Treatment Of Acute Burns Research Articles

Autologous fat grafting and adipose-derived stem cells therapy for acute burns and burn-related scar: A systematic review.

The objective of this study was to analyze all available research on the application of autologous fat grafting (AFG) and adipose-derived stem cells (ADSC) to present evidence-based recommendations, particularly in the clinical treatment of acute burns and burn-related scars. We conducted a systematic search of PubMed, COCHRANE, and EMBASE, as well as a manual search of previous reviews' reference lists up. The risk of bias (RoB) was assessed using RoB 2.0 and ROBINS-I, where appropriate. Six eligible studies were selected (2 randomized clinical trials [RCT], 1 retrospective cohort, and 3 experimental studies) with subjects ranging from 3 to 100. Only one study evaluated the use of AFG for acute burns. Improvements in wound healing, vascularization, scar characteristics, and tissue architecture were generally observed in some studies, supported by molecular markers, while one study reported nonsignificant results. Subjective patient satisfaction was reported to have improved. Functional outcomes improvement in the treated regions was minimal. However, study heterogeneity arose mainly from treatment protocols. Cautious results interpretation due to potential bias, especially in selection and confounding domains, and limited clinical trials are important to note. More studies are needed to evaluate. AFG and ADSC hold potential as valuable treatment options for burn-related scars, supported by a body of evidence, but further well-designed RCT are needed. The efficacy of acute burn settings is yet to be further evaluated since evidence is limited.

Efficacy and Complications Associated with Acellular Dermal Substitute Use in the Treatment of Acute Burns: A Systematic Review and Meta-Analysis

Over several decades, skin substitutes have become an essential tool in acute burn surgery, particularly in major burns, where scarce donor tissues can limit the availability of autografts. This systematic review aimed to assess the efficacy, complication rates, and long-term outcomes of acellular dermal substitutes in acute burns and compare these to conventional skin grafting methods of coverage. A search of PubMed, Web of Science, and CENTRAL for appropriate randomized controlled trials (RCTs), non-randomized trials, and observational studies was conducted. Following screening, nine RCTs and seven observational studies fulfilled our inclusion and exclusion criteria. Our primary outcomes, which were graft take and incidence of infection, found no significant difference between the substitute and control procedures in a meta-analysis (p = 0.37 and p = 0.87, respectively). For our secondary outcomes, the studies were analyzed via narrative synthesis, which reported variable rates of graft loss and duration of acute hospital stay, from which definitive conclusions could not be drawn due to the heterogeneity in reporting. Despite a high risk of bias in the included studies, the evidence reviewed suggests that the treatment of an acute burn with a substitute may improve scar quality when compared to conventional grafting. This review therefore suggests that acellular dermal substitutes offer a viable method for staging the closure of deep partial- and full-thickness acute burns, although more robust RCTs with less heterogeneity are needed to support these conclusions.

Exploring Hyaluronic Acid as a Potential Standard Dressing for Burn Wound

A massive loss of dermis layer such as in deep burn wounds brings several important consequences and complications which contribute to major problems, personally and economically, for the burn patients and their families. Ideal burn wound treatment should not focus merely on removing devitalized tissue, controlling bacterial growth, and promoting healing, but also on accelerating the healing process and preventing scar-related complications. The evolution of biomaterial science for burn wounds has provided physicians with novel dressing materials based on natural and also synthetic polymers, and the latest development introduces the use of hyaluronic acid (HA) as a potential burn wound dressing. HA has been studied to have involvement in many phases of the wound healing process, such as inflammation, granulation, and re-epithelialization. Dealing with the unfavorable physical properties of the native polymer such as solubility and rapid degradation, modification and improvement are designed to produce insoluble molecules to facilitate hyaluronic acid-based (HA-based) wound dressing products as a valuable option for the treatment of deep burns. Our literature review shares the development and the outcome of the use of these products in burns. The currently available clinical experience suggests that these HA-based wound dressing products provide a safe therapeutic method useful for the treatment of acute burns and minimize scar-related complications, although further improvements are still required to make an ideal HA-based wound dressing product for standard burn wound treatment.

The Impact of Plastic Surgery Volume on Inpatient Burn Outcomes.

Acute burn care involves multiple types of physicians. Plastic surgery offers the full spectrum of acute burn care and reconstructive surgery. The authors hypothesize that access to plastic surgery will be associated with improved inpatient outcomes in the treatment of acute burns. Acute burn encounters with known percentage total body surface area were extracted from the National Inpatient Sample from 2012 to 2014 based on International Classification of Diseases, Ninth Edition, codes. Plastic surgery volume per facility was determined based on procedure codes for flaps, breast reconstruction, and complex hand reconstruction. Outcomes included odds of receiving a flap, patient safety indicators, and mortality. Regression models included the following variables: age, percentage total body surface area, gender, inhalation injury, comorbidities, hospital size, and urban/teaching status of hospital. The weighted sample included 99,510 burn admissions with a mean percentage total body surface area of 15.5 percent. The weighted median plastic surgery volume by facility was 245 cases per year. Compared with the lowest quartile, the upper three quartiles of plastic surgery volume were associated with increased likelihood of undergoing flap procedures (p < 0.03). The top quartile of plastic surgery volume was also associated with decreased odds of patient safety indicator events (p < 0.001). Plastic surgery facility volume was not significantly associated with a difference in the likelihood of inpatient death. Burn encounters treated at high-volume plastic surgery facilities were more likely to undergo flap operations. High-volume plastic surgery centers were also associated with a lower likelihood of inpatient complications. Therefore, where feasible, acute burn patients should be triaged to high-volume centers. Therapeutic, III.

51 Negative Pressure Wound Therapy for Small-to-medium-sized Paediatric Thermal Burns: A Randomized Controlled Trial (SONATA in C)

Abstract Introduction In the setting of burns, negative pressure wound therapy (NPWT) has been widely adopted as a means of wound bed preparation prior to skin grafting and graft immobilization. Its role in the treatment of acute burns has been less well-studied, although there is limited evidence to suggest that it might facilitate physiological healing. This study aimed to assess its efficacy in the management of acute burns in children with small-to-medium-sized thermal injuries. Methods In this single-center, two-arm, parallel, randomized, controlled clinical trial, we assigned patients under 17 years of age with acute thermal burns covering &amp;lt; 5% of their total body surface area to either an active control (nanocrystalline silver dressings) or an experimental treatment combining standard dressings with NPWT. Patients were excluded if their burn occurred &amp;gt;7 days prior to presentation, affected the face, or was deemed by clinicians to be trivial. The primary outcome was time to re-epithelialization. Secondary outcomes included scarring, grafting, pain, ease of management, and adverse events. Results A total of 114 children underwent randomization. The median time to re-epithelialization was 8 days (interquartile range (IQR) 7–10) for the NPWT group and 10 days (IQR 8–12.25) for the control group (hazard ratio, 1.515; 95% confidence interval (CI) 1.003 to 2.289; P=0.048). Children administered NPWT within 48 hours of their injury (n=16) re-epithelialized in a median of 7 days (IQR 5–8; HR, 2.129; 95% CI 1.155 to 3.922; P=0.015). The proportion of children referred to scar management was 8.7% for the experimental group and 25.9% for the control group (odds ratio, 0.27; 95% CI 0.08 to 0.90; P=0.032). There were no significant differences in grafting (2.2% vs. 7.4%; odds ratio, 0.28; 95% CI 0.03 to 2.58; P=0.260), pain during dressing changes (P=0.946), or at-home pain between dressing changes (P=0.592). NPWT was associated with a greater treatment burden (P&amp;lt; 0.001) and incidence of adverse events, which included minor blistering and wound maceration. Conclusions In children with small-to-medium-sized thermal burns, NPWT accelerated re-epithelialization and decreased the need for long-term scar management. Applicability of Research to Practice This study found NPWT to be a promising adjunct to standard care in the treatment of pediatric thermal burns. (Clinical Trials Registry number, ACTRN12618000256279.)

704 Lessons Learned from a Mass Disaster: Successful Institutional Planning and Preparedness

Abstract Introduction This abstract discusses the experience of a Burn disaster at the largest thermal power plant of the country, which was successfully managed at our center. The experience gained will hopefully help in the planning and management of similar disaster scenes in resource-constrained developing countries. Methods In a National thermal power plant, there was an explosion in the 500-megawatt unit. Hot fuel gases and steam escaped affecting close to 100 people working around the area. Twenty-six people succumbed to death and six victims who sustained burn injuries were referred to our trauma center where they were received about twenty-six hours after the injury. Despite having no infrastructure supporting the treatment of acute burns, proper planning and coordinated effort by all sectors and persons concerned were immediately initiated and ultimately all patients were discharged in a healthy state with no incidence of mortality or significant morbidity from the burns. Results All the six patients were males ranging from 25 to 45 years age and sustained 20% to 45% deep thermal burns over their bodies. All patients were initially evaluated in the emergency where triage was conducted, and four patients out of six were found to have symptoms of respiratory burns and carbon monoxide poisoning. One high dependency unit (HDU) was immediately converted to a burn ICU(Intensive care unit), and all these patients were nursed in isolation. Two patients had severe airway burns and had to be intubated and ventilated. These patients also required hyperbaric oxygen therapy to revert the carbon monoxide poisoning. Out of the six patients, two patients underwent tangential burn wound excision of both upper limbs and skin allograft placement procured from Skin bank. The other four patients underwent debridement, and allograft application subsequently. all the patients recovered from the burn injuries and were discharged with advice to continue rehabilitation at the regional center. This was one of a kind effort where a trauma center was converted to a full-fledged burn ICU to provide the best possible burn care to the victims. A team of 20 people consisting of Plastic Surgeons, Intensivists, Physiotherapists, Nutritionists, Infection Control Nurses, Wound Care Nurses, Hyperbaric oxygen therapist, and other support staff contributed immensely for management of these patients. Conclusions planned cooperation and prepared coordination between the team of doctors and other support staff are the key in the successful management of a disaster. Applicability of Research to Practice In the event of a mass disaster a level 1 trauma center was immediately converted to a facility equipped to handle burns. This experience gained may be useful in the future in the planning and management of similar disaster scenes in developing countries with limited resources.

Comparative long-term study between two dermal regeneration templates for the reconstruction of burn scar contractures in humans: Clinical and histological results

The advent of dermal regeneration templates has fostered major advances in the treatment of acute burns and their sequelae, in the last three decades. Both data on morphological aspects of the newly-formed tissue, and clinical trials comparing different templates, are few. The goal of this study was to prospectively analyze the outcome of randomized patients treated with two of the existing templates, followed by thin skin autograft. They are both 2 mm-thick bovine collagen templates (Matriderm® and Integra®), the latter includes a superficial silicone layer. Surgery was performed on patients with impaired mobility resulting from burn sequelae (n = 12 per template) in a two-step procedure. Negative pressure therapy was applied after surgery; patients were monitored for 12 months. No intra or postoperative complications were observed. Data on scar skin quality (Vancouver scar scale), rate of mobility recovery, and graft contraction were recorded; as well as morphological analyses at light microscopical level. Improvement in mobility and skin quality were demonstrated along with graft contraction, in all patients. The double layer template showed the best performance in retraction rate, skin quality and mobility recovery. The subepidermal newly-formed connective tissue showed no histoarchitectural differences between the templates. The double layer template was not absorbed up to 12 months after placement.

T1 A Comparative Study of Autologous Skin Cell Suspension to Split-thickness Autografting in the Treatment of Acute Burns

Split-thickness autografts (STAG) are the current standard of care for the permanent coverage of deep partial-thickness (DPT) burns. However, grafting is often complicated by hypertrophic scarring and dyspigmentation. Non-cultured, autologous, cell suspension systems are potential alternatives to autografting appropriately selected burn wounds. ReCell® is a device for the rapid, point-of-care preparation and application of non-cultured, autologous skin cells that provides an expansion ratio of 80:1 but is currently limited by US law to investigational use only. We present the results of the initial FDA approval trial for ReCell®. This was a prospective, randomized, within-patient controlled, GCP-compliant, FDA IDE trial comparing ReCell® to STAG for the treatment of acute, DPT burns in adults suffering 1–20% TBSA thermal burns. Comparable burn wounds measuring 100–320 cm2 were randomized to treatment with ReCell® vs. 2:1 meshed STAG. The co-primary effectiveness endpoints were donor site healing at 1 week (superiority) and recipient site healing at 4 weeks (non-inferiority) between the ReCell®-treated and autografted wounds. Secondary effectiveness endpoints included percent epithelialization over time, pain, and patient satisfaction. Safety endpoints included graft loss, infection, scarring, and adverse events. Data were analysed by intention-to-treat (ITT) and modified per-protocol (MPP) populations, as appropriate. A total of 101 subjects across 12 US Burn Centers were enrolled (n=101 ITT, n=83 MPP). The superiority effectiveness endpoint was met for ReCell® donor site healing in the ITT population (p=0.004), and the non-inferiority effectiveness endpoint was met at -2.4% [-8.4 to 2.3%] in the MPP population for ReCell® recipient site healing vs. STAG healing. Secondary effectiveness endpoints demonstrated similar rates of epithelialization and patient satisfaction with respect to the recipient wounds, while there was significantly reduced pain and significantly higher patient satisfaction with respect to the ReCell® donor site wounds. No demonstrable safety signal was generated. ReCell® can be used to safely treat acute, DPT, thermal burns in adults with comparable wound closure and scarring outcomes, but with significantly smaller and less painful donor sites that patients clearly prefer, when compared to conventional STAG. Using ReCell® allows the burn surgeon to “graft” a DPT burn with ~98% less skin than with conventional STAG, resulting in comparable healing, reduced pain, improved aesthetics, and increased overall patient satisfaction.

Economical Burden of Burn Injuries in a Developing Country.

Burn injuries have economical impacts on patients in several ways. Understanding the charges of burn treatment is very important for patients, families, governmental authorities, and insurance companies. During the protocol of their treatment, they may be admitted several times for treatment of acute burn and then for reconstructive treatments of burn's complications. Calculating the hospital burn charges can serve as an objective criteria for authorities to plan for a sufficient budget for acute burn treatment, for additional management for chronic complications, and as a guide for planning preventive and public educational programs. The authors used data of their burn registry program. During more than 3 years, the authors had 912 patients with multiple admissions for burns. All of hospital costs during several admissions were recorded. Men were 71% and women were 29% of the patients. Burns caused by flame were the most frequent (50.1%) followed by scald (34.0%). Mean hospital stay was 14.1 days (range, 0-64 days). Patients with TBSA equal to or less than 10% were 38.8%, TBSA between 11 and 22% were 29.1%, and TBSA more than 23% were 32.1%. Those who were admitted for 30 days or less were 34.1%, those between 31 and 131 days were 32.7%, and those with more than 132 days of admission were 33.2%. Mean hospital cost for all patients during the 3 years was about $2766 (range, from $143 to $33,566; median = 1586.93; SE = 93.84). The patients were admitted for treatment of acute burns and later admitted for reconstruction of the burn sequels. Total number of admissions was up to six times (median = 2). About 66.27% of the total charges were the cost of first admission, 19.39% the cost of second admission, 7.34% the cost of third admission, 3.56% for fourth admission, 2.3% for fifth admission, and 1.15% for last or sixth admission. The authors conducted a multiple linear regression test. Male sex, TBSA, length of stay, and number of admissions were significantly related to total treatment charges. But "age" did not influence the charges. Mean total cost of several burn admissions in one patient was around $2766. TBSA, length of stay, male sex, and number of admissions were significantly related to the hospital costs.

Surgical treatment of acute burns and post burn skin contractures: Consequences for scar management and rehabilitation

Surgical treatment of acute burns and post burn skin contractures: Consequences for scar management and rehabilitation

G14 Are Healthcare Professionals able to Estimate the Surface Area of a Burn in a Child?

AimsWhen different Healthcare Professionals estimate the surface area of a burn there can be significant discrepancies. This is particularly true in Paediatrics, where there are several methods commonly used to...

The Inaugural Congress of the International Society of Plastic Regenerative Surgery

The Inaugural Congress of the International Society of Plastic Regenerative Surgery

Rehabilitation of burn patients: An underestimated socio-economic burden

PurposePatients with burns utilise intensive medical care and rehabilitation. Deep dermal burns lead to scar contractures. Virtually no published data exists on costs for treatment of acute burns in comparison to burn sequelae. Our purpose was to collect financial data on burn therapy to estimate the socio-economic burden of thermal injuries. MethodsGerman-DRG for in-patient treatment of burns was collected from our burn center. DRG-related T95.- coding served as a search tool for burn associated sequelae. To include rehabilitation costs, data from the largest health care insurance and a workmen compensation fund were acquired. FindingsAcute burn treatment comprised 92% of costs for intensive care with approximately 4.600 EUR per percent total burned surface area (TBSA). Expenses for non-intensive care patients were significantly lower than for burn sequelae. Rehabilitation expenses were 4.4-fold higher than costs for acute burns including 59% for manual therapy and 37% for auxiliary material. ConclusionsTBSA multiplied by factor 4600 could serve for cost calculation of severely burned patients. Approximately 0.3 billion EUR in total or 270.000 EUR per patient/year were spent on burn sequelae. Early admission to specialized burn centers is advocated with state-of-the-art treatment to minimize burn sequelae and health care expenses.

Analysis of attitudes toward the source of progenitor cells in tissue‐engineered products for use in burns compared with other disease states

The first trials using progenitor cells to improve burn wound healing are beginning. However, there remains a paucity of data on patients' opinions of the source of stem cells. In this study, 279 patients attending plastic surgery/burns outpatient and medical outpatient clinics were questioned to assess willingness to accept a tissue-engineered skin product derived from a variety of sources. Levels of acceptance for the use of progenitor cells derived from these sources for treatment across a range of disease states (burns, Parkinson's disease, diabetes, and for cosmetic use) were also assessed. Overall, 80% of those questioned would accept a tissue-engineered product. Autologous cells were the preferred choice of cells (acute burns 94%, diabetes 95%, Parkinson's 93.9%). Allogeneic cells were still widely accepted (acute burns 67%, diabetes 66.7%, Parkinson's 69.2%). There was no difference observed between plastic surgical patients and medical patients in acceptance of cell therapy for burns, Parkinson's disease, or diabetes. There is good potential acceptance for the use of both autologous and allogeneic cells for the treatment of acute burns and burns' scarring as well as in diabetes and Parkinson's disease. Disease state does not appear to influence overall acceptability and choice of cells.

Plasma Levels of Lignocaine during Tumescent Local Anaesthesia in Children with Burns

The aim of the study was to assess the changes in plasma lignocaine concentrations over time when the tumescent solution is injected into subcutaneous tissue of children undergoing surgical treatment of burns. Sixteen consecutive children with burns were studied using a prospective study design. After induction of general anesthesia, tumescent lignocaine solution 0.1% with adrenaline in nine patients (adrenaline group) for the treatment of postburn sequelae, or without adrenaline in seven patients (no-adrenaline group) for the treatment of acute burns, was injected into the subcutaneous tissue of burned and donor areas. The maximum dose of lignocaine was 7 mg/kg. Blood samples were collected before the start of the injection as well as at 5, 10, 20, 30, 45, 60, 90 minutes and 2, 4, 8, 12, 24 hours after the infiltration was completed. The course of lignocaine plasma levels was chaotic in the adrenaline group and biphasic during the first hour in the no-adrenaline group. The maximum plasma concentration of lignocaine was 2.09 microg/ml in the adrenaline group and 1.98 microg/ml in the no-adrenaline group. No adverse reactions were noted. Tumescent injection in burned children resulted in lignocaine plasma concentrations that were always lower than the often quoted value of 5 microg/ml, considered to be the toxic plasma threshold in adults. These data lend support to the use of lignocaine using the tumescent technique in burned paediatric patients.

Modified thin abdominal wall flap (glove flap) for the treatment of acute burns to the hands and fingers

Burns to the dorsum of the fingers and hands require debridement and immediate coverage by skin flap at the earliest opportunity. In such situations, the conventional abdominal wall flap is still commonly used as it is a convenient and safe technique, but the foremost problem with this flap is that it is thick and therefore cosmetically unacceptable; it is also functionally not very suitable as the bulkiness of the digits prevents full range of motion. We have developed a modified thin abdominal flap (glove flap) which attains good results. Incisions are made in the skin of the abdominal wall only where the hand is to be inserted and where each of the finger tips will be pulled through. The flap is undermined just under the skin to the depth that preserves the subcutaneous vascular networks to create a thin flap. The interdigital area of the flaps should not be undermined so as to create a glove-type pocket. The hand is then inserted in this subcutaneous pocket. After insertion of the injured hand for 10 to 14 days, the flap is resected and attached to the hand. Seven hands of 5 patients were treated by this technique and all the flaps survived safely. The function of the hands and fingers, including range of motion (ROM) in each joint, was successfully salvaged. The reconstructed hands and fingers were aesthetically pleasing. Although the abdominal wall flap is not a new technique, our modifications to this flap make it possible to acquire functionally and aesthetically better results. Although many excellent techniques such as perforator flaps have been reported recently, we conclude that the abdominal wall flap is still a very useful technique because it can be performed easily, safely and within a short time.

Canadian Society of Plastic Surgeons

Team communication is essential to patient safety, and research suggests that poor or insufficient communication is a primary cause of medical errors. Strong team communication may be facilitated through the use of communication protocols that are standardized within an organization or team. This presentation will describe a research program - “Team Talk” -which has implemented and evaluated preoperative briefings to structure interprofessional discussions among surgeons, anesthesiologists, and nurses prior to surgical procedures. Results will include the team briefing’s impact on team communication failure rates and collaborative work processes, followed by a discussion of challenges and lessons learned. LEARNING OBJECTIVES: At the end of this presentation, audience members will be able to: Understand the relationship between team communication and patient safety Explain how preoperative team briefings can impact communication breakdowns and work processes Appreciate the facilitators and barriers to implementing new communication routines in the operating room. Can J Plast Surg. 2008 Summer; 16(2): 97–125. » EF02 The Burned Face: Acute Care and Reconstruction Can J Plast Surg. 2008 Summer; 16(2): 97–98. EF02 The Burned Face: Acute Care and Reconstruction R Spence Copyright and License information ► Copyright © 2008, Pulsus Group Inc. All rights reserved Abstract OBJECTIVES: Understand recent advances in acute care of the burned face. Understand an approach to the analysis and reconstruction of severe facial burn deformities. Understand techniques used personally in the reconstruction of total and subtotal facial reconstruction. OUTLINE: Advances in Treatment of Acute Burns of the Face Determination of depth of burn Usual criteria – make most diagnoses Laser Doppler Imaging Superficial burn – topical treatment Deep burn – excision and grafting Thick split-thickness skin grafts IntegraTM synthetic dermis Burn Reconstruction of the Head and Neck Problems in Facial Burn Reconstruction Scarcity of donor sites, esp. in large burns. Leave deforming donor sites. Require multiple operations. Beyond skill, patience, and/or courage of most reconstructive surgeons. Fundamental Principles Gillies Principles Aesthetic units (Gonzalez–Ulloa) Matching of skin qualities (e.g. color, texture, thickness) (Gonzalez–Ulloa, Edgerton & Hanson) Optimize use of original facial skin. Ideal Facial Reconstruction System: Reliable and reproducible. Provides economy of tissue. Results in adequate well-matched skin. Minimizes donor site deformity. Minimizes hospital stay and operations. Within the skill and patience of most reconstructive surgeons. Use of patient’s own tissues – no rejection/immunosuppression. The Story Expanded full-thickness skin grafts Expanded transposition flap The Algorithm Distinct regions of the face Peripheral Resurface large areas with skin with similar qualities to facial skin. Flap better than skin graft. Central Reconstruct fine architectural structures. Resurface with thin skin well-matched in qualities. Flap generally too thick for resurfacing. Combination of Peripheral and Central Shoulder/Chest skin available – expanded transposition flap provides both flap for peripheral and FTSG for central deformities Shoulder/Chest skin not available – expand available normal skin and resurface with expanded FTSG. Techniques: Skin Grafts Full-thickness skin grafts – Workhorse Defatting – drum dermatome technique Neck contracture releases Central portion of the face Lower lip-chin resurfacing Upper lip – aesthetic units Nose Peripheral areas when local skin not available for flaps Split thickness skin grafts Eyelids Upper – dynamic Lower – static Forehead Miscellaneous Composite Grafts Philtrum reconstruction Nasal ala reconstruction Ear reconstruction Conchal transposition flap Prosthetics Tissue expanders Scalp Direct for advancement flap To develop skin for FTSG Expanded transposition flaps

The Social Milieu of Burn Injury and Recovery: Using “Social Capital” As a Framework for Evaluating Sex Differences

This retrospective review describes differences in social and demographic factors of women and men hospitalized for acute burns. These differences are examined using the framework of social capital to assess burn injury outcomes. Our TRACS-ABA registry was used to identify adult women admitted for the treatment of acute burns from 1998 to 2002. Each woman was matched by age (+/-5 years), %TBSA (+/-5%), and inhalation injury to a man hospitalized during the same period. Patient medical records were reviewed for sociodemographic data, burn etiology, hospital course, and discharge information. One hundred forty-five adult women hospitalized for burn injury during the study period were successfully matched by age, burn size, and inhalation injury to 145 men. The mean age of study patients was 46.4 +/- 18 years. The mean %TBSA burned was 13.0 +/- 18, and 15.5% had inhalation injury. There were no sex-related differences in any clinical outcomes evaluated. A surprising finding was that women were admitted to the hospital significantly later than men after injury (3.7 vs 1.2 days; P < .05). Days from admit to injury negatively correlated with %TBSA in women, but not in men. Women also differed from men in a number of sociodemographic factors. Social and demographic differences exist between men and women admitted for treatment of acute burn injury. These differences influence admission after burn injury. Additional efforts are needed to better measure and evaluate the role of social capital in burn injury epidemiology, management, and outcomes.

The surgical treatment of acute burns

BACKGROUND: In the last decades, burn care has improved, so the trend in the current treatment extends beyond the preservation of life; the ultimate goal is the return of burn victims, as full members, back into their families and communities. This paper was prepared to consider the complex treatment of burns. METHODS: This paper is mainly based on our experience in treating patients suffering from burn injuries. RESULTS: One of the major problems that face any burn surgeon is the decision on the nature of treatment (conservative versus operative), so the key decision in the treatment is based on the exact determination of burn wound depth. In case of deep lesions early excision and suitable grafting and coverage should be performed whenever possible. Moreover, the adequate nutritional support is of utmost importance for the surgical treatment of burns. CONCLUSIONS: This paper is designed as a guideline and instruction manual to guide those with less experience through difficult situations in surgical burn care. Moreover it should be used as a guide to detect patients that require a referral to a burn centre after initial assessment.

A case of successful delayed reconstruction using a collagen based dermal substitute of a chemical burn injury to the face caused by sulphuric acid

Though only 3% of all burns are caused by exposure to chemical agents, these injuries account for approximately 30% of burn deaths [1]. The severity of chemical burns generally depends on the concentration and duration of exposure to the chemical agent [2]. Chemical burns usually occur in exposed areas of the body such as the hands and the face. All burn wounds, whether chemical or thermal, result in the denaturations of proteins [3]. Sulfuric acid and its precursor, sulphur trioxide, are strong acids and desiccants with many industrial applications. It is a very oily liquid and can cause coagulation necrosis. Mixing with water leads to heat production [3]. Sulfuric acid is highly corrosive to all parts of the body. Furthermore, sulfuric acid fumes can cause inhalation injury with a sudden onset of a pulmonary edema [4]. IntegraTM (Integra Life Sciences Corporation, Plainsboro, USA) is a skin substitute developed to improve the functional and aesthetic results after the acute phase of burns [5–7]. The inner layer is a matrix of bovine collagen and chondroitin-6-sulfate. The outer layer is a silicone membrane, which acts as a temporary epidermis. The coverage needs to be applied as soon as possible on a non-infected wound bed. The promising aesthetic and functional results obtained in the treatment of acute burns [8] suggest applications for reconstructive surgery. We treated a patient with chemical burns to the face with delayed IntegraTM reconstruction 21 days after the insult. Furthermore, we used an industrial foam helmet to ensure