Superficial Partial Thickness Research Articles

Novel multi-spectral short-wave infrared imaging for assessment of human burn wound depth.

Burn depth determination is critical for patient care but is currently lacking accuracy. Recent animal studies showed that Short Wave Infrared (SWIR) imaging can distinguish between superficial and deep burns. This is a first human study correlating reflectance of multiple SWIR bands using a SWIR assessment tool (SWAT) with burn depth classifications by surgeons and histology. Burns and adjacent normal skin in 11 patients with thermal injuries were imaged with visual and narrow bands centred at 1200, 1650, 1940 and 2250 nm and biopsies were taken from select areas. Reflectance intensities for each band in 273 regions of interest (ROI) were divided by the normal skin reflectance and combined into three Reflectance Indices (RIs). In addition, burns in ROIs and biopsies were classified by five surgeons and three pathologists, respectively, as superficial partial, deep partial, or full thickness. Results show that for burn depth increase classified by the surgeons, reflectance increased at 1200 and 2250, decreased at 1940, and didn't change at 1650 nm. In contrast, all three RIs increase with burn depth and predict the deep and full depths ROIs representing operable regions (Area Under Curve >0.6507, p < 0.0001). Pathologists' classification matched surgeons' classification of burn category only in eight of 21 biopsies (38.1%), but reflectance at all bands and one RI for all deep partial and full thickness biopsies were larger than in non-biopsy normal and superficial partial thickness ROIs (p < 0.0118). In conclusion, multi-spectral imaging with a new SWAT is a promising approach for evaluation of burn wound depth.

FP7.20 - Peri-orbital burns: A 5-Year Review of the Epidemiological Characteristics and Outcomes at a Regional Burns Centre in the UK 2019 – 2023

Abstract Background Burn injuries are a major cause of global morbidity. Despite being infrequent, peri-orbital and ocular burns can have significant implications on a patient’s vision and overall quality of life. In Northern Ireland, the current epidemiological landscape of peri-orbital burns is not clear. This study aimed at assessing the incidence of peri-orbital and ocular burns and the management outcomes of patients admitted at the regional burns unit in Northern Ireland 2019-2023. Methods Patients admitted to the regional burns unit in Northern Ireland between January 2019 and September 2023 with periorbital burns were identified from the burns unit electronic records, the burns unit database and hospital image database. Results Over 5 years, 100 patients with facial burns were treated, including 60 patients with eyelid burns. 71% were males and 29% were females with a mean age of 47 years. The mean burn size was 14% total body surface area. The burn depth varied; 55% superficial partial thickness, 22% mixed, 17% full thickness and 6% deep dermal. Majority of burns were flame burns 64%. In total, 7 patients sustained corneal burns, one patient responded to steroids, one underwent amniotic membrane grafting, one lost complete vision in both eyes, one had physical debridement and topical antimicrobials and three patients required periorbital reconstruction to maintain eye closure. Conclusion 60% of Facial burns were associated with eyelid burns, the majority of which were caused by flame burns and were managed conservatively with wound cleaning, physical debridement, and application of topical antimicrobials. Despite being rare, complete loss of vision was associated with mortality among our patients.

Prevalence and characteristics of paediatric burns at the National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Ghana

IntroductionBurn injuries among children have emerged as a significant global public health concern, accounting for substantial morbidity and mortality worldwide. Low and Middle-Income Countries bear a significant burden of paediatric burn injuries. In Ghana, limited data exists on the prevalence, characteristics and outcomes of paediatric burns. This study provides vital data on the local burden and epidemiology of paediatric burns at Ghana’s main burns treatment center. The findings have significant value in informing prevention strategies, allocating resources, and improving quality of paediatric burn care. Study objectiveTo establish the prevalence and characteristics of paediatric burns injuries in Ghana’s leading burn center. MethodologyA retrospective cohort study analyzed data from 662 adult and paediatric patients who presented with burns from all over Ghana between 2020 and 2022. The study encompassed medical records of paediatric burn cases (aged 0–14 years) admitted to the center from January 2020 to December 2022. A purposive sampling technique was used to select cases based on the inclusion criteria and elimination of cases with 20 % missing data. A total of 335 paediatric records were reviewed. Data analytical methodsDescriptive statistics, such as frequencies, mean, percentages were used to establish period prevalence and demographic characteristics of paediatric burns. Chi-square analysis and univariate logistic regression was utilized to explore associations between categorical variables, and predictors of burn outcome. ResultsThe period prevalence of paediatric burns was found to be 50.6 %. Paediatric burn cases predominantly affected males (57.6 %). Majority of cases fell within the age range of 1 to 5 years (70.1 %). Hot water emerged as the leading cause (58.4 %), whiles superficial partial thickness burns (51.9 %) was the predominant type of burn. Most cases involved burns affecting less than 20 % Total Body Surface Area (59.0 %). Multi-part body injuries were common (87.2 %), with the lower limb being the most affected (25.36 %). The mortality rate was calculated to be 21.0 %. Higher TBSA was a significant predictor of mortality (p < 0.001). ConclusionThis study found a high prevalence of paediatric burns with hot water and foods being the predominant causes. Higher TBSA predicted lower chances of survival. The findings have scientific value in informing prevention strategies, allocating resources, and improving the quality of care.

Factors Influencing Surgical Care and Outcome of Pediatric Burn Injuries and the Use of Synthetic Skin Substitutes

Abstract Burn trauma is one of the most common causes of inpatient treatment in children and is associated with severe physical and psychological consequences. Synthetic skin substitutes are designed to reduce the risk of infection, minimize wound pain, and reduce the frequency of dressing changes. However, data regarding premature detachment of these materials is scarce. The aim of this study was to identify factors associated with early detachment and subsequent consequences for surgical treatment. A retrospective analysis of 392 children with superficial and deep partial thickness burns undergoing inpatient treatment with the application of a skin substitute (Suprathel) was performed. Patient age, wound localization and progression, as well as burned total body surface area (TBSA%) were investigated as possible risk factors for early detachment of wound dressings and surgical intervention. Premature material detachment was significantly associated with burn localization (P &amp;lt; .001) and correlated with burn depth progression (r = 0.23, &amp;lt;0.001) and patient age (r = 0.22, &amp;lt;0.001). Surgical revision after material detachment was required in 13% of patients. Patient age and burn localization seem to increase the risk of premature material detachment. In addition, we observed increased premature detachment of Suprathel® in areas that elicited higher wound progression rates. Identifying these areas might prove pivotal in the improvement of pediatric burn trauma management.

Evaluating Burn Injuries at the University of Sierra Leone Teaching Hospitals Complex, Freetown

Background: As with most low- and middle-income countries (LMICs), burns are a major public health problem in Sierra Leone, yet they are poorly studied. This retrospective study of burn injuries at the Connaught Hospital unit of the University of Sierra Leone Teaching Hospitals Complex aims to bridge this gap by examining the patterns and outcomes of burn injuries over a two-year period and comparing these findings with previous studies from the same region. Methods: A total of 146 patients were included in the study over a two-year period from January 1, 2021, to December 31, 2022. Results: The 146 patients seen during the study period represented an average rate of 1.39 cases per week. The median age was 3.9 years (range: 2 months to 56 years) with 59.4% male involvement. Eighty percent suffered from scalds, mostly from hot water. The modal percentage of Total Body Surface Area (%TBSA) affected was 10% (range: 1–75%), and 68.1% had superficial partial thickness burns. The %TBSA of scalds was significantly smaller than that of flame burns. The most common complication was anaemia. Conclusions: Burns continue to pose a significant challenge in Sierra Leone and the situation has not changed significantly over the past decade. There is a need to institute burn preventive measures in the country and to have dedicated functioning burns units to address this common public health problem.

Management of Pediatric Superficial Partial-Thickness Burns with Polyhexamethylene Biguanide: Outcomes and Influencing Factors.

Background: In burn care, achieving swift healing with minimal complications remains paramount. This investigation assesses the role of polyhexamethylene biguanide (PHMB) in managing pediatric superficial partial-thickness burns, focusing on the effects of various patient-specific factors on recovery. Methods: Through a retrospective analysis of 27 pediatric cases treated with PHMB, we evaluated the impact of age, burn size, dressing frequency, treatment delay, cold therapy application, and analgesic usage on the time until reepithelialization (TTRE). Results: The majority of patients benefited from early cold therapy, yet only 1 in 3 patients received analgesics. A mean healing time of 8.78 (SD: 2.64) days was observed, with the extent of the burn showing a strong correlation (r: 0.63) to TTRE. Most treatments were managed outpatient, evidenced by a negligible average hospital stay (0.96 days), with recorded no complications. Conclusions: Our findings endorse PHMB as a promising treatment for superficial second-degree burns in young patients, due to the observed stable and rapid wound closure without the association of increased risks. Continued exploration into the optimal application of prehospital interventions and the comprehensive benefits of PHMB in pediatric burn management is necessary. Future research should assess long-term outcomes, including functionality, scar quality, and patient satisfaction.

A randomised investigation of film-forming silicone gel in superficial partial thickness face and neck burn patients: Indication of improved early scar pigmentation outcomes

IntroductionBurns to the face and neck are a source of considerable distress and a challenge to manage with dressings. Further, these often superficial injuries pose a risk of scarring and altered pigmentation. Silicone gels have emerged as a potential solution to the challenges of conservative management for face and neck burn injuries. The aims of this study were to explore the effect of topical silicone compared to routine treatment of conservatively managed burns to the face and neck. MethodsThis single-blind, randomised, controlled trial compared topical silicone film-forming dressing to standard of care for superficial partial thickness burns to the face and neck. Time to healing was the primary outcome and secondary outcomes included: 1) scar assessments (modified Vancouver Scar Scale, Dermalab Combo and Patient and Observer Scar Assessment Scale) at six weeks and three months; and 2) pain intensity scale at wound review appointments. ResultsOf the 55 participants in the face/neck study, 34 were male and 21 were female. Median age was 36 years (range from 25 to 47 years). The median time to healing for the silicone group was 9 days (CI 7.6 −10.4) and the control group was 7 days (CI 5.3- 8.7), p = 0.056. Analysis demonstrated significantly reduced pigmentation at six weeks in mVSS scores for the silicone group (Md = 0, IQR = 0) compared to the control group (Md = 0, IQR = 0 – 3), p = 0.043. We found no evidence of differences in reported pain between the groups (Silicone - Md = 1.15, IQR 0.3 – 4.5 vs control group - Md = 1.5, IQR 0.6 – 3.8, z = −0.63, p = 0.53). No other differences were observed, and no adverse events were associated with the topical silicone in the study whereas an infection and a reaction were experienced in the control group. ConclusionFilm-forming silicone gel had comparable effects to standard of care emollient on wound healing of superficial partial thickness burns of the face and neck. Silicone treated wounds were associated with a significant improvement in scar pigmentation outcome at six weeks post-burn.

PATTERNS AND OUTCOMES OF PEDIATRIC BURN INJURIES IN A TERTIARY HOSPITAL’s BURN UNIT

IntroductionBurn is skin and tissue damage caused by various agents such as fire, scalds, electricity, chemicals, or radiation injuries. Globally, burn injuries pose a substantial public health challenge, with a high risk of mortality and morbidity, accounting for over 310,000 annual deaths. Nearly 75 % of burns in young children result from scald burns and infants have the highest mortality rates. Factors such as large surface area of burn, inhalational injury, poverty, and the presence of sepsis contribute significantly to mortality and morbidity in burns. ObjectiveTo assess the pattern of presentation of pediatric burn injuries and their management outcomes. MethodsA hospital-based retrospective cross-sectional study was conducted. Data were extracted from patient charts, cleaned, coded, checked for completeness, and entered into SPSS version 25 for analysis. Descriptive statistics and logistic regression were used for data analysis, and graphical presentations were utilized to present the result findings. ResultsAmong the 218 paediatric burn patients admitted to the Addis Ababa Burn, Emergency and Trauma Hospital’s burn unit, 71.1 % had sustained scald burns due to hot water splashes, while 20.2 % of the patients were admitted due to flame burns. Superficial partial thickness burns occurred in 53.6 % of the patients, with the upper extremity and trunk being the most commonly affected sites. Approximately 38.2 % of the patients developed acute complications, with sepsis of the wound focus being the most common. Chronic complications occurred in 30.7 % of patients, primarily in the form of post-burn contractures. A mortality rate of 3.2 % was observed during the admission period with 2.3 % of deaths occurring in children under 5 years and those with major burns. Conclusion & RecommendationThe primary causes of burns in the pediatric age group are predominantly preventable scalds. Children, especially when unsupervised at home, particularly in kitchens, demand meticulous attention and care to mitigate the risk of burn injuries.

Cold burn injuries in the United Kingdom: A five-year cohort study of patients presenting to a regional burn unit

AimsTo assess the aetiology, management and outcomes of cold burn injuries presenting to a regional burn unit in the United Kingdom. MethodsRetrospective cohort study of consecutive patients over a five-year period (2018-22). ResultsSixty-two patients (M:F 34:38; median age 23.5 years) were identified. The most common aetiology was aerosol (n=28, 45.2%). Seven (11.5%) injuries were sustained during a social media or peer ‘challenge’ and nineteen (31.2%) were self-harm, of whom five (26.3%) were inpatients on a mental health ward at the time of injury. All ‘challenge’ and self-harm injuries were caused by aerosol. ‘Challenge’ injury patients were younger than those with self-harm (p=.007) and non-intentional injuries (p<.001). A greater proportion of self-harm injuries were in female patients compared to non-intentional injuries (p<.001). Median TBSA was 0.35% (IQR 0.3). Most burns were superficial partial-thickness (n=35, 56.5%), followed by deep-dermal (n=18, 29.0%), full-thickness (n=8, 12.9%), and superficial (n=1, 1.6%). The upper limb was most frequently affected (n=35, 56.5%). Aetiology and whether a non-intentional, ‘challenge’ or self-harm injury did not affect TBSA (p=0.776 & p=0.364) or depth (p=0.353 & p=0.381). Five (8.1%) patients underwent autografting. The median time to healing was 17 days (range 7-45, IQR 22.75). Follow-up ranged from 1-173 weeks. ConclusionsThe incidence of cold burns has increased when compared with previous literature. A disproportionate number of cold burns are self-inflicted using aerosols, either as self-harm or due to social media or peer ‘challenges’. Other emerging aetiologies include non-intentional skin contact with nitrous oxide containers during its recreational use.

Experimenting with Pig-based Skin Model for Burns. Testing of Mean Literature Findings.

Introduction: Animal models that closely mimic human burn wound healing processes are essential for developing effective burn wound treatments. Pigs are useful animal models for studying burn wound healing. From their extensive literature review, Andrews and Cuttle (2017) reported mean temperature and exposure time values. This study was done to provide initial burn depth for another experiment comparing two burn wound treatments. The secondary goal was to validate a systematic review on porcine burn model standardization. Material and Methods: Six four-week-old Large White x Landrace gilts were housed in a closed structure for 10 days to acclimatize. The procedures were performed under general anesthesia. A round 2.5 cm copper plate welded to an aluminum rod with a wooden handle caused the injuries. The burning device was used to reach a contact temperature of 110 C on the pig's skin. The objective was to create a superficial partial thickness (SPT) burn for 10 seconds (Group 10s) and a deep partial thickness (DPT) burn for 20 seconds (Group 20s) using a plate heated at 110ºC. No stabilizer or pressure controller was used. Wounds were conclusively dressed and harvested 24 hours later. The usual hematoxylin-eosin protocol was used to cut and stain 4-micron sections. Results: A significant difference (p 0.01) was observed in dermis involvement, with a mean of 85.61 % (95% CI= 80.62 to 90.61) for group 10s and 123.71% (95% CI= 114.91 to 132.50) for group 20s. An exposure time of 20 seconds increased dermis depth-related total collagen denaturation by almost 50% compared to 10 seconds. Conclusions: In conclusion, our experiment produced DPT burns in 10 seconds and FT burns in 20 seconds without a pressure application device.

Using Computer Vision and Artificial Intelligence to Track the Healing of Severe Burns.

Burn care management includes assessing the severity of burns accurately, especially distinguishing superficial partial-thickness burns from deep partial-thickness burns, in the context of providing definitive, downstream treatment. Moreover, the healing of the wound in the subacute care setting requires continuous tracking to avoid complications. Artificial intelligence (AI) and computer vision (CV) provide a unique opportunity to build low-cost and accessible tools to classify burn severity and track changes in wound parameters, both in the clinic by physicians and nurses and asynchronously in the remote setting by the patient themselves. Wound assessments can be achieved by AI-CV using the principles of image-guided therapy using high-quality 2D color images. Wound parameters can include wound 2D spatial dimension and the characterization of wound color changes, which demonstrates physiological changes such as the presentation of eschar/necrotic tissue, pustulence, granulation tissue, and scabbing. Here we present the development of AI-CV-based Skin Abnormality Tracking Algorithm pipeline. Additionally, we provide the results on a single localized burn tracked for a 6-week period in the clinic and an additional 2-week period of home monitoring.

The effect of T-lysine cream on the wound healing process

Background and objective: Wound healing is a dynamic process that can be compromised in patients with chronic and metabolic conditions or unhealthy lifestyles. Objectives of study is to demonstrate a hyaluronate-containing supramolecular structure which enhances repalysYAL®cream effectiveness, sodium chloride with thymine (T-LysYal®); 1) notable progress in the healing of wounds. 2) the production of minuscule collagen strands 3) a shorter recovery period. Methods: Case study, the test group received standard treatment followed by lysine cream to indicate the size and depth ulcer from the 1st week to the 3rd week. Our patients were a 1-year child and 29 years old male who presented with a second degree of total body surface area (TBSA) burn and skin grafts at the burn center of Rozhawa Hospital/ Hawler/Iraq. The observations were approved by the Ethics committee college of pharmacy in compliance with the ethical standard. Initially assessed as superficial partial-thickness in-depth, the wounds were treated conservatively with dressings and repalysYAL® cream 2-3 times per day; however, represents the healing process in short-term individual therapy. Results: In case 1; The patient had been exposed to flash deep burn to the right palm (thermal injury) mainly of superficial partial thickness; any necrotic tissue present needs to be removed to take full advantage of the product’s potential. When (repalysYAL®) cream is used, there will be a physiological increase in the exudate, which will have to be managed to avoid maceration. While in case 2;The patient presented surgical wound dehiscence in the inner compartment of the left foot with leakage of purulent material and signs of necrotizing fasciitis. with using (repalysYAL®) cream, the wound reduces scar formation due to 90% and increase fibroblast by 30% when a blood vessel is formed to which blood is supplied, the cells are cultivated and divided to form new tissue and an organ. Conclusion: Signaling pathways that induce cellular and tissue responses after injury, which may be impeded during chronic wound healing, were greatly improved using lysine cream as a therapy.

Burn Injuries From TikTok Challenges: A Brief Report.

Social media (e.g., TikTok) challenge is a relatively new phenomenon wherein a user creates and posts videos performing an often-dangerous task. The ease of access and availability of social media in recent times make teens and young adults susceptible to these viral Internet challenges and accidental injury. The severity, morbidity, and mortality of burn injuries from social media challenges have not readily been documented in the medical literature. In this brief report, we present three cases of accidental burns after attempting social media challenges involving boiling water or flame. The injuries ranged from superficial partial thickness burns to 24% total body surface area (TBSA) full thickness burns. Online challenges show the potential for severe injury and disability and underlie the importance of awareness and education of the public, further research into the usage of TikTok and other media platforms, and early referral to the American Burn Association recognized center.

Endometriosis with colonic and rectal involvement: surgical approach and outcomes in 142 patients.

Endometriosis involving the colon and/or rectum (CRE) is operatively managed using various methods. We aimed to determine if a more limited excision is associated with 30-day complications, symptom improvement, and/or recurrence. This is a retrospective review of consecutive cases of patients who underwent surgical management of CRE between 2010 and 2018. Primary outcomes were the associations between risk factors and symptom improvement, 30-day complications, and time to recurrence. Multivariable logistic regression assessed the independent risk factors. Of 2681 endometriosis cases, 142 [5.3%of total, mean age 35.4 (31.0; 39.0) years, 73.9% stage IV] underwent CRE excision (superficial partial = 66.9%,segmental = 27.5%,full thickness = 1.41%). Minor complications (14.8%) were associated with blood loss [150 (112; 288) vs. 100 (50.0; 200) mls, p = 0.046], Sigmoid involvement [45.5% vs. 12.2%, HR 5.89 (1.4; 22.5), p = 0.01], stoma formation[52.6% vs. 8.9%, HR 10.9 (3.65; 34.1), p < 0.001], and segmental resection [38.5% vs. 5.8%, HR 9.75 (3.54; 30.4), p < 0.001]. Superficial, partial-thickness resections were associated with decreased risk [(4.2% vs. 36.2%), HR 0.08 (0.02; 0.24), p < 0.001]. Factors associated with major complications (8.5%) were blood loss [250 (100; 400) vs. 100 (50.0; 200) mls, p = 0.03], open surgery [31.6% vs. 4.9%, HR 8.74 (2.36; 32.9), p = 0.001], stomaformation [42% vs. 3.3%, HR 20.3 (5.41; 90.0), p < 0.001], and segmental colectomy [28.2% vs. 0.9%, HR 34.6 (6.25; 876), p < 0.001]. Partial-thickness resection was associated with decreased risk ([.05% vs. 23.4%, HR 8.74 (2.36; 32.9), p < 0.001]. 19.1% experienced recurrence. Open surgery [5.2% vs. 21.3%, HR 0.14 (0.02; 1.05), p = 0.027] and superficial partial thickness excision [23.4% vs. 10.6%, HR 2.86 (1.08; 7.59), p = 0.027] were associated. Segmental resection was associated with decreasedrecurrence risk [7.6% vs. 23.5%, HR 0.27 (0.08; 0.91), p = 0.024]. Limiting resection to partial-thickness or full-thickness disc excision compared to bowel resection may improve complications but increase recurrence risk.

Human amniotic membranes as an allogenic biological dressing for the treatment of burn wounds: Protocol for a randomized-controlled study

BackgroundBurn wounds pose significant challenges in medical treatment due to their devastating nature and resource-intensive requirements. Temporary coverage of burn wounds using synthetic or biological dressings allows for reepithelization before definitive skin grafting. Allogenic skin grafts have been widely used but come with drawbacks such as rejection and disease transmission. The use of amniotic membranes (AMs) offers a promising alternative for temporary coverage, as they possess biological properties that promote faster healing and improved scar quality. The various components of the amniotic membrane, including pluripotent stem cells, extracellular matrix proteins, and regenerative factors, contribute to cell growth, migration, and differentiation, as well as preservation of the original epithelial phenotype. ObjectiveReliable information on the treatment of burn wounds with AM is needed. The knowledge gained in this project may help to include this advantageous modern concept of biological dressings in clinical practice. The purpose of this study is to use human amniotic membranes from our in hospital laboratory, as an allogenic biological dressing after enzymatic debridement in superficial partial thickness, deep partial thickness or full thickness burn wounds. MethodsWe will include 30 patients in a randomized-controlled trial with each patient receiving the study intervention and the control intervention. Two 7 × 7 cm burn wound areas will be compared regarding percentage of skin graft take, healing time, healing percentage value and total healing time. Human amniotic membranes will be compared to allogenic skin grafts.

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.

Effectiveness of Aloe Vera Gel in Management of Superficial Burn in Children

Background: Aloe vera has been used traditionally for healing burn and inflammation. Though, the evidence for the effectiveness of aloe vera for healing burn is not sufficient.&#x0D; Objective: The aim of this study was to assess the effectiveness of aloe vera gel in management of superficial burn in children.&#x0D; Methods: This retrospective study was taken place in the Department of Burn and Reconstructive Surgery, Bangladesh Shishu Hospital &amp; Institute, Dhaka and other two privet clinics at Dhaka, from September, 2019 to March, 2022. Total 47 patients with superficial partial thickness burn was included in the study.&#x0D; Results: In this study, majority (48.94%) patients were belonged to the age group of £24 months. The mean age was found 38.9±26.31 months. The current study observed that almost two third (61.70%) patients were male. In our study, majority (63.83%) patients stayed hospital for 1-5 days. In the present study, mean (±SD) pain relief time was 3.56±1.24 days and mean (±SD) wound healing time was found 8.19±1.6 days. The current study observed that only 3(6.38%) patients had found wound infection. In current study showed that mean treatment cost was found 76.46±31.88 Taka.&#x0D; Conclusion: Aloe vera gel facilitated early pain alleviation, wound healing, and costeffective superficial burn treatment in children. Therefore, it can be utilized to treat superficial burns in children to get better results.&#x0D; DS (Child) H J 2021; 38(1): 39-43

72 Multi-Spectral SWIR Imaging in Humans Reveals Correlations with Distinct Skin Burn Depths

Abstract Introduction Burn depth determination is a critical aspect of burn patient care but currently lacks accuracy in clinical practice. We have shown first in animal models and then in a two-patient characterization that Short Wave Infrared (SWIR) imaging, which penetrates tissue better than visual or near-infrared light and is very sensitive to water content, can distinguish between superficial and deep tissue necrosis. Here we present the findings from our pilot study of 10 patients showing the use of multi-spectral SWIR imaging of human burn injury as a potential technique for burn depth determination. Methods Ten patients admitted for mixed depth thermal injuries between 5-40% TBSA were analyzed using our SWIR assessment tool. Prior to burn excision the SWIR system was used to image burn areas and normal skin at 4 different SWIR wavelengths (Figure 1A). Standard photographs from imaged areas were collected and presented for 5 independent, blinded, surgeons’ assessments. Using the visual and SWIR images, 5-15 regions of interest (ROI) were selected from each of the burned areas and normalized to adjacent normal skin and the reflected light intensity in each ROI was averaged at each wavelength. Statistics were done using Mann-Whitney U tests. Results Visual and SWIR images were collected from burn areas in 10 patients for a total of 273 burn ROIs. The ROIs were assessed by the surgeons with ROIs being agreed upon as being superficial or superficial partial thickness (SPT) (n=47), deep partial thickness (DPT) (n=97), or full thickness (FT) (n=129) burns by a majority (60% or above) consensus. As seen in Figure 1B, the reflectance intensities (RIs) from superficial and SPT burns were significantly different than the DPT burns at the 1940 nm wavelength (p=0.05) and significantly different than FT burns at 1200 nm (p=0.008) and 1940 nm (p=0.009). When DPT and FT burns were compared there was a significant difference a 1200 nm (p=0.003) and 2250 nm (p=0.01). Conclusions Here we present a 10 patient SWIR pilot study demonstrating distinct ROIs of SWIR wavelengths for different burn depths based on consensus surgeon assessments. Overall, as burn depth increases, the 1200 and 2250 nm wavelengths show increasing RIs and 1940 nm show decreasing RIs. These results motivate further studies of SWIR imaging including pending histological analysis in the hope to non-invasively and accurately identify operative versus non-operative burns. Applicability of Research to Practice This new SWIR technology may enable us to more objectively assess burn depth, leading to improved surgical decision making and better patient outcomes.

75 Tranexamic Acid Reduces Burn Wound Conversion and Lung Inflammation in a Murine Comb Burn Model

Abstract Introduction Burn wound conversion is a process where superficial partial thickness burns convert into deep partial and even full thickness burn injuries. Unfortunately, the pathophysiology of this phenomenon is poorly understood. A therapeutic intervention that may prevent secondary progression and cell death in burn-injured tissue is desirable. Recent work by our group has established that tranexamic acid (TXA) has significant anti-inflammatory properties in addition to its well-known anti-fibrinolytic effects. This study investigates tranexamic acid as a novel therapeutic treatment to mitigate burn wound conversion and reduce systemic inflammation. Methods Sprague-Dawley rats were subjected to a hot comb burn contact injury using a 150-g brass comb preheated to 100°C, to create four rectangular burns, separated by three unburned interspaces. A subset of animals underwent the comb burn injury with an adjacent 30% TBSA contact injury using solid brass rods. The interspaces represent the ischemic zones simulating the zone of stasis. The treatment group received IP injection of TXA (100mg/kg) immediately after injury and once daily until sacrifice. Sham animals underwent an identical procedure, with application of a room temperature comb. Animals were sacrificed at 6hrs and 7-day time points post-injury. Photo images were obtained of the comb burn injury. Full-thickness biopsies from the ischemic zones and lung tissue were assessed with established histological and immunohistochemical (IHC) techniques. Results At 7-days post injury, the percentage of ischemic zones with necrosis was significantly reduced in the treatment group when compared with untreated burn controls by photographic image analysis. When compared with controls, the treatment groups had significantly less progression of ischemic zones to necrosis when assessed by standard microscopy. These findings were consistent in both the comb burn only and comb burn + 30%TBSA injury models. The TXA treatment group demonstrated significantly more expression of the regeneration marker (CTHRC-1) and a trend toward increased expression of the Ki-67 proliferation marker when compared to untreated burn group. At 6 hours post-injury, TXA significantly decreased infiltration of neutrophils in the lungs for the 30%TBSA burn injury model. Furthermore, systemic levels of mitochondrial DNA, IL-1α and TNFα were significantly lower in TXA treated animals when compared to untreated burn controls. Conclusions Animals treated with tranexamic acid demonstrated reduced burn wound conversion and decreased burn-induced SIRS response. Lung inflammation was also significantly reduced by administration of TXA after injury. Applicability of Research to Practice Tranexamic acid and agents with similar mechanisms of action may provide a treatment to reduce burn wound conversion. This therapy could be easily incorporated into standard acute burn care practices.

A Rare Case of a Second-Degree Chemical Burn due to Successive Contacts of Acidic Wart Removal Solution and Paint Solution

Introduction: Chemical burns are an uncommon form of burn injury, accounting for 2.1% to 6.5% of all burn centre admissions. We presented one rare case of a second degree chemical burn due to successive contacts of acidic wart removal solution and paint mixture solution. Case: A 38-year-old male with chemical burn on both feet due to reckless usage of a self-purchased wart removal solution, and accidental contact with paint mixture solution. Our surgeon author diagnosed a superficial partial thickness (second-degree) chemical burn on this patient, and performed surgical debridement followed by hyaluronic-enhanced silver sulfadiazine topical dressing to provide antimicrobial protection to the wound and topical petrolatum-based ointment to maintain moist environment for the wound and the periwound. Our team also gave Ceftaroline, a cephalosporin for serious infections of the skin and tissues below the skin, intravenously. Result: One day after the surgical procedure, the wound dimensions were slightly more extensive than the initial size due to extensive debridement and necrotomy. All wounds produced no or minimal exudate, showed no slough nor pus inside the granulation area, and no swelling nor maceration in the periwound area. The fifth day after the surgical procedure, the wound on the lateral side of patient’s right foot was almost completely covered by epithelialization. The wound on the sole of patient’s right foot was about 70-80% covered by epithelialization, and the wound on the sole of patient’s left foot was also about 70% covered by epithelialization. Discussion: Topical solution for wart removal consists of many chemicals agents (i.e. salicylic acid and acetic acid) and its application should strongly be under guidance and monitoring by physician due to its potential to harm human bodies and trigger chemical burn injury in varying degrees. Paint mixture is usually safe, risks no or minimal harms when in contact with skin, however it can provide a more difficult scenario and consequently a more extensive cleansing during the wound debridement procedure. Immediate decontamination and adequate dilution through massive irrigation is a major determinant of burn severity after chemical injury. Application of 1% silver sulfadiazine topical antibiotics enhanced with 0.2% hyaluronic acid for moisturizer displayed significant improvement for the burn wound healing. Conclusion: Knowing exactly what type of chemical substance in contact with the skin and tissues that caused the chemical burn injury is as equally important as the comprehensive management itself. For acidic burn injuries, a proper and sometimes extensive necrotomy procedure is mandatory to provide a good tissue regeneration.