Prognostic factors for amputation in severe burn patients

Physiotherapy Approach in Transradial Amputation Following the Sequelae of Electric Burn: A Case Report

A considerable amount of mortality and morbidity has been attributed to burn injuries. Because of expanding industrial development, greater consumption of electricity, and electric appliances at home, the number of burns caused by electricity is expanding. When it pertains to addressing burn injuries, therapeutic pursuits are necessary. The 18-year-old female patient in this case reported a history of burns due to electrical shock to her left upper and lower limbs along with her right foot. She came to the hospital, and after necessary investigations and examination, she was suggested for below elbow amputation or transradial amputation with debridement of the wound over the left axilla, foot, and right foot. Following the surgical procedure, the patient had pain, reduced muscle strength, limited joint mobility, and edema. For further rehabilitation, community health physiotherapy was advised. Routine physiotherapy treatment was provided to the patient for fifteen days. We report that after surgery, the effects of physical therapy showed decreased pain intensity, enhanced range of motion (ROM) of the affected and peripheral joints, and improved strength in adjacent muscles.

Burn Injury Complications Impacting Rehabilitation

Successful post-burn rehabilitation requires an understanding of a wide range of complications to maximize functional recovery. This article reviews a range of potential challenges including burn scar contracture, amputation, peripheral nerve injury, heterotopic ossification, dysphagia, altered skin physiology, pain, and pruritis. The overall focus is to serve as a guide for post-injury therapy and rehabilitation spanning the phases of care and considering evidence-based approaches, prevention, and treatment with an ultimate goal of aiding in the functional recovery and long-term quality of life for burn survivors.

Burn Center Patients at Risk for Upper Extremity Amputations

Introduction Burn center patients present not only with burn injuries but also necrotizing infections, purpura fulminans, frostbite, toxic epidermal necrolysis, chronic wounds, and trauma. Burn surgeons are often faced with the need to amputate when limb salvage is no longer a viable option. The purpose of this study was to determine factors which predispose patients to extremity amputations. Methods: This retrospective registry review (2000-2019) compared patients who required upper extremity amputations with those who did not. Cases were pair-matched by age, sex, percent total body surface area (%TBSA), and type/location of injury to control for possible confounding variables. Results: There were 77 upper extremity amputee patients (APs) and 77 pair-matched non-amputees (NAPs) with the median age 45- and 43-years, %TBSA 21 and 10, respectively; second and third degree burn injuries were similar in the 2 groups. The AP group had longer hospitalizations (median 40 vs 15 days) P < .0001, with more intensive care unit days (median 28 vs 18 days). APs presented with significantly more cardiac, renal, and pulmonary comorbidities, acquired infections (61 [64%] vs 35 [36%]), escharotomies, and fasciotomies than the NAP, P < .0001. Mortality was similar (AP 14 [18.2%] vs NAP 9 [11.7%]), P = .26. Conclusions: Escharotomies, fasciotomies, sepsis, pneumonia, wound, and urinary tract infections contributed to prolonged hospitalizations and increased risk for upper extremity amputations in the AP group.

Revision Surgery Following Severe Frostbite Injury Compared to Similar Hand and Foot Burns

Severe frostbite is associated with loss of digits or limbs and high levels of morbidity. The current practice is to salvage as much of the limb/digit as possible with the use of thrombolytic and adjuvant therapies. Sequelae from amputation can include severe nerve pain and poor wound healing requiring revision surgery. The aim of this study was to examine the rate of revision surgery after primary amputation and compare this to revision surgery in isolated hand/foot burns. Frostbite and burn patients from 2014 to 2019 were identified in the prospectively maintained database at a single urban burn and trauma center. Patients with primary amputations related to isolated hand/foot burns or frostbite were included in the study. Descriptive statistics included Student's t-test and Fisher's exact test. A total of 63 patients, 54 frostbite injuries and 9 isolated hand or foot burns, met inclusion criteria for the study. The rate of revision surgery was similar following frostbite and burn injury (24% vs 33%, P = .681). There were no significant differences in age, sex, or length of stay on the primary hospitalization between those that required revision surgery and those that did not. Neither the impacted limb nor the presence of infection or cellulitis on primary amputation was associated with future need for revision surgery. Of the 16 patients requiring revision surgery, 5 (31%) required additional debridement alone, 6 (38%) required reamputation alone, and 5 required both. A total of 6 patients (38%) had cellulitis or infection at the time of revision surgery. Time from primary surgery to revision ranged from 4 days to 3 years. Planned, delayed primary amputation is a mainstay of frostbite management. To our knowledge, this is the first assessment of revision surgery in the setting of severe frostbite injury. Our observed rate of revision surgery following frostbite injury did not differ significantly from revision surgery in the setting of isolated hand or foot burns. This study brings up important questions of timing and surgical planning in these complex patients that will require a multicenter collaborative study.

Most prominent factors contributing to burn injury-related amputations: an analysis of a referral Burn Center

Amputations are un-common surgical procedures in patients with severe burn injuries. However, these patients often face extreme physical and psychological challenges that result in social stigmatization and inadequate rehabilitation facilities. A retrospective cohort study was designed for the patients admitted to the Burn Center of Adana City Training and Research Hospital (ACTRH). During the study period, a total of 2007 patients aged 0.5 to 92 years were hospitalized and treated at the burn center from January 2016 to June 2020. The incidence of amputation observed among inpatient burn injuries regardless of the etiology was 1.9%, and 87.2% were male. The univariate and multivariate logistic regression analysis was performed to detect the most prominent factors contributing to burn injury-related amputations. The cause of burns appears to be one of the main factors in the past research, and in this context, the electrical burns stand out, likewise, the fire-flame-related burns, full-thickness burns, the existence of infection, male gender, patients aged within the 18 to 64 age group, and the burn extent within the total body surface area (TBSA) range of 10 to <50% were found to be the most leading factors of amputations among patients having severe burns. Although they are rare, amputations related to burns commonly cause a decrease in quality of life. Therefore, besides increasing occupational health and safety methods for these risk groups, especially for adults of working age; also, it is essential to increase the importance and awareness of the precautions to be taken in daily life.

Analysis of the Efficacy of Iloprost Treatment in Amputations Due to Burn

The aim of our study was to demonstrate the decrease in amputation rates with iloprost treatment in patients who develop vascular injury due to burns. The data of 366 adult burn patients who were admitted to the emergency department of our hospital between 2016 and 2019 were analyzed. Demographic characteristics, burn factors, vascular examination findings, medical treatments, amputation rates, and levels were recorded. The amputation rates of the patients who were treated with iloprost and who were not treated with iloprost were compared. The mean age of 366 adult patients treated for burns was 37.8 ± 16.4 years, and of these patients, 220 (59.9%) were under 40 years of age. Although heat burns (n = 331.85%) were the most common burn etiology, it was found that the incidence of vascular injury was higher in burns caused by electricity (11.7%) and cold (3.3%) (P < 0.001). Vascular injury was detected in 60 (16.3%) of the patients and 21 (35%) of these patients were treated with iloprost. Amputation was observed in 20 (5.5%) of all burn patients, but only one of the patients treated with iloprost underwent amputation (P < .001). The individual and social impacts of amputations caused by burns are unquestionable. The authors are of the opinion that iloprost treatment is effective in reducing amputations due to burns.

Amputation Following Burn Injury

Amputation following burn injury is rare. Previous studies describe the risk of amputation after electrical burn injuries. Therefore, we describe the distribution of amputations and evaluate risk factors for amputation following burn injury at a large regional burn center. We conducted a retrospective analysis of patients ≥17 years admitted from January 2002 to December 2015. Patients who did and did not undergo an amputation procedure were compared. A multivariate logistic regression model was used to determine the risk factors for amputation. Amputations were further categorized by extremity location and type (major, minor) for comparison. Of the 8313 patients included for analysis, 1.4% had at least one amputation (n = 119). Amputees were older (46.7 ± 17.4 years) than nonamputees (42.6 ± 16.8 years; P = .009). The majority of amputees were white (47.9%) followed by black (39.5%) when compared with nonamputees (white: 57.1%, black: 27.3%; P = .012). The most common burn etiology for amputees was flame (41.2%) followed by electrical (23.5%) and other (21.9%). Black race (odds ratio [OR]: 2.29; 95% confidence interval [CI]: 1.22-4.30; P = .010), electric (OR: 13.54; 95% CI: 6.23-29.45; P < .001) and increased %TBSA (OR: 1.03; 95% CI: 1.02-1.05; P < .001) were associated with amputation. Burn etiology, the presence of preexisting comorbidities, black race, and increased %TBSA increase the odds of post burn injury. The role of race on the risk of amputation requires further study.

A Six-Year Study on Epidemiology of Electrical Burns in Northern Iran: Is It Time to Pay Attention?

BACKGROUND

Although electrical burns are less prevalent than other types, they put socioeconomic burden on communities, yielding higher mortalities. Therefore, the frequency and causes of electrical burns in the largest burn center in northern Iran were studied.

METHODS

All patients with electrical burn injuries admitted to Velayat Hospital, Rasht, Iran participated in this descriptive cross-sectional study. The data collection tool was a checklist including demographic data, damage mechanism, voltage classification (high or low), injured organ, ICU need, length of stay (LOC), electrical burn severity (degree and area of burns based on TBSA), surgical interventions, and return to work. All data were gathered through HIS system and analyzed.

RESULTS

Most electrical burns occurred in men (99.4%) and most of whom had electricity-related jobs (26%). The majority of victims had third-degree burns (63%), and electrical current-induced burns in entry points occurred in the upper and lower extremities, head and other organs ranked the first to fourth, respectively. Most burns happened due to abrupt contact with electrical current (83.33%) in routine home activities (52.78%). The mean LOC was 8.73 days, suggesting that LOC increased significantly, if the electrical current entered the body through lower extremities, while it decreased significantly, if the electrical current exited through lower extremities.

CONCLUSION

The majority of electrical burn victims were men. Most burns occurred in urban communities in summer. Most people were affected by high voltage electricity.

Procurement of Extended Vascularized Skin Flaps from the Donor Enables Hand Transplantation in Severe Upper Extremity Burns: An Anatomical Study

BACKGROUND

Hand transplantation in patients with severe upper extremity burns can be associated with an increased risk of exposure of vessels, tendons, and nerves because of extensive skin and soft-tissue deficit. This study evaluated how to reliably transfer additional extended skin flaps with a standard hand allograft.

METHODS

Twenty-five upper extremities were used. Sixteen were injected with latex to map the perforating branches of the brachial, superior ulnar collateral, radial, ulnar, and posterior interosseous arteries. Nine hand allografts were procured, injected with blue ink through the brachial artery to assess the perfusion of the skin flaps, and then mock transplanted.

RESULTS

Sizable perforators from the brachial, superior ulnar collateral, radial, ulnar, and posterior interosseous arteries were used to augment the vascularization of the skin flaps. The average stained area of the medial arm flap was between 85.7 and 93.9 percent. The stained area of the volar forearm flap was the smallest when based on perforators within 6 cm from the wrist crease (51.22 percent). The dorsal forearm flap showed the least amount of staining (34.7 to 46.1 percent). The average time to repair tendons, nerves, and vessels was longer when a single volar forearm-arm flap was harvested (171.6 minutes). Harvest of the allograft associated with a distally based forearm flap and islanded arm flap was the fastest (181.6 ± 17.55 minutes).

CONCLUSION

Extended skin flaps, based on perforators of the main axial vessels, can be reliably transplanted with a standard hand allograft based on the brachial or axillary vascular pedicle.

Occupational burns treated in emergency departments

BACKGROUND

Despite reported declines, occupational burn injuries remain a workplace safety concern. More severe burns may result in costly medical treatment and long-term physical and psychological consequences.

METHODS

We used the National Electronic Injury Surveillance System-Occupational Supplement to produce national estimates of burns treated in emergency departments (EDs). We analyzed data trends from 1999 to 2008 and provided detailed descriptions of 2008 data.

RESULTS

From 1999 to 2008 there were 1,132,000 (95% CI: ±192,300) nonfatal occupational burns treated in EDs. Burn numbers and rates declined approximately 40% over the 10 years. In 2008, men and younger workers 15-24 years old had the highest rates. Scalds and thermal burns accounted for more than 60% of burns. Accommodation and food service, manufacturing, and construction industries had the largest number of burns.

CONCLUSIONS

Despite declining burn rates, emphasis is needed on reducing burn hazards to young food service workers and using job specific hazard analyses to prevent burns.