Partial-thickness Injury Research Articles

Exploratory Laparotomy in a Hemodynamically Stable Patient for an Abdominal Gunshot Wound

The patient in this case presented with an abdominal gunshot wound and peritonitis. Here, Dr. Williams and Dr. Suah perform an exploratory laparotomy and repair a through-and-through gunshot wound to the distal jejunum and a partial-thickness injury to the proximal cecum.

45 A Three Year Analysis of a Multi-tiered Orthotic Protocol

Abstract Introduction A variety of factors affect the fit of custom orthoses in those with burn injuries. A resting hand orthosis (RHO) is a common device within burn care, yet fabrication and fitting of this custom orthosis requires precision and expert assessment. However, burn therapists have varying degrees of education and credentials and previously we had noted preventable complications. Our center implemented a multi-tiered protocol focused on custom RHOs and found a marked decrease in complications immediately following implementation. The purpose of this QI project was to evaluate whether these improvements had been sustained over the following three-year period. Methods This was a retrospective chart review. Per protocol an RHO could be fabricated by a single certified hand therapist (CHT) or co-fabricated by two (non-CHT) therapists. Incidence of orthosis complications, defined as erythema and/or an orthotic induced partial-thickness injury to the volar second metacarpal head (index finger) was the primary outcome measure. Other data collected were average time to fabricate & modify devices and average refabrication(s) required between CHT vs non-CHT devices. Patients with missing data points was excluded. Results Eighty-five patient hands were examined from 2019-2022. Prior to implementation, total erythema occurrences were reported in 23.4% of orthoses (n=18) and total orthotic induced partial thickness injury occurred in 11.7% (n=9) of cases. Post protocol implementation erythema occurred in 5% of cases (n=5), and partial thickness injury in 0% of cases (n=0). This represents a decrease of 95% and 100%, respectively. On average CHTs fabricated RHOs in 59 minutes vs 48 minutes for non CHTs. CHTs had a complication rate of 0.0% vs 10.98% for non-CHTs. Potential complication was also limited to 0.0% for CHTS and 27% of non-CHTs. Modification rates were limited to 18.75% for CHTS vs 47.56% of non-CHTs. Conclusions Data from this QI project showed a clinically significant decrease in erythema and decrease in breakdown and number of modifications needed from utilization of either a CHT or two therapists when managing hand orthoses. Since instituting our protocol focusing on RHOs, our center has decreased complications and potential complications to improve patient outcomes. Although, most therapists receive standard education, it can be inferred that CHTs may approach orthotic fabrication through a different lens. The required studying and education required to maintain an advanced practice certification may benefit burn therapy departments. Therapists without this specialty certification can enhance skill and outcomes via co-fabrication and assessment. Applicability of Research to Practice Orthotic induced erythema may be decreased by utilizing CHTs or two non-CHTs to manage RHOs. This protocol can be expanded to include other orthoses or with other advanced certifications.

Characterization and modeling of partial-thickness cutaneous injury from debris-simulating kinetic projectiles

Partial-thickness cutaneous injuries distributed over exposed body locations, such as the face and extremities, pose a significant risk of infection, function loss, and extensive scarring. These injuries commonly result from impact of kinetic debris from industrial accidents or blast weaponry such as improvised explosive devices. However, the quantitative connections between partial-thickness injuries and debris attributes (kinetic energy, shape, orientation, etc.) remain unknown, with little means to predict damage processes or design protection. Here we quantitatively characterize damage in near-live human skin after impact by debris-simulating kinetic projectiles at differing impact angles and energies. Impact events are monitored using high-speed and quantitative imaging to visualize skin injuries. These findings are utilized to develop a highly predictive, dynamic computational skin-injury model. Results provide quantitative insights revealing how the dermal-epidermal junction controls more severe wound processes. Findings can illuminate expected wound severity and morbidity risks to inform clinical treatment, and assess effectiveness of emerging personal protective equipment.

750 Paddling into danger - Key lessons for a summertime

IntroductionPaddling pools are a source of entertainment for many children. In cooler climates, parents often attempt to heat up the water temperature by adding freshly boiled water into outdoor pools. Our Regional Burns Centre has seen many of these injuries and we wanted to investigate trends and prevalence.MethodsUtilising the local Burn Injury Database, we searched for paddling pool related injuries which occurred between 2015-2020. We retrieved age, burn size and depth, need for surgical intervention and outcome, as well as circumstances surrounding the injury.ResultsWe identified 26 injuries over six years, of which 11 were in 2020. The age of children ranged between 6 months and 13 years old (median 4 years 8 months). The majority, 22 (84%) of patients, had superficial partial thickness injuries. Only five patients (19%) had burns larger than 2% TBSA and only a single patient required general anaesthetic procedure to clean and dress the wounds. Two patients were admitted (length of stay 2- 5 days). Burns affected a range of locations with the majority being lower limbs (11) and upper limbs (8). Head and neck area was affected in 4 cases followed by flank (3), abdomen (2) and buttocks (2). Injuries occurred between April and August and the majority happened during the Friday – Sunday period 18 (69%). All burns occurred between 11:00 and 18:30, with average time being 14:40.ConclusionsPaddling pools represent a common potential risk to children. With the recent of COVID-19 pandemic leading to closure of the schools, there has been a significant increase in paddling pool sales, resulting in an increase in these injuries and, without relevant education, they are expected to become more common.

Burn Injuries Associated with At-Home Hair Braiding.

Hair braiding that incorporates synthetic extensions has increased in popularity across all age groups. As part of the styling process, the ends of the braid are commonly dipped in scalding water; an increasing number of patients have presented to our center after containers of recently boiled water are accidentally tipped over and spilled onto patients. A retrospective chart review was performed of all patients who sustained burn injuries related to at-home hair braiding presenting to an ABA-verified burn center between January 1, 2006 and July 31, 2020. A total of 41 patients presented over the study period, and the frequency of this type of burn increased over time, with 54% of injuries occurring in the past 3 years (2018-2020). The mean patient age was 7.5 years, and the majority of patients were under 18 years of age (97%), female (95%), and African-American (98%). Seventy-three percent of injuries occurred in the home and 88% involved another person in the hair braiding process. The mean TBSA burned was 5% (range 1-20%). The most commonly involved areas were the back (54%), thigh/leg (37%), and neck (24%). Ninety percent were partial-thickness injuries only, with 10% having some degree of full-thickness injury. Ninety percent of patients required inpatient admission, and 34% of patients required at least one operative procedure. Hair braiding, with the use of scalding water to seal and set the ends of braids, can lead to burn injuries that require hospitalization and the need for surgical intervention.

Collagen Dressing Versus Conventional Vaseline Gauze Dressing in Reducing Pain and Infection at the Donor Area for Skin Grafting: A Prospective Interventional Study

Introduction: The harvest of a split thickness skin graft causes a partial thickness injury and an outflow of blood and protein rich exudate from the donor site wound. Conventionally, closed dressings are employed using petroleum jelly impregnated gauge which are permeable to bacteria and wound exudate soaks through. This may lead to pain and infection of the donor site. Biological dressings create the most physiological interface between the wound surfaces and the environment and also dressings are natural, non immunogenic, non pyrogenic and hypo allergenic. Collagen sheet is one such dressing material used. Aim: To compare the conventional dressing using petroleum jelly impregnated gauze versus biological dressing with collagen sheets in terms of pain, infection and healing at skin graft site. Materials and Methods: It was a prospective interventional study conducted in Department of Surgery, SSG Hospital and Medical College, Baroda, Gujarat, India over a period of November 2012 to November 2017 on 220 participants. Randomisation was done by choosing an envelope containing cards marked ‘A’ or ‘B’. The group A (110) was a study group with collagen sheet dressing while group B (110) was the control group with conventional vaseline gauze dressing. Both group patients were examined at six hours postoperatively and then two times a day at 8:00 am and 8:00 pm daily. They were evaluated for pain with Visual Analogue Scale (VAS) score, infection, haematoma formation, healing at donor site and allergic reaction to collagen. Results: Mean VAS score for pain showed that it decreased over a period of time in both the groups. The group with collagen sheet dressing shows decreasing means VAS score from 4.34 on 1st day to 0.29 on 3rd day (p<0.0001). Similarly, the vaseline gauze dressing shows decreasing mean VAS score from 5.64 on 1st day to 1.39 on 3rd day (p<0.0001). Conclusion: Collagen sheet dressing are easy to apply, with advantage of less pain at donor site and lower infection rate. Also healing time required is less than the vaseline gauze dressing. collagen sheet dressing is clinically more efficient overall.

104 A Quality Improvement Project to Reduce Orthoses Complications

Abstract Introduction Anatomical structures of the hand are complex and delicate making hand burns particularly challenging to manage. Orthoses are a cornerstone treatment modality and unsuccessful therapeutic interventions can result in hand contracture and deformities, which can result in up to 95% impairment in upper extremity function. Therapists at our burn center have varying degrees of education and credentials, and we had noticed increased incidence of orthotic induced complications in the hand. The purpose of this QI project was to implement a formal protocol that provided guidelines around fabricating and fitting hand orthoses. Methods The protocol mandated that custom fabricated resting hand orthoses should be fabricated by a single CHT or co-fabricated by two (non-CHT) therapists. Orthoses were fabricated as indicated. Orthosis modifications and orthosis complications, defined as erythema and/or an orthotic induced partial-thickness injury to the volar second metacarpal head (index finger) were documented. For the purposes of our study, breakdown was limited to the index finger. These modifications and complication totals were compared to pre-implementation data. Any patient with missing data points was excluded. Results Seventy-seven patient hands were examined from 2016–2019. Prior to implementation of the protocol, erythema occurred with 23.4% (n=18) of orthoses and orthosis induced partial thickness injury was found in 11.7% (n=9) of cases. Post protocol implementation involved examination of 51 hands. Erythema occurred in just 2.0% of cases (n=1) and partial thickness injury in 3.9% of cases (n=2) This represents a decrease of 94.4% and 77.7%, respectively. Number of modifications was reduced by 40.9%, from 22 to 13. Conclusions Orthosis fabrication is a specialized therapy skill, requiring hands-on training and advanced anatomical knowledge. While orthotic fabrication is part of general therapy education, the depth and breadth of this education is limited by the clinical opportunities presented to each therapist. CHT’s have undergone rigorous study and testing to make them experts in orthosis management and can bolster skills in a burn therapy department. For therapists without this specialty certification, co-fabrication can also lead to improved outcomes, through real time peer review. Data from this QI project showed a statistically significant decrease in erythema and decrease in breakdown and number of modifications needed from utilization of either a CHT or two therapists when managing hand orthoses.

601 Burn Injuries Associated with At-home Hair Braiding

Abstract Introduction Hair braiding that incorporates synthetic extensions has increased in popularity across all age groups. During the styling process, the ends of the braid are commonly dipped in hot water. As a result of this practice, an increasing number of patients have presented to our Burn Center after containers of recently boiled water are accidentally tipped over and spilled onto patients. Here, we report on patient demographics, outcomes, and our experience managing this injury pattern. Methods A retrospective chart review was performed of all patients who sustained burn injuries associated with at-home hair braiding presenting to an ABA-verified Burn Center between January 1, 2006 and July 31, 2020. Data on patient demographics, injury characteristics, wound management and, burn outcomes was collected. Results A total of 41 patients presented over the study period with burn injuries related to at-home hair braiding. The frequency of this type of burn increased over time, with 54% of injuries occurring in the last three years (2018–2020). The mean patient age was 7.5 years (range 0.7 – 32 years). Demographically, the vast majority of patients were under 18 years of age (90%), female (95%), and African American (98%). Seventy-three percent of injuries occurred at the patient’s home and 88% of incidents involved another person in the hair braiding process. The mean total body surface area of burn was 5% (range 1–20%). The most commonly involved areas were the back (54%), thigh/leg (37%), neck (24%), shoulder (24%), and arm/forearm (22%). Ninety percent were entirely partial thickness injuries with 10% of patients suffering some degree of full thickness injury. Ninety percent of patients required inpatient admission, and 36% of patients required at least one operative procedure. For those managed as inpatients, the average length of stay was 5.4 days (range 1–30 days). Three patients were reported to experience complications with one developing respiratory failure and two with delayed wound healing. Conclusions Hair braiding, with the use of scalding water to seal and set the ends of braids, can lead to significant accidental burn injuries. At our institution, these injuries occur predominantly in young African-American females. These burns can result in acute hospitalization and the need for surgical intervention. This is the largest series of this injury type to date with trends towards increasing frequency in the most recent time period.

The impact of simultaneous inoculation of Pseudomonas aeruginosa, Staphylococcus aureus, and Candida albicans on rodent burn wounds

Burn wound infection often involves a diverse combination of bacterial and fungal pathogens. In this study, we characterize the mixed species burn wound infection by inoculating the burn surface with 1 × 103/4/5 CFU of Pseudomonas aeruginosa, Staphylococcus aureus, and Candida albicans in a 1:1:1 ratio. Using the revised Walker–Mason scald burn rat model, 168 male Sprague-Dawley rats (350–450 g) subject to ∼10% TBSA burn injury, with or without inoculation, were evaluated for 11 days after burn. In the wound, P. aeruginosa and S. aureus formed robust biofilms as determined by the bacterial tissue load, ∼1 × 109 CFU/g, and expression of key biofilm genes. Interestingly, within 3 days C. albicans achieved tissue loads of ∼1 × 106 CFU/g, but its numbers were significantly reduced beyond the limit of detection in the burn wound by day 7 in partial-thickness injuries and by day 11 in full-thickness injuries. The pathogenic biofilms contributed to burn depth progression, increased release of HMGB-1 into circulation from injured tissue, and significantly elevated the numbers of circulating innate immune cells (Neutrophils, Monocytes, and Basophils). This robust model of multi-species burn wound infection will serve as the basis for the development of new antimicrobials for combating biofilm-based wound infections.

Urethrocutaneous fistulas after voluntary medical male circumcision for HIV prevention\u201415 African Countries, 2015\u20132019

BackgroundVoluntary medical male circumcision (VMMC) is an HIV prevention strategy recommended to partially protect men from heterosexually acquired HIV. From 2015 to 2019, the President’s Emergency Plan for AIDS Relief (PEPFAR) has supported approximately 14.9 million VMMCs in 15 African countries. Urethrocutaneous fistulas, abnormal openings between the urethra and penile skin through which urine can escape, are rare, severe adverse events (AEs) that can occur with VMMC. This analysis describes fistula cases, identifies possible risks and mechanisms of injury, and offers mitigation actions.MethodsDemographic and clinical program data were reviewed from all reported fistula cases during 2015 to 2019, descriptive analyses were performed, and an odds ratio was calculated by patient age group.ResultsIn total, 41 fistula cases were reported. Median patient age for fistula cases was 11 years and 40/41 (98%) occurred in patients aged < 15 years. Fistulas were more often reported among patients < 15 compared to ≥ 15 years old (0.61 vs. 0.01 fistulas per 100,000 VMMCs, odds ratio 50.9 (95% confidence interval [CI] = 8.6–2060.0)). Median time from VMMC surgery to appearance of fistula was 20 days (interquartile range (IQR) 14–27).ConclusionsUrethral fistulas were significantly more common in patients under age 15 years. Thinner tissue overlying the urethra in immature genitalia may predispose boys to injury. The delay between procedure and symptom onset of 2–3 weeks indicates partial thickness injury or suture violation of the urethral wall as more likely mechanisms of injury than intra-operative urethral transection. This analysis helped to inform PEPFAR’s recent decision to change VMMC eligibility policy in 2020, raising the minimum age to 15 years.

Coming to Consensus: What Defines Deep Partial Thickness Burn Injuries in Porcine Models?

Deep partial thickness burns are clinically prevalent and difficult to diagnose. In order to develop methods to assess burn depth and therapies to treat deep partial thickness burns, reliable, accurate animal models are needed. The variety of animal models in the literature and the lack of precise details reported for the experimental procedures make comparison of research between investigators challenging and ultimately affect translation to patients. They sought to compare deep partial thickness porcine burn models from five well-established laboratories. In doing so, they uncovered a lack of consistency in approaches to the evaluation of burn injury depth that was present within and among various models. They then used an iterative process to develop a scoring rubric with an educational component to facilitate burn injury depth evaluation that improved reliability of the scoring. Using the developed rubric to re-score the five burn models, they found that all models created a deep partial thickness injury and that agreement about specific characteristics identified on histological staining was improved. Finally, they present consensus statements on the evaluation and interpretation of the microanatomy of deep partial thickness burns in pigs.

734 A Comparison of Burn Depth Assessment Between Clinical Diagnosis and Laser Doppler Imaging

Abstract Introduction Accurate burn assessment is crucial to prescribing appropriate treatment and is dependent upon the experience of the provider and the timing of diagnosis relative to the burn injury evaluation. Differentiating between a deep partial thickness and full thickness burn may not be easily discernible. To augment the clinical diagnosis of burn depth, a laser doppler image measures the microvascular blood flow of injured tissue to predict burn wound healing. The aim of this study is to evaluate the clinical assessment of burn wounds by experienced burn providers compared to the laser doppler image assessment in predicting which burn wounds should heal spontaneously in 3 weeks. Methods A retrospective chart review from 2012–2016, included 54 subjects. The clinical assessment included a description of burn variables relevant to the determination of spontaneous burn wound healing (burn depth, total body surface area, mechanism of injury, anatomical location, clinical burn depth diagnosis, and laser doppler image). A chi-square analysis compared the clinical diagnosis and the laser doppler assessment of burn wound depth, as well as the correlation between clinical diagnosis versus laser doppler image in predicting spontaneous burn wound healing. Results Comparing partial thickness burn injuries, there were 38 clinically diagnosed partial thickness injuries (by experienced burn providers) and 38 partial thickness burn injures diagnosed via LDI. Deep partial thickness burn injuries were diagnosed clinically in 9 subjects, compared to 10 via LDI. Full thickness burn injuries were diagnosed clinically in 7 subjects and 6 via LDI. A chi-square test was performed to examine the relationship between clinical diagnosis of burn depth and laser doppler image. The relation between these variables was significant,X2= 26.884, p&amp;lt; .000. Comparing clinically diagnosed burn depth to LDI, each approach (clinical or LDI) diagnosed 42 subjects with partial thickness or deep partial thickness burn injuries and all healed spontaneously. Two of the clinically diagnosed full thickness burn injuries required skin grafting. Six patients were lost to follow-up (X2= 17.745, p &amp;lt; .001). Conclusions This study confirms there is no difference between an experienced burn provider’s clinical diagnosis of burn wound depth and prognosis for spontaneous healing compared to a laser doppler image prognosis of burn wound healing. Applicability of Research to Practice In an era of advanced technologies, expert clinical bedside assessment is the standard of care.

54 Validation of Infrared Thermography for Prediction of 21-day Burn Wound Healing

Abstract Introduction Although trained specialists easily identify most full and superficial partial thickness burn injuries, deep partial-thickness injuries present a true challenge to the clinician. Various imaging modalities to assess perfusion and determine healing potential include skin biopsy with histology, laser doppler imaging, active dynamic and static infrared thermography, vital dyes, indocyanine green video angiography and others. Prior studies indicate, with small clinical and animal studies, forward looking infrared is a valid tool to assess healing potential and 21-day healing within the first 48 hrs after presentation. The aim of our study is to determine if an absolute increase or decrease in temperature (°C) measurements across a burn wound in a large clinical cohort correlates with 21-day healing after 48 hrs from time of injury. Methods After informed photo consent was obtained, thermographic images were captured at presentation, 24hrs, and 48hrs from patients admitted to our center between October 2018 and August 2019. Thermographic images were reviewed and temp measurements obtained using a linear vector through the wound. Next we determined if patients healed within 21 days. Data collected includes demographic data, burn characteristics, injury site (based on Lund Browder segmentation) and wound temp (average, minimum, maximum). Data was analyzed using Wilcoxon rank sum test with continuity correction. Results We reviewed images for 159 burn sites from 29 patients, the largest image set to be reviewed to date. The cases were 84% male, the mean and range was 33.1 years (1.7 – 70) for age and 25% (2 – 54.5) for TBSA. We found an average temp difference between 24 hrs – 48 hrs (p-value= 0.007) was significant, and no significant difference in average temp change when evaluating admit – 24 hrs (p-value=0.053) and admit – 48 hrs (p-value=0.316), consistent with predictions of prior studies. Average temp from admit – 24 hrs decreased by 0.86°C in healed (n=48) vs non-healed (n=91); increased on average by 1.25°C in healed (n=39) vs non-healed (n=74) from 24 hrs – 48 hrs; and showed a modest decrease by 0.3°C in healed (n=50) vs non-healed (n=82) when comparing admit 48 hr temp. Conclusions These data demonstrate that burn wound temperature difference between 24 and 48 hours after admittance as measured by infrared thermography correlates with clinical outcomes and 21 day healing. Applicability of Research to Practice Infrared thermography is a validated tool to assess burn depth after 48 hrs. In the future, this modality may impact triage in the military, rural, accidental and non-accidental disasters.

A comparative clinical study of collagen and paraffin gauze dressing on skin donor site

Background: Split skin grafting (SSG) is a commonly performed plastic surgical procedure. It is done to cover wounds, defects from excision of cutaneous lesions, donor sites of fascio-cutaneous flaps. The harvest of a split thickness skin graft causes a partial thickness injury. Complete re-epithelialization occurs in 10-14 days, although the rate may be affected by the local wound environment. However, tissue desiccation and infection can convert a partial thickness injury to a full thickness loss. Aims and Objectives: The purpose of the study was to determine the best method of dressing the donor site split-thickness graft between conventional paraffin gauze dressing and collagen-based dressings with respect to the rate of healing, pain, secretion, infection, and cost. Settings and Design A hospital based Non-Randomized control trial was conducted in a tertiary hospital setup in Manipur, India, for a period of 2 years. This study was done on 60 patients who underwent split skin graft procedure. Materials and Methods: The selected sample will be divided into two groups. The donor site dressing was done in two different ways. One was dressed with collagen sheet and the other with paraffin gauze dressing. The two groups were compared on the basis of post-operative pain, complication, and healing. Statistical analysis Statistical analysis was done by using IBM SPSS Version 21 for windows. Descriptive statistics such as mean, proportion, percentage were used to present the result. Chi square test was used to see the association of proportions. Student's t- test and repeated ANOVA were used for the continuous variables. P-value Conclusion: In this study it was found that dressing the donor site for split-thickness graft with collagen-based dressings gave better results with respect to the rate of healing and post-operative pain scores than conventional paraffin gauze dressing.

Comparative effectiveness of Biobrane\xae, RECELL\xae Autologous skin Cell suspension and Silver dressings in partial thickness paediatric burns: BRACS randomised trial protocol

BackgroundMixed partial thickness burns are the most common depth of burn injury managed at a large Australian paediatric hospital specialty burns unit. Prolonged time until re-epithelialisation is associated with increased burn depth and scar formation. Whilst current wound management approaches have benefits such as anti-microbial cover, these are not without inherent limitations including multiple dressing changes. The Biobrane® RECELL® Autologous skin Cell suspension and Silver dressings (BRACS) trial aims to identify the most effective wound management approach for mixed partial thickness injuries in children.MethodsAll children presenting with an acute burn injury to the study site will be screened for eligibility. This is a single-centre, three-arm, parallel group, randomised trial. Children younger than 16 years, with burns ≥ 5% total body surface area involving any anatomical location, up to 48 h after the burn injury, and of a superficial partial to mid-dermal depth, will be included. A sample size of 84 participants will be randomised to standard silver dressing or a Regenerative Epithelial Suspension (RES™) with Biobrane® or Biobrane® alone. The first dressing will be applied under general anaesthesia and subsequent dressings will be changed every 3 to 5 days until the wound is ≥ 95% re-epithelialised, with re-epithelialisation time the primary outcome. Secondary outcomes of acute pain, acute itch, scar severity, health-related quality of life, treatment satisfaction, dressing application ease and healthcare resource use will be assessed at each dressing change and 3, 6 and 12 months post-burn injury.DiscussionThe findings of this study can potentially change the wound management approach for superficial partial to mid-dermal burns in children locally and worldwide.Trial registrationThe Australian New Zealand Clinical Trials Registry (ACTRN12618000245291) approved prospective registration on 15 February 2018. Registration details can be viewed at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374272&isReview=true.

Rectal Injury After Foreign Body Insertion: Secondary Analysis From the AAST Contemporary Management of Rectal Injuries Study Group

BackgroundRetained rectal foreign bodies are a common but incompletely studied problem. This study defined the epidemiology, injury severity, and outcomes after rectal injuries following foreign body insertion. MethodsTwenty-two level I trauma centers retrospectively identified all patients sustaining a rectal injury in this AAST multi-institutional trial (2005-2014). Only patients injured by foreign body insertion were included in this secondary analysis. Exclusion criteria were death before rectal injury management or ≤48 h of admission. Demographics, clinical data, and outcomes were collected. Study groups were defined as partial thickness (AAST grade I) versus full thickness (AAST grades II-V) injuries. Subgroup analysis was performed by management strategy (nonoperative versus operative). ResultsAfter exclusions, 33 patients were identified. Mean age was 41 y (range 18-57), and 85% (n = 28) were male. Eleven (33%) had full thickness injuries and 22 (67%) had partial thickness injuries, of which 14 (64%) were managed nonoperatively and 8 (36%) operatively (proximal diversion alone [n = 3, 14%]; direct repair with proximal diversion [n = 2, 9%]; laparotomy without rectal intervention [n = 2, 9%]; and direct repair alone [n = 1, 5%]). Subgroup analysis of outcomes after partial thickness injury demonstrated significantly shorter hospital length of stay (2 ± 1; 2 [1-5] versus 5 ± 2; 4 [2-8] d, P = 0.0001) after nonoperative versus operative management. ConclusionsAlthough partial thickness rectal injuries do not require intervention, difficulty excluding full thickness injuries led some surgeons in this series to manage partial thickness injuries operatively. This was associated with significantly longer hospital length of stay. Therefore, we recommend nonoperative management after a retained rectal foreign body unless full thickness injury is conclusively identified.

Crab cuticle membrane application for treatment of corneal lamellar laceration in rats: a preliminary study

Corneal lamellar laceration defined as a partial thickness injury to the cornea that may affect vision in various degree. Prompt management is needed to maintain integrity of the cornea and to avoid possible complications resulting from the injury. Material such as amniotic membrane had been widely use to promote reepithelization after corneal injury. Result from previous studies revealed that chitin, the most abundant substance in the cuticle layer of crab shell, is contribute to reepithelization after injury. Crab cuticle membrane preparation were made similar to amniotic membrane that is widely use in the management of corneal injury, therefore chitin might be sought as alternative material in the management of corneal injury which promote reepithelization. This study aimed to assess corneal epithelial proliferation profile and the number of keratocyte in rats after corneal lamellar laceration injury with and without application of crab cuticle membrane. Rats with corneal lamellar laceration injury were divided into groups treated with and without crab cuticle membrane application. Eyes were enucleated on the first and third days after treatment. Histologic preparations were made to assess corneal epithelial proliferation process and number of keratocyte in all groups. Cellular migration of more than 50 % were found in 66.7% of samples on 1 day after treatment and 61.1% of samples on the third days after treatment with crab cuticle membrane. The average number of keratocyte were 33.89 ± 5.27 cells/LPF on 1 day after treatment and 46.22 ± 9.55 cells/LPF on the third days after treatment with crab cuticle membrane. Epithelial proliferation after corneal lamellar laceration in rats treated with crab cuticle membrane application is faster and the number of keratocyte is more abundant compared to treatment without the application of crab cuticle membrane.

МРТ-семиотика вывиха акромиального конца ключицы

Objective To develop magnetic resonance imaging (MRI) protocol for assessing acromioclavicular joint (ACJ) in patients with dislocation of the acromial end of the clavicle, grading severity of injury after trauma and evaluating outcome of surgical treatment. Material and methods MRI was performed for 15 patients with ACJ injury before and after treatment. Based on MRI findings patients were subdivided into three groups depending on the degree of ACJ injury. Results In addition to radiography MRI yields important findings on a complex of pathological changes in ligaments, muscles and subcutaneous tissues. The imaging showed edema and a partial-thickness injury to the trapezius muscle (n=7), swollen subcutaneous tissue (n=15), a glenoid labral tear (n=4) and a rotator cuff injury (n=7). Conclusion MRI has been particularly effective in characterizing ACJ injuries and associated changes in the bone and soft tissues. The capabilities of MRI in visualization of soft tissues have made this imaging modality invaluable in the assessment of outcomes of the dislocation of the acromial end of the clavicle.

111 10 Years of Clinical Experience Using Point of Care Non Cultured Autologous Skin Cell Suspension

Time to healing is a key driver of scar outcome in the repair of skin post burn injury. Autologous skin cell suspension has facilitated early intervention or wound healing in isolation in partial thickness injuries and in combination with traditional techniques in deeper injuries with limited donor sites. The aim of the presentation is the analysis of the impact of the introduction of cell based therapies into a clinical model of care in a health system providing burn care to a population of 2.5 million The data captured prospectively from the point of injury to the 1 year follow up was analysed retrospectively. A comprehensive data base has been well established to include the injury details, interventions and an outcome battery considering functional psychological and aesthetic outcomes at multiple time points. The data was subject to a data hack process followed by in-depth data analytics using 1.2 million rows of data points. In a 10 year period the cell based therapy technique was used in 3500 cases, 9% scar revision, 90% acute burn injury and 1% miscellaneous wounds. Of the cases requiring surgical intervention 12% received SSG alone, 48% SSG and cells and 40% cells alone. The use of cell therapies was associated with a reduction in the number of surgical procedures, with earlier intervention and reduction in time to healing and length of stay. When using a cumulative outcome index the intervention within 1 week of injury was associated with significant improvement at 3 months which was maintained at 1 year post injury. Cell based therapies are associated with earlier intervention and associated reduction in scarring and measurable improvement in outcomes. Since evolving from cultured epithelial autograft sheets to suspension in 1995 then onto non cultured skin cell suspension in 1998, the use of skin cell therapies has become integrated into the standard of care. The results need to be taken in the context of a comprehensive model of care which focuses on every intervention from the time of injury to optimise marginal gains along the clinical pathway.

11 A Retrospective Review Evaluating the Institution of a Burn Dressing Algorithm for the Treatment of Patients Being Managed at Home

The ideal burn dressing prevents infection, promotes healing, manages pain / exudate, is easy to use and cost effective. Advances in technology have resulted in a plethora of new dressings and in teaching facilities, nursing has a considerable influence on decision making. Our center developed an algorithm to standardize and simplify dressings used for patients managed at home. The algorithm was based on wound depth and presence / absence of eschar. Three dressings are included, 2 silver impregnated dressings and 1 bismuth tribromophenate petroleum impregnated gauze. The purpose of this study was to evaluate the compliance, effectiveness and safety of our dressing algorithm. This was a retrospective study of outpatients managed using the new algorithm. The 6-month study period was started after the algorithm had been in place for 1 month. Compliance with the algorithm was measured using AgSD as a surrogate marker for non-compliance. Basic descriptive statistics were calculated. A total of 605 charts were reviewed, mean age was 27.4 years and 55% were male. The population consisted primarily of Caucasians (45%) and Hispanics (37%). Most patients had a payor source with Medicaid (39%) and private insurance (34%) being the most common. Initial presentation to the Burn Emergency Department was 1.84 days post-injury, mean TBSA was 1.43%, and the majority (86%) were superficial partial thickness (SPT) injuries. The most common mechanism was scald (53%), followed by flame/flash (21%). The most frequent areas of injury were hands (37%) and arms (22%). The first two months of the study period, the rate of noncompliance with the algorithm was 38%, compliance improved over the next 4 months with noncompliance dropping to 12% (p < 0.001). Overall infection rate was 2.5% and was associated with algorithm noncompliance (p = 0.0002). Patients requiring subsequent hospitalization was 24 (4%), which was also associated with noncompliance (p < 0.001). The average length of stay for patients requiring inpatient care was 6.21 days, 71% required surgery, with 66% requiring autografting. Despite excluding patients treated the 1st month post initiation of the algorithm from the data-set, initial compliance was poor. Nursing and physician education was provided and over the next 4 months adherence to the algorithm increased significantly. Compliance with the dressing algorithm was associated with improved outcomes, specifically reduction of infections and hospitalizations. Following implementation of new treatment protocols, ongoing monitoring of compliance is needed so that the effect of the intervention can be appropriately evaluated.