Clinical Outcomes Among Elderly People With Burns

Burns in the elderly are a public health concern. This study aimed to analyze etiology, clinical characteristics, and independent risk factors for outcomes of burns in elderly patients. This retrospective study included elderly patients (65 years and over) admitted to a major burn unit between 2006 and 2016. Demographic data, clinical characteristics and outcomes were analyzed. One hundred and thirty patients were included. Most were female (56.2%) and the highest incidence was among those aged 75-84 years. The median burn area was 10.5%. The incidence in winter (50%) was higher (p<0.001) and flame burns predominated (p<0.001). The mortality rate was 32.3%. Independent risk factors for death were older age, larger extent burns, need for escharotomy, and cardiac disease as comorbidity. Amongst the survivors, the median length of stay was 36 days. Development of pressure sores, need for skin grafts, larger extent burns, presence of full-thickness burns, and cardiac disease were shown to be significantly associated with increased length of stay amongst survivors. Preventive measures should target women aged between 75-84 years. Flame burns occurred more frequently in winter. Prognosis is related to age, extent of burns, need for escharotomy at admission, and cardiac disease.

Burn patients in Portugal: analysis of 14,797 cases during 1993-1999

The incidence and cause of burns in Portugal are unknown. The present study seeks to collect these data as a basis for future studies in prevention and development of treatment regimes. The data used in this work was obtained from the registries existing in The Direcção Geral de Saúde (General Health Administration) and relates to burn patients admitted to 91 Portuguese hospitals--that serve all the territory--during the period of 1993-1999. All patients selected had at least one diagnosis of burn (ICD-9: 94.###) among all the diagnoses motivating an admission. A total of 14,797 burn patients were obtained. Among all the patients admitted to hospitals, 8731 (59.0%) were male and 6066 (41.0%) were female, with a male/female ratio of 1.44:1. The mean length of in-hospital stay was 15.5+/-21.0 days. Throughout this period, 553 (3.7%) patients died in Portuguese hospitals as a result of burn injury. There were no significant differences in the number of deaths in each year, P=0.45, in contrast to the decrease of burn mortality rates reported in other studies. It is likely that the reason for this situation is the lack of investment in the last years in this area and the delay in opening new Burn Centres.

The distally based island superficial sural artery flap: clinical experience with 36 flaps

The principles of neurocutaneous flaps, first described by Masquelet in 1992, represented a new concept in skin vascularization. The distally based superficial sural artery flap is an example of this kind of flap, which is supplied by the vascular axis that accompanies the sural nerve. The authors treated 36 patients with 36 distally based superficial sural artery flaps. All flaps survived, but six of them exhibited partial necrosis. No patient experienced anesthesia of the lateral side of the foot or neuroma at the donor site 12 months after surgery. The authors confirmed that this flap is very useful for soft-tissue reconstruction of the distal third of the leg and foot. Additionally they conclude that the principal advantages are that the blood supply is reliable, execution is easy and fast, the operation can be performed under regional anesthesia, the flap has a large arc of rotation, direct closure of the donor area is possible for small flaps, major arteries or nerves are not sacrificed, and excellent durability is achieved, even on weight-bearing areas. The major drawback is the donor site scar.

[Free flaps in the reconstruction of head and neck. Clinical experience]

The reconstruction of head and neck defects, due to trauma, tumor resection or other, begins with a careful assessment of the patient and the respective defect. Ideally, it ends with the successful reconstructive procedure that optimally restores form and function to the patient. Free flaps have often been used as a last resort reconstructive option in the head and neck because of the need for added technical skill, a longer operating time and a perception of poor reliability. This study reviews our experience with forty-eight patients submitted to microvascular reconstructive procedures. Twelve different kinds of free flaps have been involved as the preferred choice for free flap reconstruction of a specific defect of the head and neck. The latissimus dorsi flap was used for scalp and skull reconstruction, whereas the serratus anterior or rectus abdominis free flaps were used for the reconstruction of complex defects of the middle third of the face. The radial forearm flap and the free jejunal transfer have become the preferred choices for intraoral and pharyngo-esophageal reconstruction, respectively. Good results were obtained with both functional and social rehabilitation. There were three flap losses probably due to thrombosis of the microvascular anastomosis. There was no surgical mortality. The indications for each free flap are discussed.