Partial Burns Research Articles

Bromelain-Based Enzymatic Debridement Versus Standard of Care in Deep Burn Injuries: A Systematic Review and Meta-Analysis.

Deep burn injuries necessitate effective debridement to promote healing and reduce complications. Traditional surgical debridement is the standard of care; however, it can lead to significant tissue loss, excessive bleeding and delayed healing. Bromelain-based enzymatic debridement offers a potential less invasive alternative that aims to selectively remove necrotic tissue while preserving viable ones. Therefore, this systematic review and meta-analysis comprehensively compares bromelain debridement versus standard care in the management of partial and full-thickness burns. Cochrane Library, Embase, and Medline were searched until May 30th, 2024 for studies comparing bromelain debridement versus standard care. R version 4.4.0 was used to pooled risk ratio and mean difference in a random-effects model. We included seven studies, comprising 484 participants, of whom 238 (49%) were treated with enzymatic debridement. Bromelain significantly reduced time to eschar removal (MD - 7.60 days 95% CI [-9.76, -5.44]; I² = 70%) in comparison with standard care. Additionally, bromelain group presented a significant reduction in the risk of surgical excision (RR 0.17; 95% CI [0.06, 0.47]; I² = 79%) and need for autografts (RR 0.40; 95% CI [0.18, 0.93]; I² = 76%) in comparison with standard group. No differences were found in behalf of time to wound closure (MD -7.64; 95% CI [-18.46]-[3.18]; I2 = 86%), nor in Modified Vancouver Scar Scale (MD -0.36; 95% CI [-0.96]-[0.23]; I2 = 0%). Bromelain-based enzymatic debridement may accelerate eschar removal and reduce the need for surgical excision and autografts, without adversely affecting wound closure time or long-term scar quality.

Caregivers and Clinic Providers View Soft Casts for Pediatric Hand Burns as Acceptable and Feasible: A Mixed Methods Survey.

Soft casts have been introduced as an efficacious strategy to manage hand burns that simplifies wound care for families. We hypothesized that the outpatient use of soft casts in pediatric hand burns would be viewed as acceptable by patient caregivers and providers, logistically feasible, and result in satisfactory clinical outcomes. A review was performed of pediatric clinic patients managed with soft casts since implementation (9/2022 - 9/2023). Patient caregivers and providers were surveyed. The primary outcome was acceptability of soft casts as a management strategy (questions targeted care burden, overall satisfaction, comfort, pragmatism, and healing concerns). Secondary outcome was feasibility (effect on clinic workflow, efficiency). Survey responses were collected from 70% of caregivers and 95% of providers. Responses overwhelmingly favored soft cast acceptability. Among providers, 84% agreed that "the soft cast method simplified the hand burn care experience in our clinic" and 100% indicated "the soft cast was easy for parents to manage at home" (Likert range 7-10, mode 10). Thirty-three English-speaking patients with partial and full thickness hand burns were managed with soft casts. A mean of 1.8 reapplications (mode 1, range 1-5) were required with median healing time of 13 days. No infections were attributed to the use of soft casting, and only one patient ultimately required grafting. Overall, the introduction of soft casts as a management strategy for pediatric hand burns was acceptable and feasible. The clinical outcomes assessed suggest soft casts are associated with good wound healing with minimal wound care responsibilities for patient and family.

Cause-and-effect chain analysis of combustion cyclic variability in a spark-ignition engine using large-eddy simulation, Part I: From tumble compression to flame initiation

Understanding, modeling, and reducing the cycle-to-cycle variability (CCV) of combustion in internal combustion engines (ICE) is a critical challenge to design engines of high efficiency and low emissions. A high level of CCV may contribute to partial burn, misfire, and knock in extreme engine cycles, which affects engine performance and eventually damages the engine. The origins of CCV have been studied both experimentally and numerically, and the variability of in-cylinder aerodynamics is recognized as one of the most important sources of CCV. However, a detailed and quantitative explanation of how in-cylinder flow CCV is generated is not yet clear. The objective of the present study is to develop a methodology to localize inside the chamber of a spark-ignition engine (SIE) the origins of flow variabilities and to identify some driving mechanisms leading to combustion variabilities. Multi-cycle wall-modeled large-eddy simulations (LES) for the TU Darmstadt optical engine under fired conditions are performed using the CFD solver Converge 3.0. The evolution of organized large-scale structures and the small-scale turbulence of the in-cylinder flow are analyzed using a developed methodology that includes the empirical mode decomposition (EMD) method adapted for 2D and 3D flow fields, and a vortex identification tool Γ3p. The contributions of different parts of the flow to CCV are quantified. In Part I of this work, the LES framework is validated against experimental data, and CCV of large-scale structures is characterized at spark timing. In Part II, the overall flow development during compression and intake strokes are quantitatively analyzed, and links are built between different engine phases to establish the cause-and-effect chain. Other CCV factors, such as spray injection and exhaust gas recirculation, are not included in the current study. However, the developed methodology for in-cylinder flow analysis could be used in studies on other engine configurations to improve the development of engine designs.Novelty and significance statementIn this work, the cycle-to-cycle variability (CCV) of combustion in a spark ignition engine is investigated to give a deeper understanding of CCV generation. The present study focuses on CCV caused by the stochastic nature of internal turbulent flow structures. LES approach is chosen due to its ability to capture CCV. The LES methodology was validated in a motored case in Ding et al. (2023). In the present study, it is validated in a reactive case against experimental in-cylinder pressures and velocity fields.A first novelty is the application of EMD methods combined with topology-based techniques to reactive LES results to characterize flow structures of different scales in the three-dimensional domain and to quantify separately their impacts on combustion.A second novelty and important finding is that a link is established between the combustion speed and the tumble formation and destabilization near BDC.Throughout our analyses in Part I and II, starting from the spark-ignition timing and going back to the early intake phase, a cause-and-effect chain is finally established between the development of in-cylinder flow and the combustion variability.

Superficial partial burns and donor sites are unique wounds: case series of extended wear Cutimed ® Sorbact ®

Superficial partial burns and donor sites are unique wounds: case series of extended wear Cutimed ^® Sorbact ^®

An on-demand antibacterial hydrogel for precise and rapid elimination of bacterial infection in a murine partial thickness scald burn wound

Burn wounds trigger prolonged inflammation, impair healing, and result in a high mortality rate. The effective management of burn patients requires a targeted approach to regulate the wound microenvironment, maintaining sterility while fostering conditions conducive to healing and functionality. Here, we developed a targeted antibacterial pH/temperature-responsive silver nanoparticle (AgNP) hydrogel triggering the release of silver ions based on changes in the burn wound microenvironment. The delivery system not only exerts a strong antibacterial effect owing to the localization and interfacial interaction of ultrasmall AgNPs against the bacterial surface and deeply embedded cells within the biofilm but also downregulates the bacterial pore-forming genes, thereby overwhelmingly deactivating bacterial responses through a multifaceted mechanism of action. We demonstrate that the application of AgNP hydrogel results in pH-dependent bacterial killing and elimination of over 95 % of pathogens while being non-toxic to mammalian cell viability and migration. Furthermore, the in vivo preclinical burn infection murine model demonstrates the eradication of S. aureus infection leading to a progressive burn repair supported by increased collagen deposition, anti-inflammatory properties, and increased burn angiogenesis. Overall, this strategy provides a targeted approach to addressing drug-resistant chronic burn infections, thereby contributing to improved management of burn injuries.

Nile Tilapia Skin Xenograft Versus Silver-Based Dressings in the Management of Partial-Thickness Burn Wounds: A Systematic Review and Meta-Analysis.

Background: Burns are a serious public health problem worldwide, causing high morbidity and mortality. This study aimed to compare two forms of treatment for partial skin burns and to determine whether one is superior to the other in terms of efficacy and benefits through a meta-analysis of randomized controlled trials. This article highlights the efficacy of tilapia skin in the treatment of burns. We performed a meta-analysis of 199 patients and highlighted the promising results that indicate the clinical relevance of this resource when we compared the cost of dressings with the daily need for dressing changes, healing potential, and reduction in pain level according to the VAS scale and reduced frequency of dressing changes. Methods: A search of PubMed, Cochrane Central, and LILACS was performed to identify randomized controlled trials comparing tilapia skin and silver-based dressings for treating burns. Studies involving overlapping populations and animals were excluded. The outcomes of interest were complete re-epithelialization, decreased pain level, and dressing change. Results: Summarize the article's main findings. Conclusions: Four randomized trials were included with a total of 199 patients with partial-thickness burns between the ages of 2 and 70 years. A total of 99 (49.74%) patients were treated with tilapia skin, and conventional treatment was used on 100 (50.25%) of the patients. Differences were found between the tilapia and silver-based treatments concerning re-epithelialization (MD -0.48; CI 95% -0.71 to -0.24; p < 0.01; I2 = 0%), decreased pain level (MD -0.79; CI 95% -1.10 to -0.47; p < 0.01; I2 = 0%), and dressing change outcome (MD -3.54; 95% CI -5.81 to -1.26; p = 0.02; I2 = 97%).

Cutaneous burn injury represents a major risk factor for the development of traumatic ectopic bone formation following blast-related extremity injury

Blast-related traumatic heterotopic ossification (tHO) impacts clinical outcomes in combat-injured patients, leading to delayed wound healing, inflammatory complications, and reduced quality of life. Blast injured patients often have significant burns. This study investigated whether a partial thickness thermal burn injury exacerbates blast-related tHO in a clinically relevant polytrauma animal model. Adult male Sprague Dawley rats were subjected to an established model involving a whole-body blast overpressure exposure (BOP), complex extremity trauma followed by hind limb amputation (CET) followed by the addition of a 10 % total body surface area (TBSA) second degree thermal burn (BU). Micro-CT scans on post-operative day 56 showed a significant increase in HO volume in the CET + BU as compared to the CET alone injury group (p < .0001; 22.83 ± 3.41 mm3 vs 4.84 ± 5.77 mm3). Additionally, CET + BU concomitant with BOP significantly increased HO (p < .0001; 34.95 ± 7.71 mm3) as compared to CET + BU alone, confirming BOP has a further synergistic effect. No HO was detectable in rats in the absence of CET. Serum analysis revealed similar significant elevated (p < .0001) levels of pro-inflammatory markers (Cxcl1 and Il6) at 6 h post-injury (hpi) in the CET + BU and BOP + CET + BU injury groups as compared to naïve baseline values. Real-time qPCR demonstrated similar levels of chondrogenic and osteogenic gene expression in muscle tissue at the site of injury at 168 hpi in both the CET + BU and BOP+CET + BU injury groups. These results support the hypothesis that a 10 % TBSA thermal burn markedly enhances tHO following acute musculoskeletal extremity injury in the presence and absence of blast overpressure. Furthermore, the influence of BOP on tHO cannot be accounted for either in regards to systemic inflammation induced from remote injury or inflammatory-osteo-chondrogenic expression changes local to the musculoskeletal trauma, suggesting that another mechanism beyond BOP and BU synergistic effects are at play. Therefore, these findings warrant future investigations to explore other mechanisms by which blast and burn influence tHO, and testing prophylactic measures to mitigate the local and systemic inflammatory effects of these injuries on development of HO.

Investigating the thermal and chemical kinetic effects of the internal residual on the cyclic dynamics at the dilute limits of a spark-ignition engine

The cyclic variability in the misfire and partial burn regimes of a dilute spark-ignition engine are primarily due to the feed-forward mechanism present in the residual gases. This study experimentally investigates the influence of the specific heat capacity/thermal effect and chemical kinetic effect of the internal residual on the heat release dynamics in the misfire and partial burn regimes of a dilute spark-ignition engine. Each effect is investigated by displacing excess air with bottled N2 and CO. Both short-term and long-term heat release dynamics are analyzed using association rules. Results show both an increased amount of dilution and higher specific heat capacity can result in similar dynamics. It was also found the misfire regime appears to be more sensitive to the chemical kinetic effect than the partial burn regime. Comparison of spark-to-CA05 and spark-to-CA50 between dilution methods was also conducted, where it was found the chemical kinetic effect did tend to reduce both spark-to-CA05 and spark-to-CA50. Overall, results from this study suggest different control strategies may be necessary to effectively mitigate the combustion instabilities when operating in each regime.

Treatment of superficial and deep partial width second degree burn's wound with allogeneic cord blood platelet gel.

Burns are caused by a variety of mechanisms, including flames, hot liquids, metallurgy, chemicals, electric current, and ionizing and non-ionizing radiation. The most significant burn wound management involves complete repair and regeneration as soon as possible while minimizing infection, contraction, and scarring in the damaged tissue area. Some factors such as delivery of nutrients, growth factors, and oxygen are essential to promote and stimulate the wound healing progress in the burns area. When these factors are not provided, the burn wound undergoes a physiological crisis. The use of growth factors is a promising approach to overcoming this limitation. Umbilical cord blood platelet concentrates are a rich natural source of growth factors. This clinical trial used growth factors released from the lysis of umbilical cord blood platelet concentrates that have a key role in promoting re-epithelization and regeneration of damaged tissues by forming a fibrin network. This study evaluated the effectiveness of allogeneic cord blood platelet gel topical dressing in a group of patients diagnosed with superficial and deep partial thickness (second-degree) burn wounds. Clinical outcomes were compared between the intervention group and a control group of patients with superficial second-degree burn wounds who received the standard routine treatment including paraffin gauze wound dressing and silver sulfadiazine ointment. The study's results showed that the increased rate of recovery and tissue granulation completely promoted to wound healing and burn wound closure, decreased the recovery time, and reduced inflammation and scars caused by burn injuries. However, the use of cord blood platelet gel topical dressing is not currently a routine treatment method in patients suffering from burn wounds. However, the study's results showed that allogenic cord blood platelet gel could be used to treat superficial and deep second-degree burns as a routine treatment. It was also shown that allogenic cord blood platelet gel topical dressing could be a candidate for autograft or after autograft skin transplantation surgery (in donor and recipient sites) instead of skin surgery in some patients. Allogeneic topical wound dressing provides an effective treatment that offers a faster rate of epithelialization and healing of wounds and also decreases patients' scar and inflammation level as well as the length of recovery time. This, finally, leads to better burn wound management and the improved quality of burn wound treatment.

517 Long Term Scarring Assessment of Burn Wounds Treated with Bioengineered Allogeneic Cellularized Construct

Abstract Introduction Bioengineered allogeneic cellularized construct (BACC) has recently been proven to be effective for treatment of burn wounds and now has FDA approval. There is a paucity of data describing long term (≥1 year) scar characteristics following treatment with BACC, including its potential to modulate the formation of hypertrophic scar (HTS). HTS causes significant physical and psychosocial implications which can result in diminished quality of life. This study aims to characterize post-burn scars resulting from BACC-treated wounds compared to within subject matched autografted wounds using clinical and histologic metrics. Methods Adult patients (n=5) were previously enrolled in a Phase III clinical trial for treatment of their deep partial thickness acute burn wounds. Subjects had clinical scar examinations including imaging, Scar Assessment Scales (POSAS), and non-invasive skin measurements to quantify skin elasticity, erythema, and melanin. Punch biopsies were collected and fixed in formalin from the autograft-treated site (A), the BACC-treated site (B), the donor-site (D), and an area of normal skin (NS). The formalin-fixed biopsies were then embedded in paraffin, sectioned, and stained with H&amp;E, Picrosirius Red, and Herovici. Results The use of BACC produced no difference in POSAS score and achieved elasticity measurements comparable to NS (Table 1). The erythema measurement demonstrated differences between scar sites and each scar site was different from NS. The donorsite also had some variation from NS. The measured melanin levels were different between each scar site, and both were different from NS. The donorsite also had detectable differences in melanin from NS. Measurements of epidermal thickness demonstrated differences between scar sites with BACC being similar to NS. Rete ridge ratio were different between scar sites and between autograft vs. NS. Papillary dermis cellularity had minor differences between scar sites and both scar sites were different from NS. Reticular dermis cellularity was equivalent between autograft and BACC sites and both were different from NS. Papillary and reticular alignment were not different between scar sites. Reticular orientation was not different between autograft and BACC but was different in BACC vs. NS. Papillary dermal thickness was different between autograft and BACC. Conclusions The HTSs resulting from wound closure achieved using BACC are similar to autografting in metrics related to clinical POSAS scores, extracellular matrix, and collagen structure. Scars following autografting or the use of BACC to achieve wound closure differ in metrics related to pigmentation, epidermal structure, and papillary dermal thickness and cellularity. Applicability of Research to Practice These findings may suggest that the use of BACC is a more optimal treatment for certain burn depths in certain patients because some HTS outcomes are equivalent, and it eliminates the need for a donor site.

Mid-Term Follow-Up Study of Children Undergoing Autologous Skin Transplantation for Burns

Deep partial and full-thickness burns require surgical treatment with autologous skin grafts after necrectomy, which is the generally accepted way to achieve permanent wound coverage. This study sought to examine the grafted and donor areas of children who underwent autologous skin transplantation, using two assessment scales to determine the severity of the scarring and the cosmetic outcome during long-term follow-up. At the Surgical Unit of the Department of Paediatrics of the University of Pécs, between 1 January 2015 and 31 December 2019, children who had been admitted consecutively and received autologous skin transplantation were analyzed. Twenty patients met the inclusion criteria in this retrospective cohort study. The authors assessed the results using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS). There was a significant difference in how parents and examiners perceived the children's scars. In the evaluation of the observer scale, the most critical variables for the area of skin grafted were relief and thickness. Besides color, relief was the worst clinical characteristic on the patient scale. However, when medical professionals evaluated the donor site, significantly better results were obtained compared to the transplanted area (average observer scale score: 1.4 and 2.35, p = 0.001; VSS: 0.85 vs. 2.60, p < 0.001), yet it was similar to the graft site in the parents' opinion (Patient Scale: 2.95 and 4.45, p = 0.181).

Algorithm of local conservative treatment of children with burns

Background. This article presents the results of using atraumatic wound dressings Branolind N and sorbing bandage Zetuvit. In research there were 10 children with superficial scalds (III degree) and parcial deep (IIIII degree) burns. Children were treated at the Burn Center of Speransky Pediatric City Hospital №9 in Moscow in June November 2021. The analysis of the conducted research testifies to the effectiveness and safety of the medical products listed above. The absence of local complications during treatment was revealed. The possibility of their simultaneous use in patients with exudating wounds has been established. Branolind N and Zetuvit bandage can be recommended for use both in a on- and outpatient cases in children with local burns. The results of treatment of children with burn injury depend on adequate diagnosis of the severity of the burn trauma, reliable determination of the depth of scald and local treatment of burn wounds. Tactics of local treatment depends on the phase of wound process, the age of the child and the presence of concomitant diseases.&#x0D; Aim. To assess the effectiveness and safety of using wound dressings ointment dressing Branolind N with Peruvian balsam and Zetuvit sorbent dressing in treatment children with burns.&#x0D; Materials and methods. Analysis of the using of Branolind N ointment dressing with Peruvian balsam and Zetuvit sorbent dressing in 10 children with burn injury was carried out. The study was completed in June November 2021. Inclusion and exclusion criteria were determined by the physicians participating in the study. The studies were carried out in accordance with Helsinki Declaration. The age of the patients ranged from 3 years 2 months up to 17 years 1 month. The depth of burn wounds in the studied patients was assessed according to the classification of the damage degree of European Burn Association: patients with superficial scalds (III degree) and partial deep burns (IIIII degree).&#x0D; Results. The absence of local skin complications during the application of the Branolind N ointment dressing with Peruvian balsam and Zetuvit sorbent dressing was revealed. The possibility of using. These wound dressings in patients with exuding wounds was established.&#x0D; Conclusion. The analysis of the conducted study testifies to the effectiveness and safety of the above medical products. Ointment bandage Branolind N with Peruvian balsam and sorbent bandage Zetuvit can be recommended for use both in out- and inpatients practice of treatment children with local skin burns.

Effect of a collagen-enriched beverage with or without omega-3 fatty acids on wound healing, metabolic biomarkers, and adipokines in patients with major burns

This study investigated the effects of collagen hydrolysate and omega-3 fatty acids (FAs) on the rate and quality of wound healing, metabolic disorders, and adipose-derived peptides in patients with major burns. In this randomized clinical trial, 66 patients with 20-45% deep partial or full-thickness burns were randomly assigned to three groups to receive either a beverage containing collagen (40 gr/d), collagen (40 gr/d) plus 3 gr/d omega-3 (ω-3) FAs, or placebo for four weeks. Wound healing rate, Vancouver scar scale (VSS), as well as baseline, weeks two and three serum concentrations of adiponectin, fibroblast growth factor 21 (FGF21), neuregulin 4 (NRG4), transforming growth factor (TGF)-β1, and pre-albumin/hs-CRP ratio were assessed. The wound healing rate during the weeks post-burn (p=0.006 and p=0.01), and days of 95% (21.3±6.8 and 22.9±8.7 vs. 34.3±14.8 days, p=0.003 and p=0.03) and complete (26±7.7 and 27.4±9.4 vs. 41.1±16.6 days, p=0.003 and p=0.01) wound healing were significantly better with Collagen and Collagen. ω-3 compared to the placebo group. The VSS was significantly lower, indicated better scar status, in the both intervention groups compared to the placebo (p=0.02 and p=0.01). Wound healing outcomes were not statistically different between the Collagen and Collagen. ω-3 groups. Hs-CRP/pre-albumin ratio was significantly lower in the Collagen. ω-3 than the placebo group at week three (1.2±1.9 vs. 4.8±7.7dl/l, p=0.03). The significant decrease in serum adiponectin seen during the trial course within the placebo (10±8.8 to 5.8±4.9mg/l, p=0.03) and Collagen (11.8±14 to 8.6±11.7mg/l, p=0.03) groups was prevented in the Collagen. ω-3 group (p=0.4). Circulating FGF21 decreased significantly within the Collagen (p=0.005) and Collagen. ω-3 (p=0.02) groups at the end of week three compared to the baseline. Adding collagen hydrolysate as part of adjunctive therapy improved wound healing rate and quality. These findings as well as the efficacy of omega-3 FAs need to be further confirmed in larger populations. This study was registered with the Iranian Registry of Clinical Trials (IRCT20090901002394N42).

Investigating the Origins of Cyclic Variability in Internal Combustion Engines Using Wall-Resolved Large Eddy Simulations

Abstract Modern internal combustion engines (ICE) operate at the ragged edge of stable operation characterized by high cycle-to-cycle variations (CCV). A key scientific challenge for ICE is the understanding, modeling, and control of CCV in engine performance, which can contribute to partial burns, misfire, and knock. The objective of this study is to use high-fidelity numerical simulations to improve the understanding of the causes of CCV. Nek5000, a leading high-order spectral element, open source code, is used to simulate the turbulent flow in the engine combustion chamber. Multicycle, wall-resolved large-eddy simulations (LESs) are performed for the General Motors (GM), Transparent Combustion Chamber (TCC-III) optical engine under motored operating conditions. The mean and root-mean-square (rms) of the in-cylinder flow fields at various piston positions are validated using particle image velocimetry (PIV) measurements during the intake and compression strokes. The large-scale flow structures, including the swirl and tumble flow patterns, are analyzed in detail and the causes for cyclic variabilities in these flow features are explained. The energy distribution across the different scales of the flow are quantified using one-dimensional (1D) energy spectra, and the effect of the tumble breakdown process on the energy distribution is examined. The insights from this study can help us develop improved engine designs with reduced cyclic variabilities in the in-cylinder flow leading to enhanced engine performance.

Practical Approach to Minor Burns

Most mild burns may be treated well in an outpatient environment and recover with little intervention. An precise categorization of burns is essential to ensuring effective treatment. Any non-superficial burn should be treated with a topical antibiotic to avoid infection. Although partial and full-thickness burns frequently require dressings, superficial burns typically do not. Especially in an emergency situation, a simple gauze patch offers enough burn protection. Increasing burn depth and contracture, monitoring for symptoms of infection, and providing appropriate analgesia are all parts of follow-up treatment. All suspected partial or full-thickness burn infections require prompt treatment, which may include hospitalization and parenteral antibiotics. Burn infections can increase the depth and breadth of a burn, turning a superficial partial-thickness burn into a deep partial-thickness or full-thickness burn in addition to producing sepsis.

Synergistic Use of Novel Technological Advances in Burn Care Significantly Reduces Hospital Length of Stay Below Predicted: A Case Series

Length of stay is an important metric in healthcare systems, primarily because it reflects the cost of care provided. In the United States, as in many countries, inpatient hospital stays are significantly more expensive than outpatient care across all healthcare conditions,1 so earlier discharge and transition to outpatient care is crucial to help control the ever-increasing cost of healthcare. In burn patients, length of stay has traditionally been estimated at 1 day per 1% total body surface area of burn. This estimation was first described in a round table discussion in 1986.2 However, since that time there has been significant evolution in the quality of care available to burn patients, in both the operating room and ICU. The use of new harvesting techniques, synthetic dermal substitution, and autologous epidermal skin cell suspension are allowing large, deep burns to be excised and covered in much quicker time frames than historically were possible. Examples include the skin harvesting and wound debridement device for grafting and excision, biodegradable temporizing matrix as a fully synthetic dermal template, and regenerative epidermal suspension concerning cell harvesting. Although these modalities can all be used separately, we believe that using them in conjunction has allowed us to shorten the length of stay in patients with severe partial and full-thickness burns. We present an initial case series of three patients with anticipated hospital lengths of stay of 54.5, 55, and 51 days, who were ready for discharge in 37, 35, and 43 days, respectively.

Investigation of the cyclic dynamics in the misfire and partial burn regime in a dilute spark-ignition engine and the role of the residual

This study compares the cycle-to-cycle dynamics in heat release between the misfire and partial burn regime in a highly lean-operated spark-ignition engine. The cyclic dynamics in these two regimes are generally deterministic as misfires and partial burns are often followed by a higher-energy cycle due to the feed-forward mechanism present in the residual gases. Both short and long-term patterns are investigated by converting the sequences into association rules. Using association rules, as opposed to symbol sequencing, allowed additional insight into the differences in the dynamics when operating in each regime. The influence of the residual amount and residual temperature on the next-cycle dynamics is also investigated using association rules. Results show there exists similar short-term dynamics between the misfire and partial burn regime. Results also indicate the residual amount impacts the next cycle more than the residual gas temperature. Understanding of the differences in the dynamics between the misfire and partial burn regime and how the residual plays a role could impact the control method used.

Platelet distribution width associated with short-term prognosis and cost in paediatrics with partial-thickness thermal burns: A retrospective comparative study.

Platelets exert important roles in burn wound healing and involving in inflammatory regulation and tissue repair. Platelet distribution width (PDW) is an indicator representing platelet morphology and activation. In this study, we try to evaluate the value of PDW in predicting short-term prognosis and cost of paediatrics with partial-thickness thermal burns. This retrospective study enrolled 73 children with partial-thickness thermal burns. The Ability of PDW to predict wound healing was evaluated by receiver operating characteristic (ROC) curve. All 73 patients were assigned into high and low PDW group according to optimal cut-off value from ROC curve. Associations between PDW and 2-weeks healing rate, time to wound healing, in-hospital cost and length of stay were evaluated. Furthermore, Univariate and multivariate logistic regression analysis were used to furtherly evaluate the significance of PDW in wound healing. We found that all baseline characteristics between groups were comparable (all P > .05). High PDW group had a significant higher 2-weeks wound healing rate than those with a low PDW (66.7% versus 32.6%, P < .01). Moreover, the mean time to wound healing of high PDW was obviously shorter than that of low PDW group (15.4 ± 10.1 vs 20.7 ± 10.9, P=.04). Univariate (OR: 0.24, 95%CI: 0.09-0.65, P < .01) and multivariate (OR: 0.15, 95CI%:0.05-0.52, P < .01) analysis confirmed PDW as an independent marker for wound healing. Patients in high PDW group had a significant lower medical burden than low PDW group, including in-hospital cost (13.7 ± 10.6 vs 21.9 ± 16.7, ×103RMB, P=.02) and length of stay (12.2 ± 8.8 vs 19.0 ± 10.8 days, P < .01). In conclusion, PDW can sever as a potential indictor to predict the short-term prognosis of paediatrics with partial thickness thermal burns.

Low level laser therapy versus polarized light therapy on healing of foot burn

Purpose: to evaluate the efficacy of the low level laser therapy (LLLT) versus polarized light therapy (BLT) on healing of foot burn. Methods of evaluation (Burn surface area and colony count). Methods: Forty patients who had partial thickness thermal burn affecting foot with the percentage of total body surface area (TBSA) ranging from 1% to 5%. Their ages were ranged from 25 to 35 years, diagnosis was clinically by physician, the patients were randomly divided into two equal groups in number; two study groups (one for LLLT and the other for BLT). The first study group (A) was composed of twenty patients who received the LLLT in addition to the traditional physical therapy routine and conservative treatment of the burn wound for one month. The second study group (B) was composed of twenty patients who received the BLT in addition to traditional physical therapy routine and conservative treatment for the burn wound. Duration of treatment was session (10 minutes) once daily, three times per week for one month or until wound healing. Results and Conclusion: Results showed that the application of both polarized light therapy and Ga-As laser had a valuable healing effect.

797 Single Stage Application of Autologous Skin Cell Suspension in Deep Partial Thickness Pediatric Facial Burns

IntroductionDeep partial thickness facial burns in the pediatric population present a dilemma. Standard burn treatment includes excision and split thickness sheet grafting for the face or closure which often yield sub-optimal results. Point-of-care system for autologous skin cell suspension (ASCS) can be utilized as a stand alone option for partial thickness burns. We sought to evaluate our early results from the treatment of pediatric deep partial thickness facial burns using ASCS.MethodsThis was a retrospective cohort analysis of pediatric deep partial thickness facial burns treated with early excision and application of ASCS. After assessment by two surgeons, patients underwent tangential excision with either standard surgical burn knives or dermabrasion. Depth was assessed and if dermal elements were present, then ASCS was applied. Primary outcome was time to >95% reepithelialization, and secondary outcomes were aesthetics, Vancouver Scar Scale, postoperative complications, number of reoperations for wound closure, and need for burn reconstruction.ResultsFrom September 2020 to July 2021, eight pediatric patients (six male and two female) with deep partial thickness facial burns were treated within one week of injury with excision and ASCS. TBSA ranged from 0.3%-24% with some having additional anatomic areas. The mean age was 2.5 years old, with a range of 1.08-5.0 years old. Burn mechanisms included flame, scald, and contact. The mean time from burn injury to initial excision and ASCS was 4.3 days, with a range of 2-7 days. Average time to complete reepithelialization was 20.3 days, with a range of 4-47 days. Average follow up duration was 218 days with a range of 98-365 days. No patients experienced complete graft loss or infection. One patient required need for reoperation with reapplication of polylactic acid skin substitute placed to a small area on the face during closure for other non-face burns. Of the 8 patients, the two patients with the longest times to complete reepithelialization required laser therapy, of which one patient also needed limited facial scar contracture release.ConclusionsEarly, single-staged ASCS application results in good aesthetic and relatively quick healing times with no complications and limited need for additional burn reconstruction. While the results are promising, there is a need for larger studies with longer term follow up before wider applicability.