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Tang XD, Qiu L, Wang F, Liu S, Lü XW, Chen XL. Safety and efficacy of waterjet debridement vs. conventional debridement in the treatment of extremely severe burns: A retrospective analysis. Burns 2023; 49:1926-1934. [PMID: 37827935 DOI: 10.1016/j.burns.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/23/2023] [Accepted: 06/12/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Patients with extremely severe burns often require rapid wound closure with a tangential excision or escharectomy combined with a skin graft to reduce life-threatening complications such as infection. Traditional tangential excision surgery using the Watson or Humby knife does not allow accurate excision of necrotic tissue and often removes too much active tissue, which is detrimental to the rapid healing of the wound. Importantly, the Versajet hydrosurgical system, with its smaller handle, allows for more precise excision of necrotic burn tissue and preserves more active dermal tissue, positively affecting wound healing and scarring. This study compared the safety and efficacy of hydrosurgical combined with autologous skin grafting to conventional excision combined with autologous skin grafting in patients with extremely severe burn. METHODS Information of sixty burn patients with total body surface area (TBSA) > 50 % treated at the first affiliated hospital of Anhui Medical University from January 2019 to August 2022 were analyzed. The patients were divided into a conventional debridement group (n = 37) and a hydrosurgical debridement group (n = 23) according to the approach used. The hydrosurgical debridement group and the conventional debridement group were compared from the difference between the duration of the first debridement surgery, wound healing time, the changes of red blood cells and hemoglobin concentration postoperative, total blood transfusion, hospitalization cost, skin grafting frequency, procalcitonin, wound bacterial culture, albumin and prealbumin. RESULTS Information on age, gender, weight, inhalation injury, hypovolemic shock, preoperative procalcitonin, preoperative albumin, preoperative prealbumin, the operation frequency (n ≥ 3), preoperative trauma culture and postoperative trauma culture were compared between both groups (P > 0.05). Operative time and wound healing time were significantly shorter in patients with hydrosurgical debridement combined with autologous skin grafting than those in the control group (P < 0.05), while hospitalization costs were not significantly different between the two groups (P > 0.05). The changes of red blood cells and hemoglobin concentration during the postoperative period in the hydrosurgical debridement group were less significantly than those in the conventional debridement group (P < 0.05). The total amount of red blood cells transfused during hospitalization was significantly lower in the hydrosurgical debridement group than that in the conventional debridement group (P < 0.05), but the total amount of fresh frozen plasma transfused during hospitalization was not statistically significant between the two groups (P > 0.05). Albumin on the third day after surgery and prealbumin on the first, third and fifth day after surgery improved more significantly than those in the control group(P < 0.05), however, there were no significant differences between the two groups in albumin on the first and fifth postoperative days (P > 0.05). The PCT level in the conventional debridement group was significantly higher than that in the hydrosurgical debridement group on the first, third and fifth days after surgery(P < 0.05). CONCLUSION The hydrosurgical debridement group presented with shorter operative time, less blood loss during surgery, faster postoperative nutritional recovery, less postoperative inflammatory response and faster wounds healing, and did not increase the hospitalization cost, postoperative bacterial culture of the wounds and the number of skin grafting surgeries. In patients with extremely severe burn, hydrosurgical debridement combined with autologous skin grafting group is safer and more effective than those in the conventional debridement combined with autologous skin grafting group.
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Affiliation(s)
- Xu-Dong Tang
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Le Qiu
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Fei Wang
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Sheng Liu
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Xiong-Wen Lü
- School of Pharmacy, Anhui Medical University, Mei Shan Road, Hefei, Anhui Province 230032, China; Institute for Liver Disease of Anhui Medical University, Mei Shan Road, Hefei, Anhui Province 230032, China.
| | - Xu-Lin Chen
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China.
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Brekke RL, Almeland SK, Hufthammer KO, Hansson E. Agreement of clinical assessment of burn size and burn depth between referring hospitals and burn centres: A systematic review. Burns 2023; 49:493-515. [PMID: 35843804 DOI: 10.1016/j.burns.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/14/2022] [Accepted: 05/09/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND The quality of burn care is highly dependent on the initial assessment and care. The aim of this systematic review was to investigate the agreement of clinical assessment of burn depth and %TBSA between the referring units and the receiving burn centres. METHODS Included articles had to meet criteria defined in a PICO (patients, interventions, comparisons, outcomes). Relevant databases were searched using a predetermined search string (November 6th 2021). Data were extracted in a standardised fashion. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for test accuracy was used to assess the certainty of evidence. The QUADAS-2 tool was used to assess the risk of bias of individual studies as 'high', 'low' or 'unclear'. RESULTS A total of 412 abstracts were retrieved and of these 28 studies with a total of 6461 patients were included, all reporting %TBSA and one burn depth. All studies were cross-sectional and most of them comprising retrospectively enrolled consecutive cohort. All studies showed a low agreement between %TBSA calculations made at referring units and at burn centres. Most studies directly comparing estimations of %TBSA at referring institutions and burn centers showed a proportion of overestimations of 50% or higher. The study of burn depth showed that 55% were equal to the estimates from the burn centre. Most studies had severe study limitations and the risk of imprecision was high. The overall certainty of evidence for accuracy of clinical estimations in referring centres is low (GRADE ⊕⊕ОО) for %TBSA and very low (GRADE ⊕ООО) for burn depth and resuscitation. CONCLUSION Overestimation of %TBSA at referring hospitals occurs very frequently. The overall certainty of evidence for accuracy of clinical estimations in referring centres is low for burn size and very low for burn depth. The findings suggest that the burn community has a significant challenge in educating and communicating better with our colleagues at referring institutions and that high-quality studies are needed.
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Affiliation(s)
- Ragnvald Ljones Brekke
- Department of Plastic, Hand and Reconstructive Surgery, Norwegian National Burn Center, Haukeland University Hospital, Haukelandsveien 22, NO-5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, NO-5021 Bergen, Norway.
| | - Stian Kreken Almeland
- Department of Plastic, Hand and Reconstructive Surgery, Norwegian National Burn Center, Haukeland University Hospital, Haukelandsveien 22, NO-5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, NO-5021 Bergen, Norway
| | - Karl Ove Hufthammer
- Centre for Clinical Research, Haukeland University Hospital, PO Box 1400, NO-5021 Bergen, Norway
| | - Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45 Gothenburg, Sweden; Department of Plastic Surgery, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45 Gothenburg, Sweden
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Muacevic A, Adler JR, Arora S. Physical Therapy Interventions of an Electrical Burn Injury-Afflicted Patient: A Case Report. Cureus 2022; 14:e31176. [PMID: 36514659 PMCID: PMC9733660 DOI: 10.7759/cureus.31176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022] Open
Abstract
Electrical injuries are uncommon but not completely rare. It is most prevalent in the male population, although females are also affected in the workplace or household-related activities. These injuries usually occur in situations where proper precautions are not taken by the individual and also appropriate safety drills and education for personnel are not carried out. Electrical burns affecting children are very rare, but when they do occur, it is usually due to accidental contact with exposed electrical sources. In this patient, there were severe levels of secondary complications following the burn injury. The patient developed blood infections and also was hampered in doing a variety of activities of daily living. The patient was diagnosed with 45%-50% body surface area (BSA) covered with burns, which suggests its severe nature. Treatment focuses on preventing wound infection, managing the excruciating amount of pain, preventing complications of immobility, promoting mobility as much as the patient can, and also educating the patient and the family members.
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Cao YL, Liu ZC, Chen XL. Efficacy of hydrosurgical excision combined with skin grafting in the treatment of deep partial-thickness and full-thickness burns: a two-year retrospective study. Burns 2022:S0305-4179(22)00194-2. [DOI: 10.1016/j.burns.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/26/2022]
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Maudet L, Pasquier M, Pantet O, Albrecht R, Carron PN. Prehospital management of burns requiring specialized burn centre evaluation: a single physician-based emergency medical service experience. Scand J Trauma Resusc Emerg Med 2020; 28:84. [PMID: 32819398 PMCID: PMC7439538 DOI: 10.1186/s13049-020-00771-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency medical services regularly encounter severe burns. As standards of care are relatively well-established regarding their hospital management, prehospital care is comparatively poorly defined. The aim of this study was to describe burned patients taken care of by our physician-staffed emergency medical service (PEMS). METHODS All patients directly transported by our PEMS to our burn centre between January 2008 and December 2017 were retrospectively enrolled. We specifically addressed three "burn-related" variables: prehospital and hospital burn size estimations, type and volume of infusion and pain assessment and management. We divided patients into two groups for comparison: TBSA < 20% and ≥ 20%. We a priori defined clinically acceptable limits of agreement in the small and large burn group to be ±5% and ± 10%, respectively. RESULTS We included 86 patients whose median age was 26 years (IQR 12-51). The median prehospital TBSA was 10% (IQR 6-25). The difference between the prehospital and hospital TBSA estimations was outside the limits of agreement at 6.2%. The limits of agreement found in the small and large burn groups were - 5.3, 4.4 and - 10.1, 11, respectively. Crystalloid infusion was reported at a median volume of 0.8 ml/kg/TBSA (IQR 0.3-1.4) during the prehospital phase, which extrapolated over the first 8 h would equal to a median volume of 10.5 ml/kg/TBSA. The median verbal numeric rating scale on scene was 6 (IQR 3-8) and 3 (IQR 2-5) at the hospital (p < 0.001). Systemic analgesia was provided to 61 (71%) patients, predominantly with fentanyl (n = 59; 69%), followed by ketamine (n = 7; 8.1%). The median doses of fentanyl and ketamine were 1.7 mcg/kg (IQR 1-2.6) and 2.1 mg/kg (IQR 0.3-3.2), respectively. CONCLUSIONS We found good agreement in burn size estimations. The quantity of crystalloid infused was higher than the recommended amount, suggesting a potential risk for fluid overload. Most patients benefited from a correct systemic analgesia. These results emphasized the need for dedicated guidelines and decision support aids for the prehospital management of burned patients.
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Affiliation(s)
- Ludovic Maudet
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, CH-1011, Lausanne, Switzerland.
- Department of Emergency Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
- Department of Anesthesiology, Lausanne University Hospital, Ru du Bugnon 46, CH-1011, Lausanne, Switzerland.
| | - Mathieu Pasquier
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, CH-1011, Lausanne, Switzerland
- Department of Emergency Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Olivier Pantet
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, CH-1011, Lausanne, Switzerland
- Department of Intensive Care Medicine and Burn Centre, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Roland Albrecht
- Rega - Swiss Air-Rescue, Rega Centre, PO Box 1414, CH-8058, Zurich, Switzerland
| | - Pierre-Nicolas Carron
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, CH-1011, Lausanne, Switzerland
- Department of Emergency Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
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A Quantitative Analysis of Animation Deformity in Prosthetic Breast Reconstruction. Plast Reconstr Surg 2019; 144:291-301. [DOI: 10.1097/prs.0000000000005800] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chen W, He M, Xie L, Li L. The optimal cleansing method for the removal of sunscreen:Water, cleanser or cleansing oil? J Cosmet Dermatol 2019; 19:180-184. [PMID: 31157512 DOI: 10.1111/jocd.12995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 03/28/2019] [Accepted: 04/22/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Wei Chen
- Department of Dermatovenereology, West China Hospital Sichuan University Chengdu China
- Department of Medical Cosmetology The Second People’s Hospital of Chengdu Chengdu China
| | - Mei He
- Department of Medical Cosmetology The Second People’s Hospital of Chengdu Chengdu China
| | - Li Xie
- Department of Dermatovenereology, West China Hospital Sichuan University Chengdu China
| | - Li Li
- Department of Dermatovenereology, West China Hospital Sichuan University Chengdu China
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Blankenberger WB, Weber EM, Chu DK, Geronimo JT, Theil J, Gaskill BN, Pritchett-Corning K, Albertelli MA, Garner JP, Ahloy-Dallaire J. Breaking up is hard to do: Does splitting cages of mice reduce aggression? Appl Anim Behav Sci 2018. [DOI: 10.1016/j.applanim.2018.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nacimento M, Mounier C, Masson Y, Donat N, Lefort H. [Not Available]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2018; 63:59-61. [PMID: 30213321 DOI: 10.1016/j.soin.2018.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Mélanie Nacimento
- Centre de traitement des brûlés, Hôpital Percy, 1, rue du Lieutenant-Batany, 92140 Clamart, France.
| | - Charlen Mounier
- Centre de traitement des brûlés, Hôpital Percy, 1, rue du Lieutenant-Batany, 92140 Clamart, France
| | - Yannick Masson
- Centre de traitement des brûlés, Hôpital Percy, 1, rue du Lieutenant-Batany, 92140 Clamart, France
| | - Nicolas Donat
- Centre de traitement des brûlés, Hôpital Percy, 1, rue du Lieutenant-Batany, 92140 Clamart, France
| | - Hugues Lefort
- Structure des urgences, hôpital d'instruction des armées Legouest, 27, rue Plantière, 57000 Metz, France
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McCulloh C, Nordin A, Talbot LJ, Shi J, Fabia R, Thakkar RK. Accuracy of Prehospital Care Providers in Determining Total Body Surface Area Burned in Severe Pediatric Thermal Injury. J Burn Care Res 2017; 39:491-496. [DOI: 10.1093/jbcr/irx004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Christopher McCulloh
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
| | - Andrew Nordin
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
| | - Lindsay J Talbot
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
| | - Junxin Shi
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
- Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
| | - Renata Fabia
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
- The Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Rajan K Thakkar
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
- The Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
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Appraising current methods for preclinical calculation of burn size – A pre-hospital perspective. Burns 2017; 43:127-136. [DOI: 10.1016/j.burns.2016.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/15/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
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Staruch RMT, Beverly A, Lewis D, Wilson Y, Martin N. Should early amputation impact initial fluid therapy algorithms in burns resuscitation? A retrospective analysis using 3D modelling. J ROY ARMY MED CORPS 2016; 163:58-64. [PMID: 27278968 DOI: 10.1136/jramc-2015-000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 11/04/2022]
Abstract
AIMS While the epidemiology of amputations in patients with burns has been investigated previously, the effect of an amputation on burn size and its impact on fluid management have not been considered in the literature. Fluid resuscitation volumes are based on the percentage of the total body surface area (%TBSA) burned calculated during the primary survey. There is currently no consensus as to whether the fluid volumes should be recalculated after an amputation to compensate for the new body surface area. The aim of this study was to model the impact of an amputation on burn size and predicted fluid requirement. METHODS A retrospective search was performed of the database at the Queen Elizabeth Hospital Birmingham Regional Burns Centre to identify all patients who had required an early amputation as a result of their burn injury. The search identified 10 patients over a 3-year period. Burn injuries were then mapped using 3D modelling software. BurnCase3D is a computer program that allows accurate plotting of burn injuries on a digital mannequin adjusted for height and weight. Theoretical fluid requirements were then calculated using the Parkland formula for the first 24 h, and Herndon formula for the second 24 h, taking into consideration the effects of the amputation on residual burn size. RESULTS AND CONCLUSIONS This study demonstrated that amputation can have an unpredictable effect on burn size that results in a significant deviation from predicted fluid resuscitation volumes. This discrepancy in fluid estimation may cause iatrogenic complications due to over-resuscitation in burn-injured casualties. Combining a more accurate estimation of postamputation burn size with goal-directed fluid therapy during the resuscitation phase should enable burn care teams to optimise patient outcomes.
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Affiliation(s)
- Robert M T Staruch
- School of Engineering & Applied Sciences, Harvard University, USA.,Department of Burns and Plastic Surgery, St Marys Hospital, Imperial College Healthcare, London, UK
| | - A Beverly
- Department of Anaesthetics, Royal Surrey County Hospital, Guildford, UK
| | - D Lewis
- Department of Burns & Plastic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Y Wilson
- Department of Burns & Plastic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - N Martin
- Department of Burns & Plastic Surgery, St Andrews Centre for Burns & Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK
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Guo ZQ, Qiu L, Gao Y, Li JH, Zhang XH, Yang XL, Peszel A, Chen XL. Use of porcine acellular dermal matrix following early dermabrasion reduces length of stay in extensive deep dermal burns. Burns 2016; 42:598-604. [PMID: 26777449 DOI: 10.1016/j.burns.2015.10.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/19/2015] [Accepted: 10/19/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Extensive deep partial-thickness burns still seriously challenge the surgeon's abilities. This study aimed to assess the impact of early dermabrasion combined with porcine acellular dermal matrix (ADM) in extensive deep dermal burns. METHODS From September 2009 to September 2013, a total of 60 adult patients sustained greater than 50% total body surface area (TBSA) burn by hot water or gas explosion were divided into three groups based on dermabrasion: group A (early dermabrasion and porcine ADM), group B (early dermabrasion and nano-silver dressings), and group C (conservative group). The wound healing time and length of hospital stay were analyzed. Scar assessment was performed at 3 and 12 months after the injury with a modified Vancouver Scar Scale linked with TBSA (mVSS-TBSA). RESULTS No significant difference was found in mean burn size, burn depth, age, male-to-female ratio, or incidence of inhalation injury between the patients in the three groups (p>0.05). Compared with groups B and C, the patients that received early dermabrasion combined with porcine ADM had a shorter wound healing time (p<0.01). The burn patients treated with early dermabrasion and porcine ADM coverage had a mean length of hospital stay of 28.3 days (±7.2), which was significantly shorter than that of groups B and C (p<0.05-0.01). The mVSS-TBSA of patients in group A was significantly improved in comparison with groups B and C at 3 and 12 months after the injury. There was no significant difference in the mortality rate between the three groups (p>0.05). CONCLUSION Early dermabrasion combined with porcine ADM coverage facilitates wound healing, reduces the length of hospital stay, and improves esthetic and functional results in extensive deep dermal burns with burn size over 50% TBSA.
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Affiliation(s)
- Zhi-Qian Guo
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China; Department of Burns and Plastic Surgery, No. 174 Hospital of PLA, Xiamen, Fujian 361003, PR China
| | - Le Qiu
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - You Gao
- Department of Burns and Plastic Surgery, No. 174 Hospital of PLA, Xiamen, Fujian 361003, PR China
| | - Jin-Hu Li
- Department of Burns and Plastic Surgery, No. 174 Hospital of PLA, Xiamen, Fujian 361003, PR China
| | - Xin-He Zhang
- Department of Burns and Plastic Surgery, No. 174 Hospital of PLA, Xiamen, Fujian 361003, PR China
| | - Xin-Lei Yang
- Department of Burns and Plastic Surgery, No. 174 Hospital of PLA, Xiamen, Fujian 361003, PR China
| | - April Peszel
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Xu-Lin Chen
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China.
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Legrand M, Guttormsen AB, Berger MM. Ten tips for managing critically ill burn patients: follow the RASTAFARI! Intensive Care Med 2015; 41:1107-9. [PMID: 25573501 DOI: 10.1007/s00134-014-3627-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Matthieu Legrand
- Department of Anesthesiology and Critical Care and Burn Unit, St-Louis Hospital, Assistance Publique-Hopitaux de Paris, GH St-Louis-Lariboisière, University of Paris 7 Denis Diderot, 1 Rue Claude Vellefaux, 75010, Paris, France,
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Abelsson A, Rystedt I, Suserud BO, Lindwall L. Mapping the use of simulation in prehospital care - a literature review. Scand J Trauma Resusc Emerg Med 2014; 22:22. [PMID: 24678868 PMCID: PMC3997227 DOI: 10.1186/1757-7241-22-22] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 03/24/2014] [Indexed: 12/15/2022] Open
Abstract
Background High energy trauma is rare and, as a result, training of prehospital care providers often takes place during the real situation, with the patient as the object for the learning process. Such training could instead be carried out in the context of simulation, out of danger for both patients and personnel. The aim of this study was to provide an overview of the development and foci of research on simulation in prehospital care practice. Methods An integrative literature review were used. Articles based on quantitative as well as qualitative research methods were included, resulting in a comprehensive overview of existing published research. For published articles to be included in the review, the focus of the article had to be prehospital care providers, in prehospital settings. Furthermore, included articles must target interventions that were carried out in a simulation context. Results The volume of published research is distributed between 1984- 2012 and across the regions North America, Europe, Oceania, Asia and Middle East. The simulation methods used were manikins, films, images or paper, live actors, animals and virtual reality. The staff categories focused upon were paramedics, emergency medical technicians (EMTs), medical doctors (MDs), nurse and fire fighters. The main topics of published research on simulation with prehospital care providers included: Intubation, Trauma care, Cardiac Pulmonary Resuscitation (CPR), Ventilation and Triage. Conclusion Simulation were described as a positive training and education method for prehospital medical staff. It provides opportunities to train assessment, treatment and implementation of procedures and devices under realistic conditions. It is crucial that the staff are familiar with and trained on the identified topics, i.e., intubation, trauma care, CPR, ventilation and triage, which all, to a very large degree, constitute prehospital care. Simulation plays an integral role in this. The current state of prehospital care, which this review reveals, includes inadequate skills of prehospital staff regarding ventilation and CPR, on both children and adults, the lack of skills in paediatric resuscitation and the lack of knowledge in assessing and managing burns victims. These circumstances suggest critical areas for further training and research, at both local and global levels.
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Affiliation(s)
- Anna Abelsson
- Department of Health Sciences, Karlstad University, Karlstad, Sweden.
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Martin NA, Lundy JB, Rickard RF. Lack of precision of burn surface area calculation by UK Armed Forces medical personnel. Burns 2014; 40:246-50. [DOI: 10.1016/j.burns.2013.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 05/13/2013] [Accepted: 05/21/2013] [Indexed: 11/24/2022]
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Abstract
Accurate burn estimation affects the use of burn resuscitation formulas and treatment strategies, and thus can affect patient outcomes. The objective of this process-improvement project was to compare the accuracy of a computer-based burn mapping program, WoundFlow (WF), with the widely used hand-mapped Lund-Browder (LB) diagram. Manikins with various burn representations (from 1% to more than 60% TBSA) were used for comparison of the WF system and LB diagrams. Burns were depicted on the manikins using red vinyl adhesive. Healthcare providers responsible for mapping of burn patients were asked to perform burn mapping of the manikins. Providers were randomized to either an LB or a WF group. Differences in the total map area between groups were analyzed. Also, direct measurements of the burn representations were taken and compared with LB and WF results. The results of 100 samples, compared using Bland-Altman analysis, showed no difference between the two methods. WF was as accurate as LB mapping for all burn surface areas. WF may be additionally beneficial in that it can track daily progress until complete wound closure, and can automatically calculate burn size, thus decreasing the chances of mathematical errors.
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Gankande TU, Wood FM, Edgar DW, Duke JM, DeJong HM, Henderson AE, Wallace HJ. A modified Vancouver Scar Scale linked with TBSA (mVSS-TBSA): Inter-rater reliability of an innovative burn scar assessment method. Burns 2013; 39:1142-9. [PMID: 23433706 DOI: 10.1016/j.burns.2013.01.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 01/19/2013] [Accepted: 01/28/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current scar assessment methods do not capture variation in scar outcome across the burn scar surface area. A new method (mVSS-TBSA) using a modified Vancouver Scar Scale (mVSS) linked with %TBSA was devised and inter-rater reliability was assessed. METHOD Three raters performed scar assessments on thirty patients with burn scars using the mVSS-TBSA. Scoring on pigmentation, vascularity, pliability and height was undertaken for the 'best' and 'worst' areas of each scar. Raters allocated the total body surface area of the scar (%TBSA) to three mVSS categories (<5, 5-10, >10). Intra-class correlation coefficient (ICC) and weighted kappa statistic (kw) were used to assess inter-rater reliability. The data were also analysed for clinically relevant misclassifications between pairs of raters. RESULTS Total mVSS scores showed 'fair to good' agreement (ICC 0.65-0.73) in the 'best' area of the scar while there was 'excellent' agreement in the 'worst' scar area (ICC 0.85-0.88). The kw of the individual mVSS components ranged from 0.44 to 0.84 and 0.02 to 0.86 for 'best' and 'worst' scar areas, respectively. Determination of scar %TBSA had 'excellent' reliability (ICC 0.91-0.96). Allocation of scar %TBSA to severity category <5 mVSS demonstrated 'good to excellent' reliability (ICC 0.63-0.80) and 'fair to good' reliability (ICC 0.42-0.74) for 5-10 mVSS category. However, misclassifications were observed for the total mVSS score in the 'worst' scar area and the allocation of scar %TBSA in the <5 mVSS category. CONCLUSION Inter-rater reliability of mVSS scores depends on the severity of the scar area being assessed. The mVSS-TBSA method of allocation of scar %TBSA to two broad mVSS categories, namely <5 and ≥5 mVSS, has 'good to excellent' reliability. The mVSS-TBSA has demonstrated utility for both clinical and research purposes; however, there is potential to misclassify scar outcome in some cases.
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Affiliation(s)
- T U Gankande
- Burns Injury Research Unit, School of Surgery, The University of Western Australia, Australia.
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Chan QE, Barzi F, Cheney L, Harvey JG, Holland AJA. Burn size estimation in children: still a problem. Emerg Med Australas 2011; 24:181-6. [PMID: 22487668 DOI: 10.1111/j.1742-6723.2011.01511.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Accurate determination of burn size and depth forms an integral part of the initial assessment of any burn injury. Errors might lead to inaccurate fluid resuscitation and inappropriate transfer of patients to specialized burns units (BUs). Although recent data suggest some improvement in the estimation of burn injury in adults, this has not been shown in children. METHODS A retrospective review of children with burn injuries referred to the BU of our institution was performed. Data were collected from all patients presenting to the BU during the calendar year 2009. The total body surface area burned (TBSA-B) estimated by the referring centre was compared with the actual TBSA determined measured on arrival at the BU. RESULTS Of the 71 paediatric patients referred during the study period, 10 did not have any TBSA-B estimation documented by the referring hospital. Inaccurate estimation of burn area was noted in 48 out of 61 patients (79%). Burn size was more likely to be overestimated than underestimated by a ratio of 2.2 to 1, especially in burns >10% TBSA-B (P= 0.002). CONCLUSIONS Inaccurate estimation of burn size remains a problem in children. The persistent miscalculation of burn size might be a result of the various methods employed in assessing burn area, the inclusion of simple erythema and inadequate training or exposure of first responders. Accurate assessment of TBSA-B and burn depth in children remains elusive and would appear to require additional training and education.
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Affiliation(s)
- Queenie E Chan
- Douglas Cohen Department of Paediatric Surgery, The Children's Hospital Burns Research Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Kato M, Iida M, Goto Y, Kondo T, Yajima I. Sunlight Exposure–Mediated DNA Damage in Young Adults. Cancer Epidemiol Biomarkers Prev 2011; 20:1622-8. [DOI: 10.1158/1055-9965.epi-11-0228] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Muehlberger T, Ottomann C, Toman N, Daigeler A, Lehnhardt M. Emergency pre-hospital care of burn patients. Surgeon 2010; 8:101-4. [DOI: 10.1016/j.surge.2009.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 10/22/2009] [Indexed: 10/20/2022]
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