- Email: [email protected]
Clinical characteristics and treatment of burn injuries following explosion of gunpowder in firecracker mills
S30
Burns 3 3 S ( 2 0 0 7 ) S1–S172
The National Burn Care Review showed that specialized physical therapy is provided only in acute units which cover a large geographical area. Patients cannot retain all the information given during appointments with the physiotherapist, which probably will have an impact on treatment compliance and the recovery process. Aim: To develop a multimedia tool with physiotherapy exercises that can be used by patients with burn injuries, after discharging them from a Burn Unit/Centre. Material and methods: The physiotherapy exercises were video-recorded, digitalized (*.avi files) and organized for each anatomical region. Written and voice instructions were added to the video shootings. Depending on anatomical areas involved by burning, specific physical exercises were collated in a multimedia CD-ROM/DVD package and handed to each patient discharged from the acute unit. Patients used the personalized multimedia tool at home at their leisure. Results: Patients’ progress was recorded and added to their CD/DVD, when they attended the physiotherapy sessions. Patients found the multimedia package a practical motivational tool, useful and easy to use. Conclusion: This simple affordable technique may prove useful to raise the level of patient cooperation and accelerate the return of functional ability. doi:10.1016/j.burns.2006.10.072 Self inflicted burns—A 11 year snapshot Malic C., Phipps A., Ausitn O., Karoo R. Pinderfields Burn Centre, United Kingdom E-mail address: [email protected] (C. Malic). Introduction: Over the last decade, the incidence of deliberate self harm (DSH) in the U.K. has increased significantly. DSH by burning is a small but important group of patients with high morbidity and mortality. Aim: To review the trends and outcome of self immolation injuries. Methods: An 11 year retrospective review of acute admissions to the Yorkshire Regional Burn Centre (1994–2004). Demographic data, mechanism of burn and outcomes were noted. Results: Of the 1745 acute burn patients reviewed, 86 (4.92%) sustained self inflicted burns of which 60.5% were male. The mean age was 37 years ±12, and average burn extent 29% TBSA. Flame was the most common type of burn (89.5%), inhalational injury being present in 41.9% of the patients. Head and neck, anterior trunk and upper limbs were the most frequent distribution areas of the burns. More than a quarter of the patients had social problems (i.e. drug/alcohol abuse, imprisoned). Fifty-four patients had positive psychiatric history, most commonly depression (33.7%). Previous history of deliberate self harm was found in five of the patients. Crude mortality was 29%. Conclusions: Self inflicted burn patients commonly exhibit social or psychiatric co-morbidity which dictates a multidisciplinary approach during hospitalization, rehabilitation and integration back into the society. doi:10.1016/j.burns.2006.10.073 Clinical characteristics and treatment of burn injuries following explosion of gunpowder in firecracker mills Chen Xue-Lin, Wang C., Hu D., Wang Y. Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China E-mail address: [email protected] (X.-L. Chen). Objective: To investigate the clinical characteristics and treatment of work-related burn injuries following explosion of gunpowder in firecracker mills so as to raise the cure rate. Methods: A retrospective study was conducted of 339 work-related burns patients sustained by gunpowder explosion and a prospective treatment principle was raised. Results: While most patients sustained burns on exposure area and the burns were usually deep dermal of full skin thickness£¬work-related burn injuries following explosion of gunpowder in firecracker mills combined with inhalation injury, compound wound and gunpowder poisoning generally where there was a high mortality and morbidity of burn shock and multiple organ dysfunction syndrome (MODS). Conclusion: Work-related burns following explosion of gunpowder in firecracker mills is a compound injury which characterized by pathologic changes of burns as the main issue. The compound wound jeopardizing life must be handled first. The fluid resuscitation should not be restricted to the formula during the exudation period while small dose of dopamine £¨2–5 g kg−1 min−1 £©and large dose of vitamin C as well as E may be useful. The organ that presents dysfunction most frequently is lung and the support of respiratory function, in our experiences, should be payed much more attention to. Since the major toxicity of gunpowder is
Burns 3 3 S ( 2 0 0 7 ) S1–S172
S31
the respiratory tract injury of sulfur dioxide and nitrogen oxides, the methylene blue and sodium hyposulfite have no effect of detoxification. It is of great use that the burn wound receives exposure therapy with silver sulfadiazine. doi:10.1016/j.burns.2006.10.074 Prevention and management of visceral complications in severely burned shipman patients Chen Xue-Lin a,b a
Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China Burns Centre, Changhai Hospital, Second Military Medical University, Shanghai, PR China E-mail address: [email protected].
b
Objective: To investigate the prevention methods and management of visceral complications in severely burned shipman patients. Methods: A retrospective review was undertaken to analyze the incidence and management of visceral complications in 31 severely burned shipman patients who admitted to our center during the period from February 1997 to May 2000. Thirty-two male-, age-, TBSA- and full thickness-matched non-shipman burns patients were selected randomly to form the control group. Results: The incidence of ARDS, stress ulcer bleeding and hepatic failure in shipman burns patients was 32.3%, 19.4% and 38.7% respectively, all of which were significantly higher than those in non-shipman burns patients. The generalized measures that emphasized on prior prevention methods were utilized to deal with the visceral complications. There were 30 cure and 1 death in shipman burns group, while all 32 non-shipman burns patients were cured. There was no significant difference in survival rate between two groups. Conclusion: Although there was a higher incidence of visceral complications, a satisfactory outcome of the shipman burns can be achieved under condition that the generalized measures that emphasized on prior prevention methods are undertaken. doi:10.1016/j.burns.2006.10.075 Co-graft of microporous xenogeneic acellular dermal matrix and autologous micoskin in the functional site with deep burns—A preliminary result Chen Xue-Lin a,b a
Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China Burns Centre, Changhai Hospital, Second Military Medical University, Shanghai, PR China E-mail address: [email protected].
b
Objective: To investigate the effect of co-graft of microporous xenogeneic acellular dermal matrix (ADM) and autologous micoskin in the functional site with deep burns. Methods: Fresh pig skin was treated with Dispase ¢o` and detergent solution Triton X-100 to get xenogeneic ADM. Then the ADM was mechanically punched to make regular pores ranged from 500–800¦I`m in diameter, separated by a distance of 3–5 mm. The functional site was early excised followed by coverage with co-graft of microporous ADM and autologous micoskin, where as the opposite functional site was severed as control and covered with autologous micoskin only. The outcome measures were time of wound healing, the functional status, and scar quality. Results: Reject reaction was not found in all patients. There were no significant differences in wound healing time between groups. According to the histological analysis at 2 months post-burn, epidermis were continuous and intact and the dermal matrix was a kind of matrix with normal structure and organization of collagen without any cellular components. The skin was smooth and has a good elasticity and no blister or ulcer in the co-graft group. Scar quality and joint function was found to be significantly improved in the co-graft treatment group. Conclusion: Co-graft of microporous xenogeneic ADM and autologous micoskin represents a superior method for the functional site with deep burns. doi:10.1016/j.burns.2006.10.076 Surgical decision making based in an algorithm of clinical findings and monitoring alternatives for peripheral circumferencial burns of the extremities Piccolo P.P., Alves N.M.B., Piccolo N.P., Piccolo-Daher R., Piccolo-Daher S., Piccolo-Lobo R., Meirelles R.P.C., Piccolo M.T.S., Piccolo M.S., Piccolo N.S. ˆ ´ Brazil Pronto Socorro Para Queimaduras, Goiania, Goias, E-mail address: nelson [email protected] (N.P. Piccolo). Peripheral burns may require escaratomy, or even fasciotomy, to release pressure upon local tissues and to warrant improvement in circulation, for maintenance of perfusion to noble tissues such as nerves and small muscles in the hands and/or feet. Occasion-
Burns 3 3 S ( 2 0 0 7 ) S1–S172
The National Burn Care Review showed that specialized physical therapy is provided only in acute units which cover a large geographical area. Patients cannot retain all the information given during appointments with the physiotherapist, which probably will have an impact on treatment compliance and the recovery process. Aim: To develop a multimedia tool with physiotherapy exercises that can be used by patients with burn injuries, after discharging them from a Burn Unit/Centre. Material and methods: The physiotherapy exercises were video-recorded, digitalized (*.avi files) and organized for each anatomical region. Written and voice instructions were added to the video shootings. Depending on anatomical areas involved by burning, specific physical exercises were collated in a multimedia CD-ROM/DVD package and handed to each patient discharged from the acute unit. Patients used the personalized multimedia tool at home at their leisure. Results: Patients’ progress was recorded and added to their CD/DVD, when they attended the physiotherapy sessions. Patients found the multimedia package a practical motivational tool, useful and easy to use. Conclusion: This simple affordable technique may prove useful to raise the level of patient cooperation and accelerate the return of functional ability. doi:10.1016/j.burns.2006.10.072 Self inflicted burns—A 11 year snapshot Malic C., Phipps A., Ausitn O., Karoo R. Pinderfields Burn Centre, United Kingdom E-mail address: [email protected] (C. Malic). Introduction: Over the last decade, the incidence of deliberate self harm (DSH) in the U.K. has increased significantly. DSH by burning is a small but important group of patients with high morbidity and mortality. Aim: To review the trends and outcome of self immolation injuries. Methods: An 11 year retrospective review of acute admissions to the Yorkshire Regional Burn Centre (1994–2004). Demographic data, mechanism of burn and outcomes were noted. Results: Of the 1745 acute burn patients reviewed, 86 (4.92%) sustained self inflicted burns of which 60.5% were male. The mean age was 37 years ±12, and average burn extent 29% TBSA. Flame was the most common type of burn (89.5%), inhalational injury being present in 41.9% of the patients. Head and neck, anterior trunk and upper limbs were the most frequent distribution areas of the burns. More than a quarter of the patients had social problems (i.e. drug/alcohol abuse, imprisoned). Fifty-four patients had positive psychiatric history, most commonly depression (33.7%). Previous history of deliberate self harm was found in five of the patients. Crude mortality was 29%. Conclusions: Self inflicted burn patients commonly exhibit social or psychiatric co-morbidity which dictates a multidisciplinary approach during hospitalization, rehabilitation and integration back into the society. doi:10.1016/j.burns.2006.10.073 Clinical characteristics and treatment of burn injuries following explosion of gunpowder in firecracker mills Chen Xue-Lin, Wang C., Hu D., Wang Y. Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China E-mail address: [email protected] (X.-L. Chen). Objective: To investigate the clinical characteristics and treatment of work-related burn injuries following explosion of gunpowder in firecracker mills so as to raise the cure rate. Methods: A retrospective study was conducted of 339 work-related burns patients sustained by gunpowder explosion and a prospective treatment principle was raised. Results: While most patients sustained burns on exposure area and the burns were usually deep dermal of full skin thickness£¬work-related burn injuries following explosion of gunpowder in firecracker mills combined with inhalation injury, compound wound and gunpowder poisoning generally where there was a high mortality and morbidity of burn shock and multiple organ dysfunction syndrome (MODS). Conclusion: Work-related burns following explosion of gunpowder in firecracker mills is a compound injury which characterized by pathologic changes of burns as the main issue. The compound wound jeopardizing life must be handled first. The fluid resuscitation should not be restricted to the formula during the exudation period while small dose of dopamine £¨2–5 g kg−1 min−1 £©and large dose of vitamin C as well as E may be useful. The organ that presents dysfunction most frequently is lung and the support of respiratory function, in our experiences, should be payed much more attention to. Since the major toxicity of gunpowder is
Burns 3 3 S ( 2 0 0 7 ) S1–S172
S31
the respiratory tract injury of sulfur dioxide and nitrogen oxides, the methylene blue and sodium hyposulfite have no effect of detoxification. It is of great use that the burn wound receives exposure therapy with silver sulfadiazine. doi:10.1016/j.burns.2006.10.074 Prevention and management of visceral complications in severely burned shipman patients Chen Xue-Lin a,b a
Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China Burns Centre, Changhai Hospital, Second Military Medical University, Shanghai, PR China E-mail address: [email protected].
b
Objective: To investigate the prevention methods and management of visceral complications in severely burned shipman patients. Methods: A retrospective review was undertaken to analyze the incidence and management of visceral complications in 31 severely burned shipman patients who admitted to our center during the period from February 1997 to May 2000. Thirty-two male-, age-, TBSA- and full thickness-matched non-shipman burns patients were selected randomly to form the control group. Results: The incidence of ARDS, stress ulcer bleeding and hepatic failure in shipman burns patients was 32.3%, 19.4% and 38.7% respectively, all of which were significantly higher than those in non-shipman burns patients. The generalized measures that emphasized on prior prevention methods were utilized to deal with the visceral complications. There were 30 cure and 1 death in shipman burns group, while all 32 non-shipman burns patients were cured. There was no significant difference in survival rate between two groups. Conclusion: Although there was a higher incidence of visceral complications, a satisfactory outcome of the shipman burns can be achieved under condition that the generalized measures that emphasized on prior prevention methods are undertaken. doi:10.1016/j.burns.2006.10.075 Co-graft of microporous xenogeneic acellular dermal matrix and autologous micoskin in the functional site with deep burns—A preliminary result Chen Xue-Lin a,b a
Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China Burns Centre, Changhai Hospital, Second Military Medical University, Shanghai, PR China E-mail address: [email protected].
b
Objective: To investigate the effect of co-graft of microporous xenogeneic acellular dermal matrix (ADM) and autologous micoskin in the functional site with deep burns. Methods: Fresh pig skin was treated with Dispase ¢o` and detergent solution Triton X-100 to get xenogeneic ADM. Then the ADM was mechanically punched to make regular pores ranged from 500–800¦I`m in diameter, separated by a distance of 3–5 mm. The functional site was early excised followed by coverage with co-graft of microporous ADM and autologous micoskin, where as the opposite functional site was severed as control and covered with autologous micoskin only. The outcome measures were time of wound healing, the functional status, and scar quality. Results: Reject reaction was not found in all patients. There were no significant differences in wound healing time between groups. According to the histological analysis at 2 months post-burn, epidermis were continuous and intact and the dermal matrix was a kind of matrix with normal structure and organization of collagen without any cellular components. The skin was smooth and has a good elasticity and no blister or ulcer in the co-graft group. Scar quality and joint function was found to be significantly improved in the co-graft treatment group. Conclusion: Co-graft of microporous xenogeneic ADM and autologous micoskin represents a superior method for the functional site with deep burns. doi:10.1016/j.burns.2006.10.076 Surgical decision making based in an algorithm of clinical findings and monitoring alternatives for peripheral circumferencial burns of the extremities Piccolo P.P., Alves N.M.B., Piccolo N.P., Piccolo-Daher R., Piccolo-Daher S., Piccolo-Lobo R., Meirelles R.P.C., Piccolo M.T.S., Piccolo M.S., Piccolo N.S. ˆ ´ Brazil Pronto Socorro Para Queimaduras, Goiania, Goias, E-mail address: nelson [email protected] (N.P. Piccolo). Peripheral burns may require escaratomy, or even fasciotomy, to release pressure upon local tissues and to warrant improvement in circulation, for maintenance of perfusion to noble tissues such as nerves and small muscles in the hands and/or feet. Occasion-