caused due to ingestion of high temperature foods or drinks. Similarly, chemical burns occur due to exposure of oral mucosa to acids or alkalis or certain drugs. Electrical burns are less common, however, they are mostly noted in children due to biting onto electrical cables or wires etc. Clinical features of all types of burns range from whitish red erythema to necrotic patches. The sites of burns usually vary based on their etiology. Although, there are some contemporary guidelines, there exists no specific standard of care with regards to management of different kinds of burns. This article aims to form a general review of burns of the oral mucosa and its treatment guidelines.

The Role of the Outpatient Occupational Therapist Treating Patients With Small Burns: A Retrospective Audit of Practice.

Current Australian burn care practice guidelines recommend therapies prescribed for burn injuries, irrespective of burn size. These guidelines have been informed by research related to large burns and associated treatment burden. This article describes the clinical management of small burns by occupational therapists at a large tertiary facility in Australia. A retrospective clinical chart audit was conducted for the 12-month period from January to December 2019. Participants were eligible if they had sustained a burn of 1% TBSA or less. Eligibility criteria were met for 454 patients, reflecting 77% of new outpatients in 2019. Of these, 247 or 54% of patients saw an occupational therapist. Noninvasive therapies such as scar massage, compression, silicone and taping were prescribed for 35%, 32.6%, 22.6%, and 5.9% of patients, respectively. Occupational therapist involvement was more likely postsurgical intervention (84.5%). The data presented contribute to limited research available for the management of small burns. Findings reflect use of traditional forms of therapies for small scar management; however, there appeared little use of alternative therapies, such as tapes, which may be beneficial. This study highlights the potential need for current standard practice guidelines be nuanced according burn surface area.

Utilization of chest tube as an esophagus stent in pediatric caustic injuries: A retrospective study.

BACKGROUNDThe management of caustic esophageal burns in the pediatric population has changed over the years, while the most optimal management with regards to effectiveness, availability, and cost-beneficent stays controvertible. AIMTo describe how to utilize a chest tube for esophageal stenting in pediatrics.METHODSData regarding the etiology, treatment, and complications of caustic injury in pediatrics over 10 years was collected retrospectively. Furthermore, data regarding the patient's follow-up who underwent esophageal chest tube (ECT) were collected. The ECT was prepared by carving a narrowed section in the chest tube while maintaining the radiopaque section. The ECT will then be positioned from the cricopharyngeal and exited through the nostril and fixed on the patient's cheek.RESULTSDuring the period of our study, data from 57 patients with an average age of 2.5 years (range 1-12; SD = 1.7) were obtained. The results showed that 89% of esophageal injury was due to alkaline and 9.4% were caused by acidic agents. The treatment methods showed that 29 patients (50.8%) recovered with dilatation alone. In 16 patients (28.06%), the esophageal repair was performed by using the colon, and in 5 patients (8.7%), other surgical methods were used and in 7 patients (12.2%), the ECT stents were used. ECT was inserted in 7 cases with a mean age of 2 (range: 1.5-3) years who were classified as grade IIB or III. Grading was performed by endoscopy assessment on the first day. Antibiotics and corticosteroids were administrated as initial medical management for all patients. ECT implantation was done during the first 8 d for 5 out of 7 cases (mean: 3.8 d). For the 2 patients, ECT was used after 27 (patient 6) d and 83 (patient 7) d. The reason for late stenting in these patients was a postponed referral to our center, in which patient 7 even received 4 dilation episodes before visiting our center. ECT was removed after an average of 44 d in the first 5 patients, while in the other 2 patients (6 and 7) was 2 and 1 wk, respectively. There was no complication related to, or failure of, stent placement. It is worth mentioning that none of the 7 ECT cases required gastrostomy or jejunostomy.CONCLUSIONThe ECT method introduced in our study can be used as a broadly available, economic, and easy-use facility for esophageal stenting, particularly in developing countries and emergency departments which have limited access to modern equipment. Further multicenter studies with higher volume patients are required for further deployment of this method.

The Use of Infrared Thermography (IRT) in Burns Depth Assessment: A Diagnostic Accuracy Meta-Analysis

Background: The timely diagnosis of burns depth is crucial to avoid unnecessary surgery and delays in adequate management of patients with burn injuries. Whilst it is mostly a clinical diagnosis, indocyanine green, laser Doppler imaging and infrared thermography have been used alongside clinical findings to support the diagnosis. Infrared thermography is a noninvasive technique which uses temperature differences to diagnose tissue burn depth. Our study aims to assess its use in differentiating between superficial and deep burns. Methods: We conducted a systematic literature review and meta-analysis using electronic databases. We used a mixed-effects logistic regression bivariate model to estimate summary sensitivity and specificity and developed hierarchical summary receiver operating characteristic (HSROC) curves. Results: We identified 6 studies reporting a total of 197 burns, of which 92 were proven to be deep burns. The reference standard was clinical assessment at the time of injury and burn healing time. The pooled estimates for sensitivity and specificity were 0.84 (95% CI 0.71–0.92) and 0.76 (95% CI 0.56–0.89), respectively. Conclusions: IRT is a promising burns assessment modality which may allow surgeons to correctly classify burn injuries at the time of presentation. This will allow a more efficient management of burns and timely surgical intervention.

Sterile thermoresponsive formulations for emergency management of burns

Initial care and treatment of burn injuries significantly influence their healing and appearance. The apt treatment for a burn patient normally depends upon the severity of the burn. This study was intended for the development of thermo-responsive formulations for the emergency management of burns prior to hospitalization.Nano calcium sulfate was prepared by probe sonication and nano copper oxide by thermal decomposition method and subsequently evaluated for particle size and poly-dispersity index. Formulations were prepared with 100 ppm of nano calcium sulphate, nano copper oxide and thermoresponsive polymers such as Poloxamer-407/ Chitosan/chitosan + Sodium β -glycerophosphate in different ratios. The products were evaluated for pH, viscosity and gelation time and those formulations which exhibited optimum viscosity, pH and gelation time were sterilized and evaluated for elemental content, skin irritation potential and in vivo burn healing activity.Nano calcium sulfate and nano copper oxide exhibited an average particle size of 220 nm and 273 nm correspondingly. SEM-EDX of selected formulations showed intense peaks of calcium and copper in all formulations. Acute dermal irritation study carried out on rabbits showed that the formations were non-irritant in nature. The percentage of wound contraction was greater in burn wounds treated with the formulation containing poloxamer-407 when compared to commercial Silverex™ ionic gel and the control group. The healing actvity of the thermoresponsive formulations was supported by histopathological studies.Nano calcium sulfate and nano copper oxide incorporated thermo-responsive formulations with burn wound healing activity were developed successfully.