Burns

Editorial Board

2012-02-01

Acknowledgement to Reviewers 2011

2012-02-01

A systematic review of the quality of burn scar rating scales for clinical and research use

Zephanie Tyack, Megan Simons, Anneliese Spinks, Jason Wasiak — 2011-11-02

Abstract: Introduction: Scar rating scales have the potential to contribute to better evaluation of scar properties in both research and clinical settings. Despite a large number of scars assessment scales being available, there is limited information regarding the clinimetric properties of many of these scales. The purpose of the review was to inform clinical and research practice by determining the quality and appropriateness of existing scales. This review summarises the available evidence for the clinimetric properties of reliability, validity (including responsiveness), interpretability and feasibility of existing scales.Methods: Electronic searches of MEDLINE, CINAHL, EMBASE and The Cochrane Library databases from 1990 onwards were used to identify English articles related to burn scar assessment scales. Scales were critically reviewed for clinimetric properties that were reported in, but not necessarily the focus of studies.Results: A total of 29 studies provided data for 18 different scar rating scales. Most scar rating scales assessed vascularity, pliability, height and thickness. Some scales contained additional items such as itch. Only the Patient and Observer Scar Assessment Scale (POSAS) received a high quality rating but only in the area of reliability for total scores and the subscale vascularity. The Vancouver Scar Scale (VSS) received indeterminate ratings for construct validity, reliability and responsiveness. Where evidence was available, all other criteria for the POSAS, VSS and the remaining 17 scales received an indeterminate rating due to methodological issues, or a low quality rating. Poorly defined hypotheses limited the ability to give a high quality rating to data pertaining to construct validity, responsiveness and interpretability. No scale had empirical testing of content validity and no scale was of sufficient quality to consider criterion validity.Conclusions: The POSAS, with high quality reliability but indeterminate validity, was considered to be superior in performance based on existing evidence. The VSS had the most thorough review of clnimetrics although available data received indeterminate quality ratings. On the basis of the evidence, the use of total scores has not been supported, nor has the measurement of pigmentation using a categorical scale.

A review on static splinting therapy to prevent burn scar contracture: Do clinical and experimental data warrant its clinical application?

H.J. Schouten, M.K. Nieuwenhuis, P.P.M. van Zuijlen — 2011-08-10

Abstract: Background: Static splinting therapy is widely considered an essential part in burn rehabilitation to prevent scar contractures in the early phase of wound healing. However, scar contractures are still a common complication. In this article we review the information concerning the incidence of scar contracture, the effectiveness of static splinting therapy in preventing scar contractures, and specifically focus on the – possible – working mechanism of static-splinting, i.e. mechanical load, at the cellular and molecular level of the healing burn wound.Method: A literature search was done including Pubmed, Cochrane library, CINAHL and PEDRO.Results: Incidence of scar contracture in patients with burns varied from 5% to 40%. No strong evidence for the effectiveness of static splinting therapy in preventing scar contracture was found, whereas in vitro and animal studies demonstrated that mechanical tension will stimulate the myofibroblast activity, resulting in the synthesis of new extracellular matrix and the maintenance of their contractile activity.Conclusion: The effect of mechanical tension on the wound healing process suggests that static splinting therapy may counteract its own purpose. This review stresses the need for randomised controlled clinical trials to establish if static splinting to prevent contractures is a well-considered intervention or just wishful thinking.

Characteristics of paediatric burns in Sichuan province: Epidemiology and prevention

Yong Liu, Ying Cen, Jun-Jie Chen, Xue-Wen Xu, Xiao-Xue Liu — 2011-11-24

Abstract: Objective: This study analysed the epidemiology of paediatric burns in Sichuan province, China, for the formulation of prevention programmes for this population.Methods: A retrospective review was performed of paediatric patients admitted to the Burn Centre of West China Hospital during 2003–2009, including patient demographics, burn aetiology, time and place of burn, rural or urban population, and education level and burn knowledge of the patients’ guardians.Results: A total of 1387 paediatric burn patients, mean age 3.21 years (range 0–14 years) were admitted. The majority (72.1%) were 0–3 years old, and the male/female ratio was 2.39:1. Most common aetiologies were scalds (81.3%), flames (17.1%), and electricity (1.3%), while chemical burns were rare. The ratio of indoor versus outdoor location was 4.93:1, and the rural/urban ratio was 4.03:1. Burns were classified as: total burn surface area (TBSA) ranging from 0% to 5%, (23.9% of patients); TBSA between 5% and 15% (33.2%); TBSA between 15% and 25% (29.8%); TBSA greater than 25% (13.1%). There was a higher prevalence from April to September, and the peak times were mealtime and bathtime. The education level was lower in the rural group. Both urban and rural groups had little knowledge of first aid for burns.Conclusions: Burn prevention programmes should promote improved living conditions, with prevention education addressed directly to the guardians of children.

Demonstration of the use of the ICF framework in detailing complex functional deficits after major burn

T.L. Grisbrook, S.M. Stearne, S.L. Reid, F.M. Wood, S.M. Rea, C.M. Elliott — 2011-11-14

Abstract: Burns can result in long term impairments, activity limitations and participation restrictions in a patients’ life. The focus of current surgeries and therapy is to improve body functions and structures. However, often this does not translate to an improvement in activity and participation for the patient. Improvement in activity and participation is the ultimate goal of all therapy to enhance patient's quality of life. The incorporation of assessment measures at all levels of the International Classification of Functioning, Disability and Health (ICF) can assist in a holistic, patient centred approach to identify the complex impairments that impact on activity and participation, with a view to appropriately targeting future therapeutic interventions. This paper presents an example case of how implementing measures at all levels of the ICF can improve our understanding of a patient's body functions and structures, activity and participation. A number of the outcome measures utilised in this study are novel in the burns population, such that video footage supplements the methodology where relevant.

Characterisation of the cell suspension harvested from the dermal epidermal junction using a ReCell® kit

Fiona M. Wood, Natalie Giles, Andrew Stevenson, Suzanne Rea, Mark Fear — 2011-11-14

Abstract: Background: The use of non-cultured autologous cells to promote wound healing and in reconstructive procedures is increasing. One common method for preparing these cells is the use of the ReCell® device. However, despite its current clinical use, no characterisation of the cell suspension produced using a ReCell® device has been published.Objective: To characterise the ReCell suspension that is applied to wounds for cell type, viability, yield, stability and proliferative potential.Methods: The ReCell® device was used to harvest cells from a 2cm2 piece of split-thickness skin isolated using a dermatome. The resulting cell suspension was analysed for cell yield, cell type, viability over time, proliferative potential and reproducibility.Results: Average viable cell yield was 1.7×106/cm2 of tissue, with 75.5% of the total cell isolate viable. Total viable cell number was not significantly reduced after 4h storage at 22°C or 4°C, and was stable for 24h at 4°C. Proliferative potential was assessed using a colony forming assay, with 0.3% of viable cells isolated forming keratinocyte colonies. Predominantly the suspension contained keratinocytes (64.3±28.8%) and fibroblasts (30.3±14.0%), with a small population of melanocytes also identified (3.5±0.5%). Finally, the supernatant contained low total protein (0.92mg/ml) and the supernatant had no significant effects on cell viability or growth when applied ex vivo.Conclusions: These results suggest the ReCell® device provides a method for the preparation of a cell suspension with high viability and proliferative potential, containing viable melanocytes and no apparent toxic cell debris. Further work on the sustained viability of these cells in vivo, and in particular after application to the wound, will be important to better understand the potential of the ReCell® device in the clinic.

Developing the first Bi-National clinical quality registry for burns—Lessons learned so far

2011-11-14

Abstract: Background: Prior to 2004, Australia and New Zealand lacked a systematic method to measure burn incidence, aetiology and quality of care or outcomes for burn patients. The Australian and New Zealand Burn Association (ANZBA) commenced the Bi-National Burns Registry (Bi-NBR) at that time. As a result of the limitations identified with the registry, ANZBA collaborated with Monash University to develop the registry as a clinical quality registry .Method: A Steering Committee was formed to oversee the conduct and development of the registry. A Reference Committee revised the minimum dataset and working parties developed clinical quality indicators, and an outcome pilot project.Results: Institutional ethics approval has been obtained for 16 out of 17 sites and a formalised governance process developed. The minimum dataset was improved and includes clinical quality indicators. The Bi-NBR clinical quality registry was launched on July 1st 2009. A long-term outcome pilot project has been developed with five burn units participating (recruitment commenced October 2009).Conclusion: Through a rigorous development process, a clinical quality registry for burns has been established which allows benchmarking of processes and outcomes between units. The intention is that all burns units across Australia and New Zealand will contribute to the registry.

Effect of 12-week isokinetic training on muscle strength in adult with healed thermal burn

Anwar A. Ebid, Mohammed T.A. Omar, Amal M. Abd El Baky — 2011-11-21

Abstract: Introduction: Severe burns result in marked and prolonged skeletal muscle catabolism and weakness, which persist despite ‘standard” rehabilitation programmes of occupational and physical therapy. Therefore, the objectives of this study were of twofold: to quantify the long-term effects of burns on leg muscle strength and to assess whether adults with thermal burn would benefit from the isokinetic training programme.Materials and methods: Burned adult patients, with 35–55% total body surface area (TBSA) burned, were assessed at 6 months after burn in respect to leg muscle strength at 150°s−1, using isokinetic dynamometry. Non-burned adults were assessed similarly, and served as controls. The burned adults participated in the resistance training programme 3 times weekly. The isokinetic exercise programme was begun with 60% of the average peak torque. Intensity of isokinetic exercise was increased from one set to five sets during the first through fifth sessions and remained at six sets for the remaining 6th to 24th sessions. Finally, a dose of 10 sets was applied for the 25th to the 36th sessions. Each set consisted of five repetitions of concentric contraction in angular velocities of 150°s−1 for knee extensors, and flexors. All exercise sessions were preceded by a 5-min warm-up period on the treadmill.Results: Subjects with burns more than 35% of TBSA produced significantly less torque, work, and power in the quadriceps and hamstring than control subjects (20.5%, 15.2%, p<0.05). Three months after isokinetic programme, muscle strength further increased by 17.9%±10.1% compared to the baseline measurement for burned patients but continued to be below the concurrent age-matched, non-burned adult.Conclusion: We found that adults with severe burns, relative to non-burned adults, had significantly lower peak torque as well as total work performance using the extensors and flexors muscles of the thigh. Participation in isokinetic training resulted in a greater improvement in extensor and flexor muscle strength in adults with held thermal burn compared to base line values.

Clinical studies of the High-Intensity Narrow-Spectrum light Environmental Decontamination System (HINS-light EDS), for continuous disinfection in the burn unit inpatient and outpatient settings

2011-11-21

Abstract: Infections are the leading cause of morbidity and mortality in burn patients and prevention of contamination from exogenous sources including the hospital environment is becoming increasingly emphasised. The High-Intensity Narrow-Spectrum light Environmental Decontamination System (HINS-light EDS) is bactericidal yet safe for humans, allowing continuous disinfection of the environment surrounding burn patients. Environmental samples were collected from inpatient isolation rooms and the outpatient clinic in the burn unit, and comparisons were then made between the bacterial contamination levels observed with and without use of the HINS-light EDS. Over 1000 samples were taken. Inpatient studies, with sampling carried out at 0800h, demonstrated a significant reduction in the average number of bacterial colonies following HINS-light EDS use of between 27% and 75%, (p<0.05). There was more variation when samples were taken at times of increased activity in the room. Outpatient studies during clinics demonstrated a 61% efficacy in the reduction of bacterial contamination on surfaces throughout the room during the course of a clinic (p=0.02). The results demonstrate that use of the HINS-light EDS allows efficacious bacterial reductions over and above that achieved by standard cleaning and infection control measures in both inpatient and outpatient settings in the burn unit.

Fibrinogen function after severe burn injury

2011-11-24

Abstract: Background: Evidence regarding hypercoagulability in the first week after burn trauma is growing. This hypercoagulable state may partly be caused by increased fibrinogen levels. Rotational thrombelastometry offers a test which measures functional fibrinogen (FIBTEM®). To test the hypothesis that in patients with severe burn injury fibrinogen function changes over time, we simultaneously measured FIBTEM® and fibrinogen concentration early after burn trauma.Methods: After Ethics Committee approval consecutive patients with severe burn trauma admitted to the burn intensive care unit of the General Hospital of Vienna were included in the study. Blood examinations were done immediately and 12, 24 and 48h after admission. At each time point fibrinogen level (Clauss) and 4 commercially available ROTEM® tests were performed.Results: 20 consecutive patients were included in the study. Fibrinogen level and FIBTEM® MCF were within the reference range until 24h after burn trauma but increased significantly 48h after trauma. There was a significant correlation between FIBTEM® MCF and fibrinogen level (R=0.714, p<0.001).Conclusion: The results of this prospective observational clinical study show that fibrinogen function changes early after burn trauma and can be visualized by ROTEM® with the fibrinogen-sensitive FIBTEM® test.

The effect of valproic acid in alleviating early death in burn shock

Sen Hu, Jing-Yuan Hou, Hai-Bin Wang, MingXing Yang, Zhi-Yong Sheng — 2011-10-31

Abstract: The aim of this study was to examine whether administration of valproic acid (VPA) improves blood circulation and survival after lethal burn shock. Forty adult male Beagle dogs underwent a 50% TBSA full-thickness flame injury. In the first 24h after burn, animals were randomly divided into four groups: NR group received no treatment. VPA group and 2M2P(2-methyl-2-pentenoic acid) group received either VPA or 2M2P (100mg of the either drug in 20mL of normal saline) intravenously. VR group received intravenous infusion of lactated Ringer's solution according to Parkland formula. In the second 24h after burn the animals of all groups received delayed IV fluid resuscitation. Hemodynamic variables and biochemical parameters were determined with animals in the conscious and cooperative state. From 4h after burn on, the levels of mean arterial pressure, cardiac index, plasma volume and intestinal mucosal blood perfusion in VPA group were significantly higher, and the levels of parameters of organ function and serum tumor necrosis factor-α were lower than those in NR group and 2M2P group (all P<0.05). Survival at 72h after burn was in following order: VR (100%)>VPA (60%)>2M2P (30%)>NR (10%). Our results showed that histone deacetylace inhibitor (HDACI) valproic acid significantly improved hemodynamics, intestinal perfusion, and the survival rate after lethal burn shock. The mechanism may be attributable partly to the lowering of the level of proinflammatory factors, ameriolation of vasopermeability-induced visceral edema, reduction of blood volume loss, and protection of vital organs through inhibition of histone deacetylase activity of cell of vital organs.

Pathogenic alteration in severe burn wounds

2011-11-21

Abstract: The present study aims to define the trend of time related changes with local bacterial alteration of bacterial resistance in severe burns in our burn center during a 12-year period. Retrospective analysis of microbiological results on severely burned wounds between 1998 and 2009 was carried out. A study of 3615 microbial isolates was performed. Staphylococcus aureus was the most commonly isolated pathogen (38.2%) followed by A. baumannii (16.2%), Streptococcus viridans (11.4%), Pseudomonas aeruginosa (10.4%), coagulase-negative staphylococci (CNS, 9.2%). The species ratios of S. aureus and A. baumannii increased significantly from 1st to 8th week of hospitalization, while those of Streptococcus viridans, P. aeruginosa and coagulase-negative staphylococci decreased during the same period. Bacterial resistance rates were compared between the periods 1998–2003 and 2004–2009. Vancomycin remained as the most sensitive antibiotic in S. aureus including methicillin-resistant S. aureus (MRSA). It was very likely that the majority of infections caused by Streptococcus viridans, P. aeruginosa and coagulase-negative staphylococci occurred in the early stage of burn course and the majority of infections caused by A. baumannii occurred 4weeks after admission. The use of different antibiotics was probably the major contributor to these trends.

Effect of Poloxamer 188 on deepening of deep second-degree burn wounds in the early stage

Shi Yuhua, Li Ligen, Chai Jiake, Sun Tongzhu — 2011-11-14

Abstract: Objective: To discuss the effect of Poloxamer 188 (P188) on deepening of deep second-degree burn wounds in the early stage after burn.Methods: We divided Wistar rats with deep second-degree burn wounds on the backs thereof into two groups, then intravenously injected P188 for the treatment group and intravenously injecting physiological saline for the control group, detecting the activity of Na+–K+–adenosine triphosphatase (Na+–K+–ATPase), myeloperoxidase (MPO) and the content of malonaldehyde (MDA) and succinic dehydrogenase (SDH) in the burn wound, and showing the degree of necrosis in the wound by haematoxylin–eosin (HE) and proliferating cell nuclear antigen (PCNA) immunohistochemical staining.Results: In the control group and treatment group, the activity of SDH and Na+–K+–ATPase dropped to the lowest point 24h after the burn took place, and then increased gradually, but was still far lower than the normal level at the furthest time point. At 24h after burn, activity of SDH and Na+–K+–ATPase in the treatment group was higher than that of the control group (P<0.05); the activity of MPO of the control group reached the highest point at 24h while that of MPO of the treatment group reached the highest point after 48h; later, that of MPO of both groups decreased, but was still higher than the normal level. Compared with the highest values of the activity of MPO of both groups, that of the control group was higher than that of the treatment group (p<0.05); the contents of MDA of both groups kept increasing after the burn; 72h later, that of the control group was higher than that of the treatment group (p<0.05). HE and PCNA staining showed progressive damage of the wound in the treatment group, which was decreased with treatment, particularly at the early stages.Conclusion: Systemic application of P188 on deep second-degree burn wounds at the early stage may alleviate wound deepening, whose mechanism may be related to timely sealing up the damaged cell membrane and inhibiting the inflammatory reaction.

Effects of Ligustrazine on pancreatic and renal damage after scald injury

Chengjin Gao, Hu Peng, Sheng Wang, Xiangyu Zhang — 2011-11-14

Abstract: Organ protection is a routine therapeutic application to severe burn/scald injuries, and organic damage following early scald injury is not absolutely elucidated. Our aim is to verify the good effects of Ligustrazine on pancreatic and renal damage associated with early scald injury.A total of 120 Lewis rats subjected to 30% total body surface area (TBSA) scald injury, were randomly divided into simple scald group (S group) and Ligustrazine treated group (L group). Both pancreatic and renal malondialdehyde (MDA) level and superoxide dismutase (SOD) were determined. Serum amylase, serum creatinine (Scr) and blood urea nitrogen (BUN) were identified as well as examining the kidneys histologically with Immunohistochemistry (IHC) for major histocompatability complex class I chain-related antigen A (MICA) and Bcl-2 at 0, 1, 6, 12, 18, 24,48 and 72h after scald.Ligustrazine decreased MDA levels and ameliorated the downregulation of SOD activity. MICA was up-regulated after scald, and the up-regulation could be greatly diminished by Ligustrazine. Bcl-2 was up-regulated after scald, especially in the L group. From 24 to 72h, in comparison with the L group, higher levels of BUN, Scr and serum amylase were observered in the S group, which were also higher than the common upper limits.Therefore, our results demonstrated potential pancreatic and renal damage associated with autoimmunity and oxidant attack occurred following early scald injury. Ligustrazine exhibits significant protective effects.

Efficacy of enzymatic debridement of deeply burned hands

2011-11-21

Abstract: Background: The burned hand is a common and difficult to care-for entity in the field of burns. Due to the anatomy of the hand (important and delicate structures crowded in a small limited space without sub-dermal soft tissue), surgical debridement of the burned tissue is technically difficult and may cause considerable complications and, therefore, should be performed judiciously.Selective enzymatic debridement of the burn wound can preserve the spontaneous epithelialisation potential and reduce the added injury to the traumatised tissue added by a surgical debridement.Objective: The aim of the study was to assess the implication of a selective enzymatic compound (Debrase® – Ds) in the special field of deep hand burns, by comparing the actual burn area that required surgical coverage after enzymatic debridement to the burn area clinically judged to require skin grafting prior to debridement.Materials and methods: This was a retrospective data collection and analysis from 154 complete files of prospective, open-label study in 275 hospitalised, Ds-treated burn patients.Results: A total of 69 hand burns diagnosed as ‘deep’ was analysed; 36% of the wounds required surgical intervention after enzymatic debridement; 28.6% of the total burned area estimated initially as deep was covered by skin graft (statistically significant p<0.001).Conclusion: Debridement of deep-hand burns with a selective enzymatic agent decreased the perceived full-thickness wound area and skin-graft use.

The protective role of ascorbic acid in burn-induced testicular damage in rats

P.I. Jewo, F.I. Duru, I.O. Fadeyibi, L.C. Saalu, C.C. Noronha — 2011-11-14

Abstract: Objective: To investigate the ability of ascorbic acid to protect the testes from damage in severe burns.Design: Experimental study.Setting: University of Lagos Medical School, Department of Anatomy.Animals: 28 adult male Wistar rats (250–300g).Intervention: Third degree burn was induced on 40% body surface area of rats and they were given ascorbic acid at 4mg/kg over 8 weeks.Main outcome measured: Weight of reproductive organs and epididymal sperm parameters were measured. Oxidative status was assayed and a semi-quantitative assessment of histologic changes was also carried out.Results: Burn caused severe seminiferous tubular damage, especially germ cell loss (p<0.05). This was matched by significant reduction in sperm density and morphology (p<0.05). Burn also increased oxidative stress, with elevated malondialdehyde (MDA) levels (p<0.01) and changes in catalase and superoxide dismutase enzyme levels. Ascorbic acid prevented the changes in all sperm parameters. It normalized MDA levels (p<0.01) and attenuated changes in the levels of catalase and superoxide dismutase. Ascorbic acid treatment also significantly reduced histologic damage to seminiferous tubules.Conclusion: This study shows that severe thermal injury causes significant testicular damage and impairs spermatogenesis. It also shows that ascorbic acid protects the testis from such damage and therefore has the potential to be a useful adjunct therapy during treatment of young males with severe burns.

The aetiology of adult burns in the Western Cape, South Africa

David Maritz, Lee Wallis, Elbie Van Der Merwe, Daan Nel — 2011-11-24

Abstract: Rural to urban migration to major cities in South Africa continues to lead to the proliferation of informal settlements. There is little recent published data on the epidemiology of adult burns in the Western Cape, South Africa. A retrospective review of patients on the Burn Unit database was undertaken, looking at patients admitted to the Burn Unit between January 2003 and December 2008. This study discusses the characteristics and outcome of patients who were treated at the Tygerburg Burn unit. A total of 1908 patients were admitted to the burn unit during the 6 year period under review. Most fatal injuries occurred in the 20–40 year age group. Injuries due to shack fires and fuel stoves comprised 21% (399) of all admissions. Mortality due to these injuries comprised 28% (137) of total mortality. Gas stoves accounted for 24% with kerosene stoves accounting for 71% of injuries. The burn death rate in this study (25%) was found to have increased dramatically from the last audit done from 1986 to 1995 in which a burn death rate of 7.5% was observed. Reasons for this are explored. It is likely that those with HIV/AIDS have poorer outcomes. Shack fires and injuries due to fuel stoves are a common reason for admission to the burn unit and mostly involve young male individuals. Other research from the Southern African region does not mention shack fires as a separate entity making it difficult to obtain an accurate idea of the scale of the problem. Their injuries are severe with a high mortality. The use of kerosene stoves are a major contributing factor. Recommendations include enforceable legislation to promote safer stove design, research into safer bio fuels and materials for building shacks as well promoting fire safety among schoolchildren in the community. Further research is needed to determine the impact of HIV/AIDS on the outcome of acute burns within the Southern African region.

An assessment of burn injury hospitalisations of adolescents and young adults in Western Australia, 1983–2008

J. Duke, F. Wood, J. Semmens, D.W. Edgar, K. Spilsbury, S. Rea — 2011-11-18

Abstract: Background: This study presents a 26-year epidemiological assessment of burn injury hospitalisations for people 15–29years of age in Western Australia.Methods: Linked hospital morbidity and death data for all persons hospitalised with an index burn injury in Western Australia for the period 1983–2008 were analyzed. Annual age-specific incidence rates were estimated. Poisson regression analyses were used to estimate temporal trends in hospital admissions.Results: There were 6404 burn hospital admissions of which 76% were male. Males had hospitalisation rates 3.0 times that of females (95%CI: 2.8–3.2) and Aboriginal people had rates 2.3 times (95%CI: 2.1–2.5) that of non-Aboriginal persons. Hospitalisations for burn injury declined by 42% (95%CI: 35–47) for males and 21% (95%CI: 6–33) for females. Hospitalisations declined by 53% (95%CI: 35–63) for Aboriginal people, and by 35% (95%CI: 29–41) for non-Aboriginal people. Significant reductions were observed for flame and electrical burn hospitalisations. The major causes of burns in males were exposure to controlled fires and ignition of inflammable materials, with scalds the predominant cause of burn in females.Conclusions: Downward trends in burn injury hospitalisations for both males and females 15–29years of age were observed; however, males and Aboriginal persons have significantly elevated hospitalisation rates.

Epidemiology of severe burn among children in Newfoundland and Labrador, Canada

2011-11-21

Abstract: Purpose: The objective of this study was to identify the epidemiologic characteristics of childhood burns in the province of Newfoundland and Labrador.Methods: A population-based study was carried out on children aged 0–16 years who were hospitalized due to burns in Newfoundland and Labrador between April 1995 and March 2001. Hospital and mortality data were obtained from the provincial hospital admission database and Mortality System, respectively. The Newfoundland and Labrador population was considered as a whole and as two separate geographic areas.Results: A total of 157 hospital admissions due to burns were identified during the study period. The rate of burns requiring hospitalization in the province was 22.3 per 100,000 person-years (P-Y). The rates for males and females was 27.7 and 16.6 per 100,000 P-Y, respectively (P=0.006). Infants (0–1 year) had the highest rate of burn (88.8 per 100,000 P-Y) followed by children aged 2–4 years (26.0 per 100,000 P-Y) (P<0.0001). Labrador, a region with high Aboriginal population (51.4 per 100,000 P-Y), had a higher rate of burn compared to Newfoundland (20.3 per 100,000 P-Y) (P<0.0001). Median age of patients with burns was 2 years for the island portion of the province and 9 years in Labrador (P<0.01). Overall, scald burn (52.2%) was the most frequent type of burn followed by flame (32.5%). In the island portion of the province, scald burn was the most common type of burn (56.4%), while in Labrador flame was the most frequent type (66.7%). Overall mortality rate due to burns was 0.9 per 100,000 P-Y.Conclusion: Age (infants) and sex (male) are factors associated with burn in Newfoundland and Labrador. Study results indicate a difference in the epidemiologic pattern of burn between the island portion of the province, Newfoundland, and mainland Labrador. It is recommended that preventive programs be directed towards high risk groups to reduce the incidence of burns.

Management of a child with von Willebrand disease (type 2A) and extensive burns: A case report

2011-11-28

Von Willebrand disease (VWD) is a common inherited bleeding disorder. Its diagnosis is based on the association of bleeding symptoms and specific biological data . The cornerstone of its treatment is the replacement of the deficient protein during acute spontaneous bleeding episodes or before invasive procedures. It may induce haemorrhagic morbidities in severe burn since the coagulation homeostasis is frequently impaired by itself in that setting and since excision and closure of burn wound are regularly required in such patients. However, the specific management of patients with both severe burn and type 2A VWD has not yet been described. We therefore report a paediatric case of type 2A VWD admitted for severe burn.

Feet burning: a traditional medical practice associated with significant burns in patients with seizures: 4 Case reports

G.H. Alabi, C.O. Omolase — 2011-10-31

Burns is a significant injury which commonly occurs among patients having seizure as well as in epileptic patients and this type of burns are usually deep and causes significant morbidity . Numerous factors have been reported to account for burns in these groups of patients . These factors include non compliance with anticonvulsant drugs intake, leading to increase in the frequency of seizures , age of the patient, gender and engaging in activities that can cause visual stimulation of the nervous system. Various parts of the body may be involved in the burns process but the more commonly affected areas are head and neck region followed by the hand . It is also a known fact that various traditional practices, religion and culture play a significant role in the epidemiology of burns . In these case reports we present three patients who had seizures, however because of the traditional medical practice prevalent in our environment they received various degrees of burns to the feet. Our aim of reporting these cases is to create awareness among the populace and help discourage this type of practice.

Antibiotic resistance and an in vitro biofilm model

Huayu Zhu, Yangang Zhang, Chengfeng Xu, Dahai Hu — 2011-11-14

Adrienne A. Hammond et al. (Volume 37, Issue 2) report that an in vitro biofilm model associated the effects of antibiotic ointments on biofilms produced by burn wound bacterial isolates. The author illustrated that gentamicin ointment did not disrupt the PACI-1 biofilm (Fig. 3b). Interestingly, the other Pseudomonas aeruginosa isolate-PACI-2 was reduced by the same ointment (Fig. 3c).

Antibiotic resistance and the in vitro biofilm model

Abdul N. Hamood — 2011-11-18

We thank Zhu et al. for their comments on our article. Our main thrust was to describe an in vitro wound biofilm model that may be utilized to accurately assess antibiotic resistance of wound biofilms produced by different bacterial pathogens. Zhu et al. discussed the differences in the gentamicin resistance among the Pseudomonas aeruginosa wound isolates PACI-1 and PACI-2. As we showed in our study , differences in the gentamicin resistance of these two isolates (Fig. 3b and c), validate our assumption regarding the efficacy of our model in detecting differences in the antibiotic resistance of wound biofilms. Similarly, Staphylococcus aureus isolates SACI-1 and SACI-2 differed in their resistance to gentamicin (Fig. 5b and c) . The induction of gentamicin-resistant mutants among gentamicin-sensitive strains (in vitro or in vivo) is very likely. However, this is not related to our model. Our model examines the resistance or sensitivity of a biofilm formed by a specific wound isolate at the time the isolate was obtained. Zhu et al. stated: “So the conclusion that gentamicin ointment reduced biofilms produced by PACI-2 remain to be confirmed” [sic]. Our study was not designed to reduce or eliminate biofilms within the burn/infected wound. We did not compare the three tested antibiotic ointments (gentamicin, mupirocin, and triple antibiotic) in their efficacy in eliminating biofilms. We simply tested the susceptibility of the biofilms formed by these wound isolates to a specific amount of each antibiotic ointment using our in vitro model.

Acticoat and Smith and Nephew

Andrew Burd — 2011-11-21

I read with interest but also some concern the paper regarding Acticoat, the nano-silver dressing marketed by Smith and Nephew . I am glad that the conflict of interest was clearly stated but what is not so clearly stated is that the conclusions made could not be supported by the evidence presented. The focus of the paper was on the systemic absorption of silver and apart from the paper from Trop et al. I have not come across this as a real clinical concern, more a hypothetical concern . What this paper completely overlooks is the concern about the toxicity of silver for eukaryotic cells. This is real, has been demonstrated in the laboratory and in animal models and indeed has been reported in this and other leading wound care publications . The conclusion in the paper under question is stated “This study has confirmed our view that Acticoat is safe for treating people with burns, large or small”. “Safe” is a relative term and we have always expressed caution about the use of these very powerful antibacterial dressings on wounds that really do not require them. We have previously expressed our concern about the message delivered by some investigators who advocate Acticoat for all burns large or small, inpatient or outpatient .

Response to Letter to the Editor: ‘Acticoat and Smith and Nephew’

Naiem S. Moiemen — 2011-07-04

As stated in the above letter, the focus of this paper was to study the systemic absorption of silver from the use of nanocrystalline silver dressings in major burns. The absorption in smaller burns was previously examined and published in this journal. This work was never intended to examine “the concern about the toxicity of silver for eukaryotic cells”. Currently, there is very little data in the literature about the systemic absorption of silver. That was the focus of this study. Readers of our manuscript will note that we do not advocate the use of silver dressings in all burns; this is not our practice and would seem to be unnecessary.

Single-layer Integra for one-stage reconstruction of scalp defects with exposed bone following full-thickness burn injury: A novel technique

2011-11-02

Full-thickness burns to the scalp with exposed bone present a challenging reconstructive problem for a plastic surgeon, especially in situations where extent of the injury precludes the use of, otherwise favored, local flaps while free flaps are not indicated due to patients comorbidities. Bi-layered dermal acellular matrix (Integra) has been used for reconstruction of defects following full thickness burn injuries and cancer resection for more than a decade as a two-stage procedure where silicone-covered acellular dermal matrix was applied to a scalp defect following debridement and burring-out the outer bony cortex to promote bleeding and integration during the first stage. Second stage would normally be performed after three weeks and includes removal of protective silicone layer and skin grafting of, by that time, integrated acellular matrix (Integra). We report for the first time the use of a single-layer acellular dermal matrix, without the silicone layer, for one stage reconstruction of post-burn full thickness scalp defects with exposed bone . A 72-year-old woman sustained 5% full-thickness flame burns to her scalp, forehead and posterior neck areas. 5 weeks after initial debridement and skin grafting was performed to her scalp (Meshed split-thickness skin grafts), she presented with 10cm×6cm and 6cm×4cm soft-tissue scalp defects with exposed bone without evidence of infection (a). Burring of outer calvarial plate was performed under general anaesthetic which was followed by reconstruction of both defects with a single-layer Integra (b), covered immediately with meshed split-thickness skin grafts (c) and VAC-dressing (d), without waiting for the recommended three weeks until signs of acellular dermal matrix integration would normally be visible. VAC-dressing was removed after continuous 7-day therapy and meshed skin grafts remained viable while the Integra remained in situ underneath (a). VAC therapy was then discontinued and wounds were dressed with jelo-net and intermittently left exposed to dry twice a day for the second week, while complete healing was seen between the second and third week with favorable aesthetic outcome (b).

The use of lignocaine gel as a shaving gel for facial burns

Sheena J. Cattanach, Shaheel Chummun — 2011-10-31

Facial burns can be very distressing for patients, not only because of the potential for disfigurement, but also because of the pain in the immediate post-injury period. Providing daily facial care for such patients provides both a holistic care and enhances their recovery.