Treatment Of Burn Patients Research Articles

Évaluation de l’efficacité et de la tolérance d’Algostéril® (compresse d’alginate de calcium) versus Jelonet® (Gaze Paraffinée) dans le traitement du site donneur de greffe dermo-épidermique du cuir chevelu. Résultats d’un essai pédiatrique

Split skin graft is frequently needed in the treatment of burned patients. Scalp is often free of burns. Due to its good skin quality and important surface, scalp is a very interesting skin donor site, specially in case of children. A controlled, randomised clinical trial was carried out in 10 French Plastic Surgery or Burns Units. It assessed the efficacy and the acceptability of calcium alginate dressing (Algosteril® 2 2 Algosteril is a Brothier Trade Mark. ) versus paraffin gauze dressing (Jelonet®) in the treatment of scalp donor sites in children. 67 children (mean age 54 months) entered the study, 34 in the alginate group and 33 in the control group. Follow-up visits were on day 2/d3, d5/d6, Day complete healing, d30 and d60 after surgery. The two groups were comparable on inclusion (demographic characteristics, burn nature and surface, donor site surface and thickness of split skin graft). The mean healing time was 10 and 11 days for Algosteril® and Jelonet® group respectively (ns). The quality of the newly formed tissue was estimated to permit a sooner skin reharvesting in the Algosteril® group than in the control group ( p = 0.003). Bleeding through dressing was significantly less important in the Algosteril® group ( p = 0.02). Changes were considered by investigators less painful with Algosteril® on day complete healing ( p = 0.0096). Hair growth is homogenous in both groups on day 30 and day 60 (ns). These results showed that scalp is a very interesting skin donor site and that Algosteril® is of a real interest in donor site treatment.

An open study comparing topical silver sulfadiazine and topical silver sulfadiazine–cerium nitrate in the treatment of moderate and severe burns

Sixty patients with moderate and severe burns were randomly assigned to receive topical silver sulfadiazine (SSD) alone ( n=30) or SSD combined with cerium nitrate (SSD–CN) ( n=30). There were four deaths in the SSD group and one in the SSD–CN group; more patients with higher risk severity survived in the SSD–CN group. Wound infection did not differ significantly between the groups. The rate of re-epithelialization of partial thickness burns was faster by 8 days in the SSD–CN group. The relatively dry shell-like eschar of the SSD–CN-treated burn allowed planned excisions with immediate autologous grafting and the tissue beneath was ready to accept grafting 11 days earlier than in the SSD group ( p=0.03). This resulted in a significantly shorter hospital stay for those in the SSD–CN group than in the SSD group (23.3 vs. 30.7 days; p=0.03) with consequent cost savings. A higher incidence of transient stinging pain was reported with application of SSD–CN, but this was effectively managed with analgesics where necessary. The results of this study confirm the greater efficacy of SSD–CN in the treatment of burns patients.

Effect of growth hormone therapy in burn patients on conservative treatment

Evaluation of growth hormone therapy in burns is limited and none is reported from developing countries where burns still carry high mortality. We analysed serial observations on the clinical and biochemical profiles in 13 patients with second and third degree burns who received recombinant human growth hormone (rhGH) (0.5 IU/kg body wt) for 2 weeks in addition to standard conservative treatment and in 9 patients who were managed with standard conservative treatment only. The two groups of patients had burns, comparable in extent and severity. Additional rhGH treatment resulted in improved wound healing ( p<0.001), delayed separation of eschars ( p<0.01), increase in haemoglobin ( p<0.05), serum albumin ( p<0.01), calcium ( p<0.05), phosphorus ( p<0.001), glomerular filtration rate ( p<0.05) and 7 fold elevation in IGF-1. Also, a reduction in weight loss ( p<0.01), nitrogen production rate ( p<0.05), catabolic index ( p<0.01), duration of sepsis ( p<0.01) and hospital stay by 40% ( p<0.01) was noted with rhGH therapy. Transient hypercalcemia (3 patients), albuminuria (2 patients) and elevated blood glucose (one patient) were noted in the rhGH treated group not necessitating any specific therapy. Mortality in rhGH treatment group was 8.3% compared to 44.5% in the “no rhGH” treatment group. These observations suggest significant benefits of short term rhGH treatment in burn patients on conservative management.

Soft Tissue Contouring with Acellular Dermal Matrix Grafts

Introduction: Acellular dermal grafts have been used extensively in the treatment of burn patients to replace lost dermis in combination with an overlying thin-skin graft. This study reports on the use of acellular dermal matrix grafts (AlloDerm) for soft tissue contouring of the face. Placement of grafts subcutaneously has resulted in successful enhancement of facial areas such as lips, forehead, tear trough deformity, acne, depressed scars, and nasolabial folds. Materials and Methods: Acellular dermal matrix grafts with biocompatible properties have been used in the treatment of burns, in plastic/reconstructive procedures, and in periodontal surgeries (AlloDerm acellular dermal graft, LifeCell Corporation, The Woodlands, Texas). AlloDerm is processed from donated skin procured by skin and tissue banks in the United States that comply with standards set forth by the Food and Drug Administration and the American Association of Tissue Banks. All donated materials are thoroughly screened serologically via culture for fast-growing microbes; donors are screened serologically for human immunodeficiency virus 1 and 2 (HIV-1 and -2); human lymphotrophic virus 1 (HTLV 1); hepatitis A, B, and C; and syphilis. Eighty-five procedures using the acellular dermal graft were performed on 39 patients with follow-up from 9 to 18 months. Patients with autoimmune connective tissue disease were excluded from receiving the graft. Conclusions: The study patients reported on here exhibited unique postoperative courses with this biological implant, these courses were characterized by initial swelling and contraction and then by either expansion and augmentation or else resorption. Short- and long-term postoperative observations are described, with a focus on the methods used to achieve optimal graft results. Acellular dermal matrix grafts make an excellent soft-tisue augmentation material. The process of tissue integration or remodeling of the matrix using the patients's own tissue makes this a very exciting implant.

The treatment of burned patients by ointment “biopin”

The treatment of burned patients by ointment “biopin”

Increased Burn Patient Survival with Once-A-Day High Dose Teicoplanin and Netilmicin. An Italian Multicenter Study

This is the final report of a large, controlled, multicenter Italian study on immuno- and chemotherapy in adult patients with burns affecting 20 to 95% of total body surface area (mean 35%). The antibiotic treatment of burn patients consisted of topical silver sulfadiazine, short-term antimicrobial chemoprophylaxis with pefloxacin (800 mg i.v. qd) for the first 4 days and polychemotherapy with teicoplanin (800 mg i.v. qd) together with netilmicin (300 mg i.m. qd) in one or more cycles of 5-12 days. At random, half of the patients received thymostimulin, 70 mg i.m. qd for the first month and every other day thereafter.The analysis at completion of 634 valid cases showed that when the results are stratified by means of the Roi risk index, 396 of the 530 patients who contracted wound infection (84%) after chemoprophylaxis were in the first three categories and a mean of 95% survived. Of the remaining 134 patients (Roi index 4-5) only 50% survived.There was no difference in survival of the immunotherapy group in comparison with the parallel group without thymostimulin. The short-term antimicrobial prophylaxis prevented wound infection in only 104 of 634 patients (16%) and they were at low risk (84% Roi index 1).Of the bacterial pathogens involved in septic complications Staphylococcus aureus and Pseudomonas aeruginosa were prevalent (86%): eradication was achieved in 43% of patients and clinical cure or improvement were seen with combination chemotherapy in 64% of all patients, mainly with only one treatment cycle. This value increased to 79% for the 395 protocol-complying patients and went down to 20% in the 135 non-compliers. The total survival of complier and non-complier patients was 447 of the 530 valid patients (84%).The overall mortality of the 634 evaluable patients was 13.1%, ranging from less than 2% to 68%. Burn mortality was directly proportional to the percentage of burned body surface area, to increasing age and other variables of the Roi index, a 50% mortality being associated with a 72.5% total body surface area burned. Normoergic burn patients had a mortality rate of 9.1% versus 35.7% in anergic patients.

8 Ethical and legal aspects of burns care

Burns injuries affect 10 000 people annually in the UK and of these 650–700 die. Many who would have previously died now survive as the treatment of burns patients improves. Ethical dilemmas may occur when decisions need to be made about the treatment of incompetent patients. These decision may concern the initiation, continuation or termination of treatment. The ethical principles of autonomy, beneficence, non-maleficence and justice are described and how their application allows, both morally and legally, the initiation and termination of treatment, even when the patient cannot be involved in the decision. The debate surrounding advance directives which would give the patient some control over what was done to him when incompetent to make decisions and euthanasia are reviewed.

Advances in the treatment of burn patients

Advances in the treatment of burn patients

Advances in the treatment of burn patients

eous tissues. The tissue surrounding the central zone of coagulation has a moderate degree of vascular injury that causes a decrease in tissue perfusion. This zone of stasis can progress to a partial-thickness or a full-thickness injury due to the release of local mediators, such as arachidonic acid, oxidants and cytokines produced by the burn wound. These mediators cause arteriolar and venular dilatation followed by platelet aggregation that causes vascular stasis. Thromboxane A2 (TXA,) is found in high concentrations in the burn wound and is thought to contribute to the decreased blood flow in the zone of stasis. TXA2 increases platelet aggregation and neutrophil migration in the wound microcirculation. TXA2 inhibitors applied locally have been shown to improve blood flow in the zone of ischaemia-'. Increased local vascular permeability may also be attenuated by the use of antioxidants, particularly xanthine oxidase inhibitors, which indicates that an ischaemic-reperfusion injury occurs 3. Many local and systemic physiological alterations are caused by the release of cytokines from the burn wound. The cytokines are involved in haemodynamic changes, tissue inflammation, wound healing, immune .defenses, hypermetabolism and catabolism. The major cytokines that have so far been found to be involved in burn injury are tumour necrosis factor (TNF), interleukin 1 (IL-1), IL-2, IL-4,

Changes in serum tumour necrosis factor-α in burned patients

Dynamic tumour necrosis factor-α (TNF-α) changes in serial serum samples of 10 burned patients were analysed in this study. The total body surface areas (TBSA) of the burn injury were from 30 to 85 per cent. Among these 10 patients, five recovered and another five died with proved sepsis. On admission which was about 5–13 h postburn, eight of the 10 patients showed their serum TNF-α levels to be higher than the mean serum TNF-α value of five healthy laboratory personnel. Furthermore, an initial peak serum TNF-α response which could be detected within 2.5 days after burn injury has also been observed. However, significant differences in both the serum TNF-α values on admission, as well as the first peak serum TNF-α levels, were not found ( P > 0.05) between patients with TBSA of greater or less than 50 per cent and patients who survived or died from burn injury. In the survivors, serum TNF-α stayed at low levels, while it increased markedly in four of the five non-survivors with proven sepsis starting at about 1 week postburn. A significant difference in the maximum serum TNF-α levels ( P < 0.05) was detected between patients who recovered and died from the thermal injury. In conclusion, great increases in serum TNF-α levels have been detected in burned patients with the occurrence of bacterial infection postburn. It is suggested that strategies for the inhibition of TNF-α production or in the neutralization of TNF-α activity should also be considered in the better treatment of burned patients.

Pattern of Burn Injuries at King Fahad Hospital, Al-Baha: A Study of 277 Cases

Burn injuries, a unique form of trauma which is sometimes avoidable,1 are categorized among the most severe injuries an individual can experience. 2,3 Burns represent a major health problem worldwide, with high mortality and morbidity,4-7 and economic loss, even with small burns.1,8 Causes, types and incidence of burns vary from one community to another and are influenced by age, sex, economic status, local customs and social and environmental circumstances. 8-13 Numerous papers discussing the various aspects of burn injuries are being published worldwide, but few works have been done in Saudi Arabia.14,15 The treatment of burn patients in a specialized facility is of inestimable worth. 3 Facilities of burn management in Saudi Arabia are distributed all over the Kingdom, with 17 burn units. 16 In Al-Baha, a rural area located in South Western Saudi Arabia, no specialized facility for burn care is available. Most burn injuries are managed in King Fahad Hospital (KFH), the only referral hospital in the region. Burn cases are admitted to the surgical wards under the care of the Plastic Surgery Unit, staffed by one consultant and one specialist. The policy of admission is to admit all referred burn cases unless they are minor (superficial and less than 10% of total body surface area [TBSA]) and can be managed as an outpatient. Surgical procedures, i.e., excision and skin grafting, are usually carried out at the end of two operating lists per week. The aim of this paper is to focus on the pattern of burn injuries at KFH and to describe the general figures of morbidity and mortality.

The use of the edema bar for the treatment of burn patients.

The edema bar is a new device that therapists can add to their repertoire of treatment approaches for burn patients. This article looks at the challenges therapists encounter while working with burn patients and describes the edema bar's design, its application to the burn rehabilitation process, and the multidisciplinary approach to its use.

Intensive care treatment of burn patients

Treatment of patients suffering extensive cutaneous burns continues to challenge all involved. Although this review begins with basic pathophysiology, it deals mainly with resuscitation and intensive care of burn patients. After the initial phase, infection control and pulmonary problems secondary to inhalation injury and/or systemic infection are main determinants of morbidity and mortality. The principles of early excision and autografting are presented together with anaesthetic considerations and guidelines for metabolic support.

The Use of Arts and Crafts in the Rehabilitation of the Adult Burn Patient

The purpose of this study was to gain insight into one small aspect of occupational therapy: the use of arts and crafts in the rehabilitation of the adult burn patient. While burn care literature is plentiful, that related specifically to occupational therapy treatment of burn patients is scarce. A survey was mailed to occupational therapists in 165 burn units across the United States. Responses to survey questions indicate that a majority of respondents (73%%) do not use arts and crafts in the rehabilitation of adult burn patients, while 26%% do use these modalities. Those respondents who do use arts and crafts stated that they use leatherwork, painting, and woodworking most frequently. Therapists who do not use arts and crafts indicated that their primary reasons for not doing so were the acutely ill status of the patients and wound drainage/sterility issues. The entire scope of occupational therapy treatment of burn patients deserves greater attention as it is a challenging and rapidly-evolving area of practice.

The treatment of burn patients. What are the prospects for the northern area of Portugal?

The AA studied the distribution of age, sex, aetiology, and destiny of the 173 in-patients at the S. João Hospital (Central hospital that has no Burn Unit). In what concerns age, 38.1% are children less than 10 years old; the male/female ratio was 1.7:1. The fire and scalds are the most important aetiology. These findings are similar to those found in other countries (except in the Arabian Countries). Of these 99 burn patients have been treated in S. João Hospital, 71 patients were sent to the Burn Unit of Prelada Hospital and 3 to the Burn Unit of Coimbra University Hospital. These findings were compared to a Burn Unit of a Spanish Hospital (Alicante) which has 18 beds for adults and children, normally interning 132 patients per year. As the WHO suggest one special bed per 30,000 persons, we should be expected to have at least 110 beds for burn patients (we only have 9 beds at Prelada Hospital), the AA suggest the establishment of a Burn Unit at S. João Hospital, also due to the fact that is the only hospital that has a permanent emergency care for Plastic Surgery.

Peripheral anchorage of dermal equivalents.

Human fibroblasts can induce collagen gel contraction with different kinetics depending on the number of cells and on the collagen concentration within this lattice, which has been considered as a dermal equivalent. Skin equivalent is a combined culture of dermo-epidermal layers which may be of therapeutic value in the treatment of burn patients. However, the current production of the dermal equivalent component gives results that present many drawbacks for their eventual clinical use as a first step in obtaining a skin equivalent. These include: (i) final surfaces which are very small; less than 20% of the initial size (ii) excessive thickness which may hamper successful graft take (iii) fibroblasts that do not have an arrangement comparable with normal dermal tissue. We propose, as a solution to these problems, the utilization of a 5-mm-wide fibre-glass filter ring peripherally attached to the surface of the Petri dishes to prevent inordinate contraction while the fibroblasts reorganize the collagen gel. Using this technique the initial surface was preserved and the dermal equivalent contracted only in thickness. Histological analysis of these anchored equivalents confirmed an alignment of fibroblasts and collagen fibres resembling normal dermal tissue. We consider this method useful in the development of dermo-epidermal sheets for clinical purposes.

Effect of exogenous growth hormone on glucose utilization in burn patients

The treatment of burn patients with recombinantly derived human growth hormone (rHGH) appears effective in counteracting protein catabolism. However, exogenous growth hormone is frequently associated with hyperglycemia, an aspect which may limit its usefulness. Therefore, to assess the affect of rHGH on glucose utilization, 13 severely burned patients (65% ± 4 TBSA burn; mean ± SEM) began receiving on admission either placebo or rHGH (0.2 mg/kg.d) in a double-blind randomized fashion. While hypermetabolic (percentage REE/predicted REE 1.41 ± 0.11) fasting oxygen consumption and CO 2 production were measured using indirect calorimetry prior to and then during a hyperinsulinemic euglycemic clamp. This experiment demonstrated that rHGH significantly reduced glucose uptake and inhibited glucose oxidation compared to the placebo patients. Since the decreases in glucose oxidation and uptake were proportional, glucose utilization (percentage glucose uptake oxidized) remained similar in both patient groups. Furthermore, the hyperinsulinemic clamp lowered the plasma amino acid concentrations in the control patients while rHGH-treated patients had no significant alterations. In conclusion, exogenous growth hormone therapy induces an insulin resistance in burn patients. Furthermore, since the glucose utilization did not change, it is likely that the mechanism of insulin resistance is due to a deficiency in glucose transport.

Suppurative chondritis: Its incidence, prevention and treatment in burn patients : DC Mills II, W Roberts, AD Mason, Jr, et al. Plas Reconstr Surg 1988; 82:267–276

Suppurative chondritis: Its incidence, prevention and treatment in burn patients : DC Mills II, W Roberts, AD Mason, Jr, et al. Plas Reconstr Surg 1988; 82:267–276

Altered Expression of Lymphocyte 11–2 Receptors in Burned Patients

Impairment of T-cell function is a consistent observation in burned patients. Concomitant with this impairment is an increase in serum factors which inhibit interleukin-2-mediated T-cell functions. These factors are heat labile and do not behave like endotoxins. Nonetheless, treatment of burned patients with endotoxin-neutralizing regimens of polymyxin B reduces the levels of these factors, suggesting that they are generated in response to endotoxin exposure. In addition to factors which inhibit Il-2 responses burn serum contains increases of circulating soluble, cell-free Il-2 receptors. However, the level of Il-2R is not altered by polymyxin B treatment and does not appear to be a direct result of endotoxin exposure. These observations suggest that multiple causes contribute to T-cell impairment in burned patients.

Alterations of ultrastructure and elemental composition in cultured human epidermal keratinocytes after treatment with nitrofurazone and silver sulfadiazine

Cell culture systems have become increasingly popular as a means of screening toxic agents and studying toxic mechanisms of drugs and other chemicals at the cellular and subcellular levels. These in vitro tests can be conducted rapidly in a broad range of relevant mammalian culture systems; a variety of biological and biochemical cytotoxicity endpoints can be examined. The following study utilized human keratinocytes to evaluate the relative cytotoxicities of nitrofurazone (NF) and silver sulfadiazine (SS), the active ingredients of FURACIN(R) Topical Cream and SILVADENE(R) Cream, respectively. These compounds are anti-infectives used in the treatment of burn patients. Cell ultrastructure and elemental composition were utilized as cytotoxicity endpoints.Normal Human Epidermal Keratinocytes (HK) were prepared from the EpiPackTM culture system (Clonetics Corporation, Boulder, CO). For scanning electron microscopy (SEM) and transmission electron microscopy (TEM), cells were seeded on sterile 35 mm Falcon plastic dishes; for elemental microanalysis, cells were plated on polished pyrolytic carbon discs (E. Fullam, Latham, NY) placed in the culture dishes.