The concept of escharotomy has long been associated with acute burns care. Nevertheless the practice of escharotomy is frequently flawed and there is considerable diversity in the teaching of the procedure. It is proposed that there should be a fundamental change in the teaching of acute burn management and the concept of decompression should be promoted. The justification for this change comes from a review of the present knowledge base using indexed, library and web-based information sources and also a review of a series of patients transferred to a regional burns unit over a five-year period which revealed that 37% of patients who required surgical decompression had not been appropriately treated prior to transfer. Based on relevant compartmental anatomy a change in the surgical decompression of limbs is proposed to allow safer and more effective management.

Burns↗

PubMed2006

Paediatric burn prevention: an epidemiological approach.

OBJECTIVE: To study the mechanism of burn in hospitalized paediatric burn patients in order to develop a focused burn prevention campaign. METHODS: Acute paediatric burn patients were identified from the unit admission records. Detailed medical records were reviewed to identify the key demographic and management information including the country of residence, age, gender, extent of injury, specific treatment and hospital stay. Parents were then contacted to provide detailed information about the mechanism of the accident, first aid given, living density and parent's educational level. RESULTS: Two hundred and eighty-four admissions were identified in a 5-year period. Two hundred and twenty-four of these patients came from a defined regional population served by the hospital. The median age of patients was 3 and male to female ratio 1:0.74. The most common age group for burns was 1-2 years. The most common type of burns were scalds. Domestic burns accounted for 84.7% of admissions. Median burn area was 4% of the total body surface area with a range of 0.2-45%. Fifty percent of patients had no first aid treatment prior to presentation at the hospital. More accidents happened in homes with a high living density and the majority of parents had both completed secondary education. The most dangerous location in the house was the living room, followed by the bathroom, kitchen then bedroom. The majority of burns were related to hot drinks, followed by hot food and then bathing. CONCLUSION: Detailed investigation of burn incidents can reveal repeated mechanisms of injury, which direct the focus of preventive strategies.

Accidents, Home↗

PubMed2006

Paraganglioma presenting as a vascular malformation: case report.

Paragangliomas are rare tumours that arise from extra-adrenal chromaffin cells or neuroectodermal chemoreceptor. They are high vascularised and can be functional, secreting catecholamines and other peptides. They occur anywhere from the skull base to the pelvic floor, within the paraganglion system. We present a case of paraganglioma with unusual location, atypical presentation and interesting vascular anatomy.

Adult↗

PubMed2006

Keloid epidemiology: population based studies needed.

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Female↗

PubMed2006

Perineum reconstruction with pedicled anterolateral thigh fasciocutaneous flap.

Eighteen pedicled anterolateral thigh perforator island flaps were used for complex perineal reconstructions between May 2003 and May 2005. The patients' average age was 48.6 years (range, 32 to 64 years), and the average follow-up period was 8 months (range, 2 to 13). In 7 cases, the perforator was septocutaneous and in 11 it was intramuscular. The application of the pedicled anterolateral thigh fasciocutaneous flap is described perineum reconstruction. The size of the perineum defects ranged from 6 x 9 cm to 16 x 17 cm, and the size of the transferred flap ranged from 8 x 11 cm to 18 x 20 cm. All flaps survived. One patient developed minor wound dehiscence in the posterior aspect of the perineal wound because of fecal contamination and skin maceration. The esthetic appearance of the reconstructed perineum was good. Despite a variable vascular anatomy that can give rise to some surgical challenge in raising the flap, the authors conclude that this is a safe and reliable flap for perineal reconstruction.

Adult↗

PubMed2006

Antimicrobial activities of silver dressings: an in vitro comparison.

A range of silver-coated or -impregnated dressings are now commercially available for use but comparative data on their antimicrobial efficacies are limited. The antibacterial activities of five commercially available silver-coated/impregnated dressings were compared against nine common burn-wound pathogens, namely methicillin-sensitive and -resistant Staphylococcus aureus (MRSA), Enterococcus faecalis, Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacae, Proteus vulgaris, Acinetobacter baumannii and a multi-drug-efflux-positive Acinetobacter baumannii (BM4454), using a broth culture method. The rapidity and extent of killing of these pathogens under in vitro conditions were evaluated. All five silver-impregnated dressings investigated exerted bactericidal activity, particularly against Gram-negative bacteria, including Enterobacter species, Proteus species and E. coli. The spectrum and rapidity of action, however, ranged widely for different dressings. Acticoat and Contreet had a broad spectrum of bactericidal activities against both Gram-positive and -negative bacteria. Contreet was characterized by a very rapid bactericidal action and achieved a reduction of > or =10,000 c.f.u. ml(-1) in the first 30 min for Enterobacter cloacae, Proteus vulgaris, Pseudomonas aeruginosa and Acinetobacter baumanii. Other dressings demonstrated a narrower range of bactericidal activities. Understanding the characteristics of these dressings may enable them to be targeted more appropriately according to the specific requirements for use of a particular dressing, as in for prophylaxis in skin grafting or for an infected wound with MRSA.

Bandages↗

PubMed2006

Plasma cell-free DNA as an indicator of severity of injury in burn patients.

BACKGROUND: Raised levels of plasma cell-free DNA have been detected in various patient groups, including trauma patients. We hypothesized that plasma DNA is increased in burn patients and may represent an objective indicator of burn severity and have predictive as well as prognostic significance. METHODS: This was a prospective clinical study with full ethical approval. With informed consent, blood samples were collected from 28 burn patients within 24 h of injury and from 12 control subjects. Plasma cell-free DNA was measured by real-time quantitative polymerase chain reaction (PCR) assay for the beta-globin gene. Descriptive analysis, non-parametric data comparison tests (Mann-Whitney) and correlation tests (Spearman rank) were performed on the data. RESULTS: Samples were taken at a mean time of 5.7 h after injury from 13 patients with flame/flash burns and 15 patients with scalds. Median plasma DNA levels in the control, scald and flame/flash burn patient groups were 287, 648 and 2685 kilogenome-equivalents/L, respectively. Plasma DNA levels correlated with the length of hospital stay, but not with admission to the intensive care unit (ICU) nor the length of ICU stay. DNA levels correlated with the burn surface area (Spearman rank r = 0.54, p = 0.04) and the number of operations needed (Spearman rank r = 0.55, p = 0.03) for scalds, but not for flame/flash burns. CONCLUSIONS: Plasma DNA is increased after burn injury and is significantly correlated with some outcome measures, including the length of hospital stay. DNA levels are higher in flame/flash patients than in scald patients; the difference may provide an objective indication of burn depth and inhalation injury.

Body Surface Area↗

PubMed2006

[Deep inferior epigastric perforator flap for vaginal reconstruction].

OBJECTIVE: To evaluate a new alternative method for the reconstruction of vagina with deep inferior epigastric perforator (DIEP) flap. METHODS: From January 2004 to May 2005, DIEP flaps were used for vaginal reconstruction in 5 patients (19 to 40 years), including 4 cases of congenital vaginal agenesis and I case of vaginal tumor. Before operation, the perforators were detected by the Doppler and the flaps based on the perforators ranged from 10 cmX 9 cm to 12 cmX 11 cm. DIEP flaps were elevated and then transferred to reconstruct the vagina. RESULTS: Deep inferior epigastric perforator flaps were used in 5 patients. Only 1 patient developed haematoma in the posterior aspect of the reconstructed vagina, but the flap was viable. The wounds healed secondarily after conservative therapy. All the flaps survived completely. No complication occurred at donor site of abdominal wall. CONCLUSION: Despite technical difficulties in elevating the deep inferior epigastric perforator flap, the flap is a good choice for vaginal reconstruction.

Adult↗

PubMed2005

Reconstruction of distal foot wounds with reverse first dorsal metatarsal artery flap.

Reconstruction of the distal portion of the foot has always represented a difficult problem in plastic surgery. We report a distally based dorsalis pedis island flap based on the first dorsal metatarsal artery, which has been successfully used to treat the distal portion of the foot in eight patients. The size of flaps ranged from 3 cm x 4 cm to 6 cm x 7 cm. In seven patients, the transferred flaps survived completely and in one flap there was superficial marginal necrosis. There was no donor site morbidity. All the patients had no difficulty in wearing shoes and were walking within 6 weeks. We suggest that the reverse first dorsal metatarsal artery flaps is a good option to reconstruct the wound of distal foot.

Adult↗

PubMed2005

Biostimulation of dermal fibroblast by sublethal Q-switched Nd:YAG 532 nm laser: collagen remodeling and pigmentation.

The application of medical lasers in treating pigmented lesions has rapidly developed over the past decade. In both clinical and cosmetic application, melanin is targeted in pigmented areas and destroyed by the mechanism of selective photothermolysis. When laser radiation passes through superficial pigmented tissue, energy will be further reduced by dermal collagen scattering and absorption. Non-pigmented dermal fibroblasts will be exposed to co-incidental laser irradiation at lower energy levels. Biostimulation of dermal fibroblasts by low energy laser is reported in this paper. The Q-switched frequency doubled Nd:YAG 532nm laser used in clinical laser therapy was used in this study. Sublethal laser fluence was determined at 0.8J/cm(2) and used to stimulate normal human fibroblasts in monolayer culture. The results showed that there was no significant difference in collagen synthesis between the stimulated fibroblasts and controls. However, significant delay in collagen remodeling activity was demonstrated in the irradiated group by measuring fibroblast populated collagen lattice (FPCL) contraction. The stimulation of SCF, HGF and b-FGF gene expression was determined by RT-PCR analysis and demonstrated to vary between cases. Two out of six cell lineages that showed stronger responses to laser stimulation on SCF, HGF and b-FGF gene expressions were used to prepare conditioned media. The conditioned media from irradiated groups showed significant increase in SCF and b-FGF content and stimulated SK-mel-3 melanoma cells to synthesize more melanin in vitro. These results suggest that sublethal laser stimulation of fibroblasts may cause post-laser hyperpigmentation through production of melanogenic stimulatory cytokines. The degree of stimulation of SCF, HGF and b-FGF production varied between individual cell lineages, which may reflect the true variation of post-laser hyperpigmentation in clinical practice.

Adult↗

PubMed2005

A global study of hospitalized paediatric burn patients.

The global incidence of hospitalized paediatric burn patients is unknown. In order to determine a working estimate of the size of the problem, one approach is to extrapolate from relevant published studies. A literature search of the Medline database was performed to identify epidemiological papers published since 1990, which addressed paediatric burn admissions. Extrapolation from population-based studies allowed global figures to be estimated. The highest incidence of hospitalized paediatric burns patients is in Africa, the lowest in the Americas. Europe, the Middle East and Asia share similar figures, but the considerably larger population of Asia indicates that it bears over half of the world's paediatric burn population. It is unfortunate that despite many published studies describing burn admission, few meet criteria that allow for comparative epidemiological data. More attention needs to be focused on uniformity in data collection and presentation to enhance the value of the data available.

Burns↗

PubMed2005

The Asia pacific burns association.

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Asia↗

PubMed2005

A retrospective analysis of 19,157 burns patients: 18-year experience from Hallym Burn Center in Seoul, Korea.

This is a retrospective, epidemiological study of 19,157 acute burn patients admitted to the Hallym Burn Centre, Hangang Sacred Heart Hospital, Seoul, Korea, during the period 1986-2003. The study was conducted to identify characteristics of burn patients that could lead to development of preventive programs to reduce both the frequency and mortality of burn injury. The majority of patients admitted had relatively minor burns, which were treated conservatively. Males predominated in all age groups with a summer peak seasonal variation. Typical burn in the children <5 years of age was a scald injury, occurring at home, affecting upper limbs and resulting in a relatively short hospital stay. Electrical burns due to steel chopsticks and steam burns due to electric rice cookers were also found in this age group. Adult burns, affecting upper and lower limbs, were caused by flames, hot liquids or electricity. Burns were sustained at the workplace and outdoors. Flame accidents in males were the leading cause of death with overall mortality of 8.2%. 13.9% of admissions needed intensive care and average length of hospital stay was 32.6 days. The annual number of patients undergoing burn related surgery has continuously increased reflecting a more aggressive surgical management. Our ongoing efforts are to promote prevention program and look for changes in the incidence of burn injury based on these epidemiologic features. Further study for implications of changes in management protocols and policies on treatment outcomes would improve the provision of appropriate care for the patients.

Accidents, Home↗