Perineal Burns Research Articles

Specificities of Management of Perineal Burns.

There is a paucity of articles addressing the management strategy for perineal burns. Pelvic floor burns present a multitude of problems. These relate to the management of stool, urine, areas of maceration, significant strain, and the risk of infection. The objective of this study was to analyze a consecutive series of perineal burns by studying their characteristics, treatment, and management of urine and feces. This was a retrospective study including 100 patients between January 2018 and December 2022. The patients had all been hospitalized after suffering burns to the perineum. In 28% of the patients, the perineal burn was complicated by infection. In 61% of cases, a cutaneous infection, in 32% of cases, a urinary tract infection, in 25% of cases, a respiratory tract infection, and in 7% of cases, an infection of the digestive tract. Superinfection is associated with an increased risk of poor engraftment. A total of 100% of the patients with poor or average engraftment had an infection in the aftermath of the burn, compared with 20% of the patients with excellent engraftment and 61% of the patients with good engraftment. In our series, the analysis revealed that, in 95% of cases, no specific procedures were implemented for stool management. Perianal involvement was associated with a risk of sub-excellent engraftment. The results were statistically significant, with P = .005 and an OR = 8.72 after multivariate analysis. We favor the least invasive approach to stool management. Indications for a rectal catheter arise in patients with the following characteristics: the patient must be sedated, the burns must be deep and close to the anal opening, and the stools must be watery and abundant. In 95% of cases, we do not install a stool management device. Colostomies should remain exceptional.

Analysis of epidemiological characteristics and risk factors of catheter-associated urinary tract infections in patients with perineal and/or hip burns

Objective: To explore the epidemiological characteristics and risk factors of catheter-associated urinary tract infections in patients with perineal and/or hip burns. Methods: This study was a retrospective case series study. From January 2018 to December 2022, 260 patients with perineal and/or hip burns and urinary catheters indwelling who met the inclusion criteria were admitted to the Department of Burns and Wound Repair of the Second Affiliated Hospital of Zhejiang University School of Medicine, including 192 males and 68 females, aged 20-93 years. The total incidence of catheter-associated urinary tract infections in patients with perineal and/or hip burns, the detection of pathogenic bacteria, and the resistance of major Gram-negative and Gram-positive bacteria to commonly used antimicrobial drugs in clinic were recorded. According to whether catheter-associated urinary tract infection occurred or not, the patients were divided into infection group (43 cases) and non-infection group (217 cases). The basic conditions including gender, age, total burn area, depth of perineal burn, depth of hip burn, and burn site on admission, complications of diabetes mellitus, inhalation injury, and hypoproteinaemia, invasive operations including tracheotomy and non-perineal/hip debridement/skin transplantation surgery, duration of catheter retention, number of urethral catheterization, and bladder irrigation of patients between the two groups were compared, and the independent risk factors influencing the occurrence of catheter-associated urinary tract infections in patients with perineal and/or hip burns were screened. Results: The total incidence of catheter-associated urinary tract infections in patients with perineal and/or hip burns in this study was 16.5% (43/260). The pathogens detected were predominantly Gram-negative, followed by fungi; the main Gram-negative bacterium was Klebsiella pneumoniae, and the main Gram-positive bacterium was Enterococcus faecalis. The resistance rates of Klebsiella pneumoniae to amoxicillin/clavulanic acid, amitraz, amikacin, ciprofloxacin, ceftriaxone, and levofloxacin were higher than 70.0%, the resistance rates of Klebsiella pneumoniae to cefoxitin, cefoperazone/sulbactam, cefepime, meropenem, imipenem, and piperacillin/tazobactam ranged from 56.3% to 68.8%, and the resistance rates of Klebsiella pneumoniae to ceftazidime and tigecycline were lower than 50.0%. The resistance rates of Enterococcus faecalis to ciprofloxacin and penicillin were both 85.7%, the resistance rates of Enterococcus faecalis to erythromycin, clindamycin, moxifloxacin, and tetracycline ranged from 14.3% to 57.1%, and the resistance rates of Enterococcus faecalis to linezolid, tigecycline, and vancomycin were all 0. The differences were statistically significant between the two groups in terms of gender, status of complication of hypoproteinaemia, depth of perineal burn, status of non-perineal/hip debridement/skin transplantation surgery, status of bladder irrigation, number of urethral catheterization, and duration of catheter retention of patients (with χ2 values of 7.80, 4.85, 10.68, 9.11, and 16.48, respectively, and Z values of -4.88 and -5.42, respectively, P<0.05). There were no statistically significant differences in the age, total burn area, complications of diabetes mellitus and inhalation injury, burn site, depth of hip burns, and status of tracheotomy of patients between the two groups (P>0.05). Multifactorial logistic regression analysis showed that gender, deep partial-thickness perineal burns, non-perineal/hip debridement/skin transplantation surgery, bladder irrigation, and duration of catheter retention were the independent risk factors for catheter-associated urinary tract infections in patients with perineal and/or hip burns (with odds ratios of 2.86, 2.63, 2.79, 2.34, and 1.04, respectively, with 95% confidence intervals of 1.21-6.73, 1.03-6.71, 1.03-7.59, 1.05-5.22, and 1.02-1.06, respectively, P<0.05). Conclusions: The incidence of catheter-associated urinary tract infections is high in patients with perineal and/or hip burns, with Klebsiella pneumoniae as the predominant pathogenic bacteria having a high resistance rate to commonly used antimicrobial drugs in clinic. Gender, deep partial-thickness perineal burns, non-perineal/hip debridement/skin transplantation surgery, bladder irrigation, and duration of catheter retention are the independent risk factors for catheter-associated urinary tract infections in patients with perineal and/or hip burns.

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

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

Epidemiological characteristics and risk factors of sepsis development and death in patients with extremely severe burns

Objective: To explore the epidemiological characteristics and risk factors of sepsis development and death in patients with extremely severe burns. Methods: A retrospective case series study was conducted. From January 2017 to December 2021, 135 patients with extremely severe burns who met the inclusion criteria were admitted to the Department of Burn and Wound Repair of the Second Affiliated Hospital of Zhejiang University School of Medicine, including 100 males and 35 females, aged 18-84 years. The incidence and diagnosis time of sepsis, the rate of positive microbial culture of blood samples (hereinafter referred to as positive blood culture), and the mortality rate of all patients, as well as the incidence of sepsis and the pathogen of infection in patients with positive blood culture were recorded (statistically analyzed with chi-square test or Fisher's exact probability test). According to the occurrence of sepsis, all patients were divided into sepsis group (58 cases) and non-sepsis group (77 cases), and the gender, age, body mass index, history of hypertension, history of diabetes, combination of inhalation injury, burn site, burn type, total burn area, and combined injury of patients were compared between the two groups. According to the outcome, all patients were divided into death group (37 cases) and survival group (98 cases), and the aforementioned data grouped according to sepsis as well as the stability of shock period and the combination of sepsis of patients were compared between the two groups. The aforementioned data between two groups were statistically analyzed with univariate analysis of independent sample t test, Wilcoxon rank-sum test, Mann-Whitney U test, chi-square test, or Fisher's exact probability test. Factors with P<0.1 were selected for multivariate logistic regression analysis to screen independent risk factors of sepsis and death in patients with extremely severe burns. Results: Among all patients, the incidence of sepsis was 42.96% (58/135), the diagnosis time of sepsis was 14 (7, 24) d after injury, the positive blood culture rate was 62.22% (84/135), and the mortality rate was 27.41% (37/135). The incidence of sepsis of patients with positive blood culture was 69.05% (58/84). The top 5 pathogenic bacteria in the detection rate of septic patients with positive blood culture were Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterobacter cloacae, ranking from high to low, and the proportion of Acinetobacter baumannii infected was significantly higher than that of non-septic patients with positive blood culture (χ2=7.49, P<0.05). Compared with those in non-sepsis group, the proportion of combination of inhalation injury, the proportion of perineal burns, and the total burn area of patients in sepsis group increased significantly (with χ2 values of 11.08 and 17.47, respectively, Z=5.68, P<0.05), while the other indicators did not change significantly (P>0.05). Multivariate logistic regression analysis showed that combination of inhalation injury, total burn area ≥80% total body surface area (TBSA), and perineal burns were independent risk factors for patients with extremely severe burns developing sepsis (with odds ratios of 3.15, 7.24, and 3.24, respectively, with 95% confidence intervals of 1.07 to 9.29, 1.79 to 29.34, and 1.21 to 8.68, respectively, P<0.05). Compared with those in survival group, the proportion of combination of inhalation injury, the proportion of perineal burns, and the proportion of combination of sepsis (with χ2 values of 6.55, 11.64, and 22.26, respectively, P values all <0.05), total burn area (Z=4.25, P<0.05), and proportion of instability of shock period (P<0.05) of patients in death group all increased significantly, while the other indicators did not change significantly (P>0.05). Multivariate logistic regression analysis showed that the instability of shock period and combination of sepsis were independent risk factors for death of patients with extremely severe burns (with odds ratios of 4.87 and 3.45, respectively, with 95% confidence intervals of 1.21 to 19.57 and 1.28 to 9.33, respectively, P<0.05). Conclusions: Patients with extremely severe burns have a high incidence of sepsis and a high mortality rate. The peak period of sepsis onset is 2 weeks after injury, with Acinetobacter baumannii as the most prominent infectious pathogen. Combination of inhalation injury, total burn area ≥80% TBSA, and perineal burns are independent risk factors for extremely severe burn patients complicated with sepsis, and combination of sepsis and instability of shock period are independent risk factors for death of patients with extremely severe burns.

Pay more attention to the management of burn wounds of special causes and sites

The treatment of burn wounds of special causes and sites is a very challenging clinical work. In this paper, we briefly discussed the incidence rates of chemical burns, electric burns, facial burns, hand burns, and perineal burns, as well as the complexity and severity of pathological injury of the corresponding wound tissue. In addition, we briefly discussed the main principles and methods of clinical treatment, as well as the difficult problems to be solved. It is hoped to attract attention and provide reference for further improving the overall treatment ability of burns.

Vesicovaginal fistula: an uncommon complication of a perineal burn in a 12-year-old girl

Perineal burns are a rare finding in children that may cause severe complications. Vesicovaginal fistulas are an uncommon complication of a perineal burn that can be a tragedy for girls suffering from them. Fistula and/or its treatment are a socially debilitating problem with significant medicolegal implications. We present a rare case of a girl with a history of traumatic perineal burns who was diagnosed with a vesicovaginal fistula and repaired through a transvaginal approach.

Characteristics of patients resuscitated after burn related out-of-hospital cardiac arrest

AimThis study’s objective was to describe the characteristics of burn injury patients who were resuscitated after burn related out-of-hospital cardiac arrest (OHCA). MethodWe conducted a retrospective cohort study and examined characteristics of burn related OHCA using data from a Japanese nationwide burn registry that was collected between April 1, 2011 and March 31, 2020. First, we compared the characteristics of burn patients with and without OHCA. Second, among burn patients with OHCA, we compared the characteristics of survivors with non-survivors. ResultsIn the database, there were 16,995 hospitalised burn patients and 256 burn related OHCA. Thirty-two of the 256 burn patients (13%) survived after admission. Among patients with burns who also had OHCA, flames were the most common injury mechanism (74%); in comparison to all other injury mechanisms, the rate of flame burn was significantly higher in burn patients with OHCA than in burn patients without OHCA. The most common cause of death for burn related OHCA is carbon-monoxide poisoning (46%). Compared with survivors, non-survivors had a larger burn area, greater age and more complications. such as inhalation injuries and perineal burn injuries. Compared to other mechanisms of burn injury, electrical burn injuries were more common among survivors. In twelve patients with electrical burns, eight patients survived (67%) OHCA; of those eight patients, six (50%) could be discharged home. ConclusionPatients with burn related OHCA have a poor prognosis; however, patients who sustain electrical shock injuries may do better.

PSOR5 Presentation Time: 11:50 AM: Interstitial Hyperthermia and High Dose-Rate Brachytherapy Combined with Short-Term Androgen Deprivation Therapy and External-Beam Radiation in High- and Very High-Risk Prostate Cancer

<h3>Purpose</h3> Multimodality treatment of high- and very-high risk prostate cancer has evolved tremendously in recent years to incorporate long-term androgen deprivation therapy (ADT), external-beam radiation therapy (EBRT), and brachytherapy, resulting in improved biochemical progression-free survival (bPFS). However, outcomes remain imperfect, and many patients are unwilling or unable to tolerate long-term ADT use. Existing studies show that hyperthermia is a potent and well-tolerated radiosensitizer. We report the outcomes of patients treated with short-term ADT, EBRT, and high dose-rate (HDR) brachytherapy combined with interstitial hyperthermia. <h3>Materials and Methods</h3> In a single-institution, retrospective study, we reviewed all patients with high- or very high-risk prostate adenocarcinoma who began definitive treatment between December 2016 and March 2020 with up to six months of ADT, whole-pelvis EBRT, and a combination of HDR brachytherapy boost and interstitial hyperthermia. Our primary endpoint was bPFS based on the Phoenix definition (PSA nadir +2 ng/mL) calculated from time of ADT initiation. We also report data on type of failure, survival, and toxicity. <h3>Results</h3> 56 patients were reviewed, including 21 with high-risk and 35 with very high-risk prostate adenocarcinoma. Median age was 72 years (range 52-82 years). Median duration of ADT use was 4 months (range 0-6 months). All patients received whole-pelvis EBRT of 45Gy/25fx. 55 patients (98%) received a 5.4Gy/3fx EBRT boost to the prostate and seminal vesicles. All patients received two Iridium-192 HDR implants to further boost the prostate and seminal vesicles, with each implant separated by at least one week (median 2 weeks, range 1-6 weeks) and consisting of two fractions of 5.5Gy separated by five to seven hours, for a total of 22Gy/4fx. All patients received at least one interstitial hyperthermia treatment of at least 45 minutes in between fractions of the same implant. 50 patients (89%) received both planned hyperthermia treatments of at least 60 minutes each at a goal temperature of 42-43 degrees Celsius. Median duration of follow-up was 28 months for all patients, with 34 months for high-risk and 28 months for very-high risk disease. The estimated two/three-year bPFS-rates were 100%/100% for high-risk and 92.0%/87.7% for very high-risk disease. Figure 1 represents the Kaplan-Meier curve for bPFS. Of the three very high-risk patients who failed biochemically, one failed regionally at 25 months, and two failed distantly at 15 and 23 months. There were no local failures. Two patients with very-high risk disease have died, both of unrelated lung disease at nine and 13 months. Four patients stopped their hyperthermia treatment early due to intolerance, with one developing an acute perineal burn that fully healed three months later. There were otherwise no grade 3 or higher acute toxicities. Four patients (7%) developed late grade 3 toxicities, all genitourinary-related. <h3>Conclusions</h3> Multimodality treatment of prostate cancer with short-term ADT, EBRT, HDR brachytherapy, and interstitial hyperthermia is safe and well-tolerated. For patients with high-risk disease, it provides excellent biochemical control while sparing long-term use of ADT. Patients with very high-risk disease may benefit from long-term use of ADT and/or other forms of systemic therapy. Longer follow-up and prospective trials are needed to validate our findings.

Perineal burns: Epidemiology, severity factors, management issues and outcome

BackgroundPerineal burns have a direct bearing on the quality of life with physical, functional, sexual, and psychological ramifications. These are defined as major burns requiring referral to a burn centre for management. Isolated genital burns are unusual, and are typically seen as part of larger burns with longer hospital stays and high morbidity and mortality. Materials and methodsThe study was conducted in the Department of Plastic Surgery and Burns (SKIMS), Srinagar, India from 2016 to 2020. Results10.1% of patients (51/503) qualified as perineal burns. The average age was 16.92 ± 45.18 years with a male to female ratio of 3:1. 59% of patients were of the pediatric group and 60% of them were scalds, while flame burns predominate (71.4%) in the adults. 13% were caused by firepot/hot-air blower. The average percentage of body surface area involved was 38.40 ± 114. Most burns were second-degree superficial (70.6%). Intensive Care Unit (ICU) admission was required in 21.6% of patients. Surgery was required in 17.6% of cases. The mortality rate was 21.6%. ConclusionsThe real incidence of perineal burns might be much higher than reported. They act as a predictor for the need for ICU care and mortality in the adult population. Firepot/hot air blower causing full-thickness burns are not infrequent in colder places; so, these hold a promising position when dispensing preventive measures. Conservative management has excellent results.

Management of post burn groin contracture: a case account

Similar to burns of the face, hands, and feet, groin and perineal burn injuries result in physical as well as psychosocial scarring for the patient. It often results in loss of functionality which is usually out of proportion to the percentage of burns. Hence, these burns are classified as major burns. Direct injury to the genitalia can lead to sexual dysfunction. In such circumstances, the treatment plan should comprehensively look into even psychosocial aspects of the patient. Both functional and cosmetic appearance should be the primary concern. With scarcely available burns unit and dedicated hospitals in India to treat burns, patients often develop severe contractures without proper post burns care. Most of the burn patients end up being treated by staff without special training in burn care. A variety of surgical procedures in post burn contractures of groin and perineum have been described all aimed to achieve satisfactory functional and cosmetic outcome. However, advantages of long-term care with regular physiotherapy, use of pressure garments, and massaging with emollient creams should not be overlooked and cannot be overemphasized. We present such a case of a young female with poor post burns care which resulted in post burn contracture of the groin and perineal area and had to endure with inconveniences. Patient was treated in our department adequately.

A Retrospective Study of Touchless Spray for Pediatric Perineal Burns Treatment.

Silver-based topical treatments have seen widespread use for the management of burns due to silver's antimicrobial activity. Recent studies suggest that silver nanoparticles could negatively affect healing time due to their toxic effect on keratinocytes and fibroblasts at higher concentrations. Zinc oxide antimicrobial activity has been demonstrated in vitro, and results from animal studies are promising for burn management. At our ABA-verified pediatric burn center, the use of silver sulfadiazine cream ("Silvadene") has been slowly replaced by a zinc oxide/dimethicone spray-on solution ("Touchless Spray"). The dimethicone allows the spray to be occlusive without interfering with clothing, yet easily removed as opposed to Silvadene cream which requires wound scrubbing to remove and replace; potentially improving patient adherence with at-home treatments. This is the first study of zinc oxide's efficacy as a burn wound management agent in humans. We sought to compare the efficacy of silver sulfadiazine and that of zinc oxide/dimethicone to determine whether zinc oxide/dimethicone, in its easy-to-use form, is a viable alternative to silver sulfadiazine. We conducted a retrospective review of the electronic medical records of all patients treated for perineal, genital, perianal, suprapubic, or buttocks burn wounds at a large pediatric-verified burn center from January 1, 2014 to October 28, 2019. Only patients with superficial second-degree scald burns that arrived at our institution less than 24 hours after injury were included. Of a total 52 patients identified, 27 patients received silver sulfadiazine while 25 received zinc oxide/dimethicone. After initial evaluation and treatment by the burn team, all patients were followed up at our weekly burn clinic until complete healing was achieved. We retrospectively extracted demographic data, wound size, depth, and location, management strategies, time to complete healing, and incidence of infectious and noninfectious complications. The control group contained patients with total body surface area burns significantly greater than the zinc oxide/dimethicone group likely due to selective treatment when zinc oxide/dimethicone was first introduced at our facility. Time to healing was significantly lower in the zinc oxide/dimethicone intervention group (12.16 ± 8.644 days) than the silver sulfadiazine control group (16.89 ± 11.342 days). No infections were observed. Limitations include the relatively small sample sizes and differences in the size of burn wounds that confounded our results and likely negatively affected healing time in the control group. The zinc oxide/dimethicone group had a significantly lower healing time than the silver sulfadiazine group in the treatment of pediatric burns to the perineum, genitalia, suprapubis, and buttocks. Zinc oxide/dimethicone may prove to be a useful tool for treating burn wounds, and further study is needed to determine its efficacy and safety.

Association Between Perineal Burns Injury and In-hospital Mortality: A Retrospective Observational Study from the Nation-Wide Burn Registry in Japan.

Although perineal burn injury is included in the burn center referral criteria for Advanced Burn Life Support, clinical evidence that perineal burn injury increases mortality risk is limited, especially from Asian countries. The objective of this study was to investigate whether perineal burns affect in-hospital mortality. Using data from the nation-wide burn registry collected from April 1, 2011 to March 31, 2019, we retrospectively identified 10,179 hospitalized burn patients over 16 years of age. The in-hospital mortality rate between the patients with perineal burn and those with other burns was compared, and the adjusted odds ratio for in-hospital mortality was determined with multivariable logistic regression analysis controlling for age, gender, mechanism of burn injury, year of admission, total burn surface area, inhalation injury, hand injury, and transfers from another hospital. One thousand one hundred forty-nine patients with perineal burn were enrolled, and the in-hospital mortality of this group was higher than that of the group of patients with other types of burns (46 vs 5.2%, P < 0.001). Multivariable analysis found that the presence of perineal burns is associated with in-hospital mortality (odds ratio 2.11 [95% confidence intervals (CI) 1.64-2.71]; P < 0.001). Our data, as evidence, certified the referral criteria that perineal burn injury is associated with higher in-hospital mortality in Japan.

626 Female External Urinary Collection Device Utilization in a Female Burn ICU Patients: A Quality Improvement Project

Abstract Introduction A significant portion of intensive care unit (ICU) patients require a Foley catheter during their admission. Foley use has become more criticized as nationwide quality improvement processes attempt to reduce catheter associated urinary tract infections (CAUTI). Burn patients in the ICU have a higher rate of catheter utilization due to difficult fluid management, need for accurate volume measurements, and significant wound care. Males may have a condom catheter exchanged once they are stabilized. Historically, a noninvasive alternative to the Foley has not been available for females. While the female external catheter has existed for quite some time and hospital systems are increasingly encouraging their use, there is no standard of practice for when they are best utilized. Specific to the burn population, potential barriers include body habitus, perineal burns, and pain on frequent changing of the device. Our study aims to evaluate the current female external catheter use in our burn ICU in order to develop a standard protocol to increase utilization while thoughtfully delineating the contraindications. Methods A quality improvement project for guidelines on the use of a female external urinary collection device was conducted. All female patients admitted to the burn ICU during 2019 were included. Data was collected on burn TBSA, anatomic location, ICU days, ventilator days, and foley catheter days. Foley catheter days, external urinary catheter days, urinary tract infection (UTI) rates, and incidence of failure of external device were collected. Results Of the 46 total female burn patients, 31 required a foley catheter at some point during their stays. 11 patients used an external urinary collection device. Of the 11 users, one urinary device had to be removed due to skin breakdown. One other patient required replacement with a Foley catheter as a result of oliguria and the need for closer fluid management. 5 of the successful users of the external catheter were clinically obese. No patients contracted a UTI while using the external catheter. 3 UTI’s developed in women while using a Foley catheter. Patients who had altered mental status and perineal wounds were not eligible to use the external catheter. Conclusions In our practice, we found contraindications to external female catheter use to include altered mental status and perineal wounds. Obesity was not a contraindication and device usage may be most beneficial in incontinent patients. Further investigation is needed to better optimize female external urinary collection device usage within the burn ICU setting. This may help minimize CAUTI’s among female burn patients.

550 A retrospective Study of a Zinc-oxide/dimethicone for Pediatric Perineal Burn Treatment

Abstract Introduction Silver-based treatments have seen widespread use for the management of burns. Recent literature, however, has demonstrated silver nanoparticles may negatively impact healing time due to its toxic effect on keratinocytes and fibroblasts at higher concentrations. At our institution, an ABA-verified pediatric burn center, the use of a silver sulfadiazine cream for management of post-discharge perineal and genital burn wounds has been replaced by a zinc-oxide/dimethicone spray-on solution initiated for its comparative ease of use. The dimethicone allows the spray to be occlusive without interfering with clothing, yet easily removed. We believed this would improve compliance with at-home treatments. Zinc-oxide’s antimicrobial activity has been demonstrated in vitro and the results from animal studies are promising for burn management. This is the first study of zinc-oxide’s efficacy as a burn management agent in humans. Our burn center’s experience with both silver sulfadiazine and zinc-oxide/dimethicone creates an opportunity to compare these products for the treatment of burn wounds. We sought to analyze the time to healing of burns treated by silver sulfadiazine against zinc-oxide/dimethicone in order to determine if zinc-oxide/dimethicone, in its easy-to-use form, is a viable alternative to silver sulfadiazine. Methods A retrospective review of medical records was conducted at a large pediatric verified burn center. Data on 98 patients was collected from the burn registry and electronic medical records. 58 patients received silver sulfadiazine while 40 received zinc-oxide/dimethicone. Four patients were removed from the silver sulfadiazine group due to incomplete data. All patients were initially treated by the burn team with follow up in burn clinic on a weekly basis until healing was achieved. Results Time to healing was significantly lower in the zinc-oxide/dimethicone intervention group (10.61 +/- .918 days) than the silver sulfadiazine control group (16.88 +/- 2.134 days). The silver sulfadiazine group contained patients with total body surface area burns significantly greater than the zinc-oxide/dimethicone group (mean: 11.57% versus 6.64%); likely due to selective treatment when zinc-oxide/dimethicone was first introduced at our facility. Differences in depth and size of burn wounds may have confound our results and negatively impacted healing time in the control group. No infection, allergic reaction, or other adverse events were noted in any patient. Conclusions Zinc-oxide/dimethicone had a significantly lower healing time than silver sulfadiazine in the treatment of at-home, post-discharge 2nd degree pediatric burns to the perineum, genitalia, suprapubis, and buttocks. Further study is needed to quantify its efficacy.

Nursing Progress of Perineal Burn in Children

Nursing Progress of Perineal Burn in Children

Post burn perineal contractures: case series and a classification system

Introduction: Perineal burn contractures remain under reported in our region. We have set out to study the pattern of presentation, describe the formation of these contractures and identify any recurring patterns that will form a basis for a classification that will be useful in planning their management. Methods: A retrospective study of the patients seen over a three year period (2009–2011) at the National Orthopaedic hospital Dala is presented. Information was retrieved from case notes in the medical records department. The bio-data, type of care received post injury associated percentage burns, formation of contractures, were all noted. Results: All the seven patients seen were children of which five were females. Flame burn was the main type of burn. All burns occurred at home. Four major types of contractures were identified as transverse bands, hooding, fusion and obliteration. An equal number of patients presented following home versus hospital care. Conclusion: The relative rarity of post burn perineal contractures leaves little experience for the young surgeon to take advantage of when in training. A classification system will help to make it easier to identify what structures are involved and make planning easier. In the absence of specialized care it is doubtful that there is any statistical difference in the likelihood of perineal contracture development of patients managed at home by traditional healers versus those presenting in peripheral centers lacking formal burn management protocols. Most childhood burns still occur at home. There is a need to continually educate the public on the need to make the home a safe place for children.

Recurrent bacteremia: A 10-year retrospective study in combat-related burn casualties

IntroductionSurviving the first episode of bacteremia predisposes burn casualties to its recurrence. Herein, we investigate the incidence, mortality, bacteriology, and source of infection of recurrent bacteremia in military burn casualties admitted to the U.S. Army Institute of Surgical Research Burn Center over a 10year period. MethodsBacteremia was defined as the growth of Gram-positive or Gram-negative organisms in a blood culture that excluded probable skin contaminants. Recurrent bacteremia was defined as a subsequent episode of bacteremia ≥7 days after the first episode. Polymicrobial bacteremia was the presence of more than one pathogen in the same blood culture. Bacteremia was attributed to UTI, pneumonia, or wound sepsis. All other bacteremias were considered non-attributable bloodstream infections. Univariate and multivariate analyses determined factors predictive of clinical outcome. ResultsOut of 952 combat-related burn casualties screened, 166 cases were identified; 63% (non-recurrent) and 37% (recurrent) with median time to recurrence of 20 days. Univariate and multivariate analysis showed that the mortality rate was two and nine-fold, respectively, higher with recurrent bacteremia. Univariate analysis found that except for urinary tract infection, large burn size (>20%), 3rd degree burns, increased injuiry severity, perineal burns, and mechanical ventilator days were independent factors predictive of recurrence of bacteremia as well as increased mortality in the recurrent bacteremia cohort. Acinetobacter baumannii complex (63%) was prevalent in the non-recurrent group, while Klebsiella pneumoniae (46% vs. 30%) and Pseudomonas aeruginosa (35% vs. 26%) were prevalent in recurrent bacteremia. Half of the recurrent bacteremia cases were polymicrobial, compared to 9% in non-recurrent bacteremia. Pneumonia was prevalent in non-recurrent bacteremia (38%) and a combination of pneumonia and wound sepsis (29%) in recurrent bacteremia casualties. ConclusionsRecurrent bacteremia increases mortality in military burn casualties. Additional research is needed to address and mitigate the underlying causes, thereby improving survival.

Treatment of Genital Burn Injuries: Traditional Procedures and New Techniques.

Because genital burns are rare, only limited information on treatment guidelines is available in the literature. Vital tissue should be preserved to promote spontaneous healing because reconstruction does not always lead to satisfying results. The aim of this report is to present a general overview of current, prevailing treatment for genital burns and compare this to study authors' experiences. In addition, the article describes an entirely new approach of tissue-preserving bromelain-based enzymatic debridement of genital burn wounds. This single-center study includes all patients who were treated for severe genital and perineal burn wounds at a burn intensive care unit between December 1995 and December 2016. A review of literature was performed in PubMed covering the years 1990 to 2016. A total of 149 patients were admitted with severe burns or scalding of the genitals or the perineum. As in the majority of cases reported in the current literature, most of these patients were treated conservatively. When there was demarcation of necrotic tissue, tangential excision and skin grafting were performed, and since 2015, 3 patients admitted to this facility have been treated with bromelain-based debridement followed by spontaneous healing. Certain small-scale studies in the literature describe a disproportionate number of surgical interventions. Based on this evidence, study authors support a conservative view of genital burn treatment. Enzymatic debridement allows earlier and more selective debridement, which can improve the aesthetic outcome.

Burns to the genitalia, perineum, and buttocks increase the risk of death among U.S. service members sustaining combat-related burns in Iraq and Afghanistan

PurposeAmong service members injured in Iraq and Afghanistan, to determine the risk of mortality associated with combat-related burns to the genitalia, perineum, and buttocks. Materials and methodsThe prospectively maintained burn registry from the United States Army Institute of Surgical Research was retrospectively reviewed to identify all service members with combat-related burns sustained in Iraq and Afghanistan from March 2003 to October 2013. The two primary risk factors of interest were (1) any burn to the genitals, perineum, and/or buttocks (PB) and (2) burns involving the entire perineal, genital, and buttock region (complete PB). Cox proportional hazard models were used to estimate the risk of mortality for both primary risk factors, and adjusted for severe non-burn-related trauma, percent of burn over total body surface area (TBSA), inhalational injury, time to urinary tract infection, and time to bacteremia. A post-hoc analysis was performed to explore the potential effect modification of TBSA burned on the relationship between PB and mortality. ResultsAmong the 902 U.S. service members with combat-related burns sustained during the study period, 226 (25.0%) had involvement of the genitalia, perineum, and/or buttocks. Complete PB was associated with a crude risk of mortality (HR: 5.3; 2.9–9.7), but not an adjusted risk (HR=1.8; 0.8–4.0). However, TBSA burned was identified as a potential negative effect modifier. Among patients with burns <60% TBSA, sustaining a complete PB conferred an adjusted risk of death (HR=2.7; 1.1–6.8). Further, patients with a perineal burn had a five-fold increased incidence of bacteremia. In adjusted models, each event of bacteremia increased the risk of mortality by 92% (HR 1.92; 1.39–2.65). Perineal burns were associated with a two-fold increased incidence of severe non-burn related trauma that also doubled mortality risk in adjusted models (HR 2.29; 1.23–4.27). ConclusionsAmong those with relatively survivable combat-related burns (<60% TBSA), genital/perineal/buttock involvement increases the risk of death. Bacteremia may account for part of this increased risk, but does not fully explain the independent risk associated with perineal burns.

Starchy liquid burns do not have worse outcomes in children relative to hot beverage scalds

AimTo characterise children presenting with hot beverage scalds versus scalds caused by starchy water. MethodsRetrospective survey of prospectively collected database of all children presenting over a two-year period. ResultsThere were 138 starch scalds and 262 hot beverage injuries. Children with hot beverage injuries were significantly younger (18.2 months; IQR 14.1, 27.8) than those suffering starch scald injuries (51.4 months; 18.7, 102.3; p<0.001). Perineal burns were more common in the starch group than the hot beverage scald group (10.9% vs. 2.4%, p<0.001). Chest/breast and abdominal burns were more common in the hot beverage group than the starch group (60.7% vs. 36.9%, p<0.001). Children under three years of age in both groups are significantly less likely to receive adequate first aid at the scene (p<0.001). There are no differences in the need for skin grafting or scar management when comparing hot beverage scalds and scalds caused by starchy liquids. ConclusionsScald injuries caused by starchy liquids do not appear to cause a more severe injury than hot beverage scalds. There is a different pattern of injury from starchy liquids in older children. Children under three years old are less likely to receive appropriate first aid at the scene.