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van Zoonen EE, van Eck IC, van Baar ME, Meij-de Vries A, van Schie CHM, van der Vlies CH. Aetiology of bioethanol related burn accidents: A qualitative study. Burns 2024; 50:733-741. [PMID: 38242767 DOI: 10.1016/j.burns.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Since insight into the motivation of behaviour in bioethanol related burn accidents is lacking, this study aimed to qualitatively examine influencing factors in bioethanol related burn accidents. In order to identify target points for effective burn prevention. METHODS Patients previously admitted with bioethanol related acute non-intentional burn injury to the three Dutch burn centres were eligible. One interviewer conducted fourteen semi-structured interviews. Interviews were transcribed and coded by two independent researchers. Conclusions were drawn based on generalised statements on the concerned topics. RESULTS Four overall themes in influencing factors were found, namely 1) motivation; including non-designated use and impaired judgement, 2) knowledge and education; including unknown product and properties and information overload, 3) risk perception; including poor recognisability of risks and preferred trial and error and 4) thresholds; including easy availability and unclear liability. CONCLUSION Trust in consumers may be over-estimated, as proper use cannot be expected. To prevent future bioethanol related burn incidents, thresholds for obtaining and using bioethanol should be increased, safe alternatives to ignite open fires and wood stoves should be provided and knowledge and warnings should be improved.
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Affiliation(s)
| | | | - Margriet E van Baar
- Association of Dutch Burn Centres (ADBC), Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Annebeth Meij-de Vries
- Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands; Association of Dutch Burn Centres (ADBC), Beverwijk, the Netherlands; Pediatric Surgical Center, Emma Children's Hospital, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | | | - Cornelis H van der Vlies
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Erasmus MC, Trauma Research Unit, Department of Surgery, University Medical Center Rotterdam, Rotterdam, the Netherlands
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2
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Suijker J, Pijpe A, Hoogerbrug D, Heymans MW, van Zuijlen PPM, Halm JA, Meij-de Vries A. IDENTIFICATION OF POTENTIALLY MODIFIABLE FACTORS TO IMPROVE RECOGNITION AND OUTCOME OF NECROTIZING SOFT-TISSUE INFECTIONS. Shock 2024; 61:585-591. [PMID: 38315508 DOI: 10.1097/shk.0000000000002325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
ABSTRACT Background : Necrotizing soft-tissue infections (NSTIs) present a surgical emergency of increasing incidence, which is often misdiagnosed and associated with substantial mortality and morbidity. A retrospective multicenter (11 hospitals) cohort study was initiated to identify the early predictors of misdiagnosis, mortality, and morbidity (skin defect size and amputation). Methods : Patients of all ages who presented with symptoms and were admitted for acute treatment of NSTIs between January 2013 and December 2017 were included. Generalized estimating equation analysis was used to identify early predictors (available before or during the first debridement surgery), with a significance level of P < 0.05. Results : The median age of the cohort (N = 216) was 59.5 (interquartile range = 23.6) years, of which 138 patients (63.9%) were male. Necrotizing soft-tissue infections most frequently originated in the legs (31.0%) and anogenital area (30.5%). More than half of the patients (n = 114, 54.3%) were initially misdiagnosed. Thirty-day mortality was 22.9%. Amputation of an extremity was performed in 26 patients (12.5%). Misdiagnosis was more likely in patients with a higher Charlson Comorbidity Index (β = 0.20, P = 0.001), and less likely when symptoms started in the anogenital area (β = -1.20, P = 0.003). Besides the established risk factors for mortality (septic shock and age), misdiagnosis was identified as an independent predictor of 30-day mortality (β = 1.03, P = 0.01). The strongest predictors of the final skin defect size were septic shock (β = 2.88, P < 0.001) and a skin-sparing approach to debridement (β = -1.79, P = 0.002). Conclusion : Recognition of the disease is essential for the survival of patients affected by NSTI, as is adequate treatment of septic shock. The application of a skin-sparing approach to surgical debridement may decrease morbidity.
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Affiliation(s)
| | | | | | - Martijn W Heymans
- Amsterdam, Department of Epidemiology and Data Science, Amsterdam, The Netherlands
| | | | - Jens A Halm
- Trauma Unit, Amsterdam UMC location AMC, Amsterdam, The Netherlands
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Salemans RFC, van Uden D, van Baar ME, Haanstra TM, van Schie CHM, van Zuijlen PPM, Lucas Y, Scholten-Jaegers SMHJ, Meij-de Vries A, Wood FM, Edgar DW, Spronk I, van der Vlies CH. Timing of surgery in acute deep partial-thickness burns: A study protocol. PLoS One 2024; 19:e0299809. [PMID: 38466683 PMCID: PMC10927102 DOI: 10.1371/journal.pone.0299809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
For deep partial-thickness burns no consensus on the optimal treatment has been reached due to conflicting study outcomes with low quality evidence. Treatment options in high- and middle-income countries include conservative treatment with delayed excision and grafting if needed; and early excision and grafting. The majority of timing of surgery studies focus on survival rather than on quality of life. This study protocol describes a study that aims to compare long-term scar quality, clinical outcomes, and patient-reported outcomes between the treatment options. A multicentre prospective study will be conducted in the three Dutch burn centres (Rotterdam, Beverwijk, and Groningen). All adult patients with acute deep-partial thickness burns, based on healing potential with Laser Doppler Imaging, are eligible for inclusion. During a nine-month baseline period, standard practice will be monitored. This includes conservative treatment with dressings and topical agents, and excision and grafting of residual defects if needed 14-21 days post-burn. The subsequent nine months, early surgery is advocated, involving excision and grafting in the first week to ten days post-burn. The primary outcome compared between the two groups is long-term scar quality assessed by the Patient and Observer Scar Assessment Scale 3.0 twelve months after discharge. Secondary outcomes include clinical outcomes and patient-reported outcomes like quality of life and return to work. The aim of the study is to assess long-term scar quality in deep partial-thickness burns after conservative treatment with delayed excision and grafting if needed, compared to early excision and grafting. Adding to the ongoing debate on the optimal treatment of these burns. The broad range of studied outcomes will be used for the development of a decision aid for deep partial-thickness burns, to fully inform patients at the point of consent to surgery and support optimal person-centred care.
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Affiliation(s)
- Roos F. C. Salemans
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Margriet E. van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Tjitske M. Haanstra
- Department of Dermal Therapy, Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, The Hague, the Netherlands
- Dutch Burns Foundation, Beverwijk, the Netherlands
- Research Group Relational Care, Centre of Expertise Health Innovation, The Hague University of Applied Sciences, The Hague, the Netherlands
| | | | - Paul P. M. van Zuijlen
- Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands
- Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, the Netherlands
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences Institute, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
- Paediatric Surgical Centre, Emma’s Children’s Hospital, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Ymke Lucas
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Annebeth Meij-de Vries
- Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands
- Paediatric Surgical Centre, Emma’s Children’s Hospital, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
- Department of Surgery, Red Cross Hospital, Beverwijk, the Netherlands
| | - Fiona M. Wood
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- State Adult Burn Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, Western Australia, Australia
| | - Dale W. Edgar
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- State Adult Burn Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, Western Australia, Australia
- Institute for Health Research, Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Burn Injury Research Unit, Faculty of Medicine and Dentistry, University of Western Australia, Crawley, Western Australia, Australia
- Safety and Quality Unit, Armadale Kalamunda Group Health Service, East Metropolitan Health Service, Mt Nasura, Western Australia, Australia
| | - Inge Spronk
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Dermal Therapy, Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, The Hague, the Netherlands
- Research Group Relational Care, Centre of Expertise Health Innovation, The Hague University of Applied Sciences, The Hague, the Netherlands
| | - Cornelis H. van der Vlies
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Trauma and Burn Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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van Balen NIM, Simon MH, Botman M, Bloemers FW, Schoonmade LJ, Meij-de Vries A. Effectiveness of prevention programmes on the rate of burn injuries in children: a systematic review. Inj Prev 2024; 30:68-74. [PMID: 38050048 DOI: 10.1136/ip-2022-044827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION Burns are a frequent injury in children and can cause great physical and psychological impairment. Studies have identified positive effects of prevention measures based on increase in knowledge or reduction in hazards. The main goal of burn prevention campaigns, however, is to prevent burns. Therefore, this review is focused on the effectiveness of prevention programmes on the rates of burns in children. METHODS A literature search was performed on PubMed, Embase, CINAHL, Web of Science, Google Scholar and Scopus, including a reference-check. Included were studies which evaluated burn prevention programmes in terms of burn injury rate in children up to 19 years old. Studies specifically focused on non-accidental burns were excluded as well as studies with only outcomes such as safety knowledge or number of hazards. RESULTS The search led to 1783 articles that were screened on title and abstract. 85 articles were screened in full text, which led to 14 relevant studies. Nine of them reported a significant reduction in burn injury rate. Five others showed no effect on the number of burn injuries. In particular, studies that focused on high-risk populations and combined active with passive preventive strategies were successful. CONCLUSION Some prevention programmes appear to be an effective manner to reduce the number of burn injuries in children. However, it is essential to interpret the results of the included studies cautiously, as several forms of biases may have influenced the observed outcomes. The research and evidence on this subject is still very limited. Therefore, it is of great importance that future studies will be evaluated on a decrease in burns and bias will be prevented. Especially in low-income countries, where most of the burns in children occur and the need for effective prevention campaigns is vital.
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Affiliation(s)
- Nina I M van Balen
- Department of Trauma Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Myrthe H Simon
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Matthijs Botman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Frank W Bloemers
- Department of Trauma Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | - Annebeth Meij-de Vries
- Department of Burns and Surgery, Red Cross Hospital, Beverwijk, The Netherlands
- Department of Pediatric Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
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Suijker J, Wurfbain L, Emmen AMLH, Pijpe A, Kwa KAA, van der Vlies CH, Nieuwenhuis MK, van Zuijlen PPM, Meij-de Vries A. The Role of Burn Centers in the Treatment of Necrotizing Soft-Tissue Infections: A Nationwide Dutch Study. J Burn Care Res 2023; 44:1405-1412. [PMID: 37227902 PMCID: PMC10628513 DOI: 10.1093/jbcr/irad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Indexed: 05/27/2023]
Abstract
Patients with extensive and complex wounds due to Necrotizing Soft-Tissue Infections (NSTI) may be referred to a burn center. This study describes the characteristics, outcomes, as well as diagnostic challenges of these patients. Patients admitted to three hospitals with a burn center for the treatment of NSTI in a 5-year period were included. Eighty patients (median age 54 years, 60% male) were identified, of whom 30 (38%) were referred by other centers, usually after survival of the initial septic phase. Those referred from other centers, compared to those primarily admitted to the study hospitals, were more likely to have group A streptococcal involvement (62% vs 35%, p = .02), larger wounds (median 7% vs 2% total body surface area, p < .001), and a longer length of stay (median 49 vs 22 days, p < .001). Despite a high incidence of septic shock (50%), the mortality rate was low (12%) for those primarily admitted. Approximately half (53%) of the patients were initially misdiagnosed upon presentation, which was associated with delay to first surgery (16 hours vs 4 hours, p < .001). Those initially misdiagnosed had more (severe) comorbidities, and less frequently reported pain or blue livid discoloration of the skin. This study underlines the burn centers' function as referral centers for extensively affected patients with NSTI. Besides the unique wound and reconstructive expertise, the low mortality rate indicates these centers provide adequate acute care as well. A major remaining challenge remains recognition of the disease upon presentation. Future studies in which factors associated with misdiagnosis are explored are needed.
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Affiliation(s)
- Jaco Suijker
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
- Association of Dutch Burn Centres, Beverwijk, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, The Netherlands
| | - Lisca Wurfbain
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
| | - Anouk M L H Emmen
- Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
| | - Anouk Pijpe
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
- Association of Dutch Burn Centres, Beverwijk, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Kelly A A Kwa
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
| | - Cornelis H van der Vlies
- Burn Centre, Maasstad Ziekenhuis, Rotterdam, The Netherlands
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marianne K Nieuwenhuis
- Association of Dutch Burn Centers, Burn Centre, Martini Hospital, Groningen, The Netherlands
- Centre for Human Movement Sciences, University Medical Centre Groningen, Groningen, The Netherlands
- Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, Nederland
| | - Paul P M van Zuijlen
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Pediatric Surgical Centre, Emma Children's Hospital, Meibergdreef 9, Amsterdam, Netherlands
| | - Annebeth Meij-de Vries
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
- Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
- Amsterdam UMC location University of Amsterdam, Pediatric Surgical Centre, Emma Children's Hospital, Meibergdreef 9, Amsterdam, Netherlands
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6
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Rijpma D, Pijpe A, Claes K, Hoeksema H, de Decker I, Verbelen J, van Zuijlen P, Monstrey S, Meij-de Vries A. Outcomes of Meek micrografting versus mesh grafting on deep dermal and full thickness (burn) wounds: Study protocol for an intra-patient randomized controlled trial. PLoS One 2023; 18:e0281347. [PMID: 36787292 PMCID: PMC9928116 DOI: 10.1371/journal.pone.0281347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/16/2022] [Indexed: 02/15/2023] Open
Abstract
INTRODUCTION Autologous split thickness skin grafting is the standard-of-care for most deep dermal and full thickness skin defects. Historically, mesh grafting is used to expand skin grafts for smaller defects and other techniques such as Meek micrografting is used to enable expansion for larger skin defects. Yet, Meek micrografting is increasingly used for smaller skin defects as well. Both techniques are frequently used, especially in burn centers, but evidence on which one is preferable for relative smaller skin defects is lacking. Therefore, an intra-patient randomized controlled trial was designed to adequately compare multiple outcomes of the Meek micrografting and mesh grafting techniques. MATERIALS AND METHODS A multicenter intra-patient controlled randomized trial is being performed in two burn centers (the Netherlands and Belgium) to compare multiple outcomes of Meek micrografting and mesh grafting burns or skin defects. Study registration number (NL74274.029.20). Adult patients with a (burn) wound and an indication for surgical excision and skin grafting were screened for inclusion. In total 70 patients will be included and the primary outcome is scar quality twelve months post-surgery assessed by the Patient and Observer Scar Assessment Scale. Moreover, graft take, re-epithelialization, infection rate, donor site size and patients' preference are also measured within hospital admission, on 3 months and 12 months post-surgery. DISCUSSION This is the first randomized trial that is intra-patient controlled, which enables a proper comparison between both skin expansion techniques. The results of this study will contribute to the clarification of the indications of both techniques and ample attention is paid for the patients' opinion on the surgical treatment options.
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Affiliation(s)
- Danielle Rijpma
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Plastic, Reconstructive and Hand Surgery, Amsterdam, The Netherlands
- Association of Dutch Burn Centers, Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
- * E-mail: (DR); (AMV)
| | - Anouk Pijpe
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Plastic, Reconstructive and Hand Surgery, Amsterdam, The Netherlands
- Association of Dutch Burn Centers, Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
| | - Karel Claes
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
- Ghent Burn Center, Ghent University Hospital, Ghent, Belgium
| | - Henk Hoeksema
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
- Ghent Burn Center, Ghent University Hospital, Ghent, Belgium
| | - Ignace de Decker
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
- Ghent Burn Center, Ghent University Hospital, Ghent, Belgium
| | - Jozef Verbelen
- Ghent Burn Center, Ghent University Hospital, Ghent, Belgium
| | - Paul van Zuijlen
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Plastic, Reconstructive and Hand Surgery, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands
- Department of Pediatric Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Stan Monstrey
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
- Ghent Burn Center, Ghent University Hospital, Ghent, Belgium
| | - Annebeth Meij-de Vries
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
- Department of Pediatric Surgery, Amsterdam UMC, Amsterdam, The Netherlands
- Department Surgery, Red Cross Hospital, Beverwijk, The Netherlands
- * E-mail: (DR); (AMV)
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7
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Rijpma D, Claes KEY, Hoeksema H, de Decker I, Verbelen J, Monstrey S, Pijpe A, van Zuijlen P, Meij-de Vries A. The Meek micrograft technique for burns; review on its outcomes. Searching for the superior skin grafting technique. Burns 2022; 48:1287-1300. [DOI: 10.1016/j.burns.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/21/2022] [Accepted: 05/09/2022] [Indexed: 11/02/2022]
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Loos MLHJ, Meij-de Vries A, Nagtegaal M, Bakx R. Child abuse and neglect in paediatric burns: The majority is caused by neglect and thus preventable. Burns 2022; 48:688-697. [PMID: 34103201 DOI: 10.1016/j.burns.2021.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/05/2021] [Accepted: 05/14/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION It is complex to distinguish negligent burns from inflicted and non-intentional burns, especially since no deliberate action caused the burn. Its recognition is important to create a safe life without (future) burns for our loved-ones who cannot take care of themselves (yet). Our aim was to investigate the incidence and associated characteristics of negligent burns are among children treated at a burn center. METHODS We retrospectively reviewed medical files of all children attending a Dutch burn center with an acute burn between January 2013-December 2015. The conclusion of the Child Abuse and Neglect team (CAN) was used to define inflicted, negligent or non-intentional burns. The remaining cases were reviewed by an expert panel using a standardized protocol. Demographic and social data as well as clinical information about the burn were collected. RESULTS In total 330 children were included. Negligent burns accounted for 56%, non-intentional for 42% and inflicted for 2% of the burns. Negligent burns were associated with: hot beverages (OR 4.40, 95%CI 2.75-7.05), a younger age (p < 0.001), occurrence at home (OR 4.87 95%CI 2.80-8.45) and were located at the anterior trunk (OR 2.75, 95%CI 1.73-4.35) and neck (OR 1.98, 95%CI 1.12-3.50). CONCLUSION This study shows that neglect is a major factor in the occurrence of burns in young children, therefore we conclude that the majority of paediatric burns are preventable. Educational programs creating awareness and focussing on prevention of these burns should be aimed at households, since the majority of negligent as cause of preventable burns occur at home.
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Affiliation(s)
- Marie-Louise H J Loos
- Emma Children's Hospital, Paediatric Surgical Centre Amsterdam, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Paediatric Surgery, Amsterdam, The Netherlands.
| | - Annebeth Meij-de Vries
- Emma Children's Hospital, Paediatric Surgical Centre Amsterdam, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Paediatric Surgery, Amsterdam, The Netherlands; Red Cross Hospital, Burn Center Beverwijk, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - Michelle Nagtegaal
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Social Paediatrics, Amsterdam, The Netherlands; Department of Forensic Medicine, Section on Forensic Paediatrics, Netherlands Forensic Institute, The Hague, The Netherlands.
| | - Roel Bakx
- Emma Children's Hospital, Paediatric Surgical Centre Amsterdam, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Paediatric Surgery, Amsterdam, The Netherlands.
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Suijker J, Hofmans FAC, van Zuijlen PPM, Cense HA, Bonjer HJ, Vries AMD. Approaches to Surgical Debridement in Necrotizing Soft Tissue Infections: Outcomes of an Animated, Interactive Survey. World J Surg 2022; 46:1051-1058. [PMID: 35187588 PMCID: PMC8971155 DOI: 10.1007/s00268-022-06470-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 10/25/2022]
Abstract
Abstract
Background
Necrotizing soft tissue infections (NSTI) affect long-term quality of life in survivors. Different approaches to debridement may influence quality of life. The aim of this study was to assess the current practice of the debridement of NSTI in the Netherlands.
Methods
An animated, interactive online survey was distributed among general surgeons and plastic surgeons in the Netherlands. Two NSTI-cases were presented, followed by questions regarding the preferred surgical approach. Case one described a woman with a swollen, red leg, with signs of sepsis and without visible necrosis. Case two described an immunocompromised man with septic shock syndrome and extensive necrosis.
Results
In total 232 responses were included (143 general surgeons, 89 plastic surgeons). In case one, 32% chose to preserve all skin, while 17% chose to resect all skin above the affected fascia, including normal-looking skin. In case two, all participants resected necrotic skin, and most (88%) also blue discolored skin. While 32% did not resect more than blue discolored and necrotic skin, 35% also resected red-colored skin, and 21% all skin overlying the affected fascia, including normal colored skin. Respondents working in a hospital with a burn center tended to preserve more skin, whereas plastic surgeons chose more often for skin resection compared to general surgeons.
Conclusions
By using a novel approach to a survey, the authors demonstrate the existence of extensive practice variety regarding the approach to debridement of NSTI among Dutch general and plastic surgeons. Consensus is needed, followed by targeted education of surgeons.
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10
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Baran KC, Gardien KLM, Roodbergen DT, Kewalapat V, van Zuidam DJ, Meij-de Vries A. [Iatrogenic burns in neonates]. Ned Tijdschr Geneeskd 2021; 165:D5670. [PMID: 34346602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Despite the availability of different medical tools to simplify blood withdrawal, an old-fashioned method is still frequently being used in neonatal infants: the use of warm elements such as a warm washcloth or a glove filled with warm water, wrapped around an extremity. Use of these warm elements may easily cause contact burns in neonates. Unfortunately, not seldom we see and treat neonates with these burn injuries. CASE DESCRIPTION We present the case of a neonate, who was referred to our outpatient clinic with an iatrogenic contact burn. The patient received topical treatment and wound dressings for over a month time. Scars remained. CONCLUSION We would like to raise awareness among care givers on this type of injuries. To prevent these iatrogenic burns injuries, we advise to use alternative methods to simplify blood withdrawal.
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Affiliation(s)
- Kiran C Baran
- Rode Kruis ziekenhuis, Beverwijk: Afd. Brandwondencentrum
- Contact: Kiran C. Baran
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11
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Kwa KA, Pijpe A, Korte DD, Snoeks A, Breederveld RS, Meij-de Vries A. Using fibrin sealant for skin graft fixation to avoid sedation in children with burns: a prospective study. J Wound Care 2020; 29:642-648. [PMID: 33175622 DOI: 10.12968/jowc.2020.29.11.642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate whether a fibrin sealant, Fitrix (Sanquin Blood Supply Foundation, The Netherlands), for fixation of skin grafts in children with burn wounds is less invasive and equally effective in comparison with skin staples. METHOD A single-centre prospective observational cohort study was conducted. Children requiring skin grafting after burns were included and received the fibrin sealant. This group was compared with a retrospective control group of children whose skin grafts were fixed with skin staples. Study outcomes were graft take, graft dislocation, other wound complications, healing and need for sedation. RESULTS In the fibrin sealant and the control groups, 17 and 27 patients were included, respectively. The percentage of total body surface area (%TBSA) grafted was smaller (p=0.028) in the fibrin sealant group (median 1.0, interquartile range (IQR) 1.5 versus 2.0, IQR 2.5). There was no significant difference in graft take or wound healing. There were two graft dislocations in the fibrin sealant group and none in the control group. Other complications included a patient with graft failure in the fibrin sealant group, and another patient with a vanishing graft and wound infection in the control group. There were fewer sedations in the fibrin sealant group compared with the control group (one versus 20, p<0.0001). CONCLUSION The fibrin sealant used in this study was non-inferior for the fixation of skin grafts in comparison with skin staples, and avoided sedation procedures.
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Affiliation(s)
- Kelly Aa Kwa
- Burn Centre, Red Cross Hospital, PO Box 1074, 1940 EB Beverwijk, the Netherlands.,Department of Traumasurgery, Leiden University Medical Centre, K6-R, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Anouk Pijpe
- Burn Centre, Red Cross Hospital, PO Box 1074, 1940 EB Beverwijk, the Netherlands
| | - Dirk de Korte
- Department Product and Process Development, Sanquin Blood Bank, Postbus 9892, 1006 AN Amsterdam, The Netherlands.,Department of Blood Cell Research, Sanquin Research, Postbus 9892, 1006 AN Amsterdam, The Netherlands
| | - Annabel Snoeks
- Burn Centre, Red Cross Hospital, PO Box 1074, 1940 EB Beverwijk, the Netherlands
| | - Roelf S Breederveld
- Burn Centre, Red Cross Hospital, PO Box 1074, 1940 EB Beverwijk, the Netherlands.,Department of Traumasurgery, Leiden University Medical Centre, K6-R, PO Box 9600, 2300 RC Leiden, the Netherlands
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van Munster IG, Baran KC, Gardien KLM, van Trier T, Meij-de Vries A. [Frostbite due to recreational nitrous oxide use]. Ned Tijdschr Geneeskd 2020; 164:D4794. [PMID: 32395947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND There is a new type of injury that is observed increasingly often: frostbite of the thighs that has occurred as result of holding a cylinder containing nitrous oxide in position between the legs during recreational use of said substance. Because skin symptoms are often mild in the first few days after the event, the severity of the injury is often not recognized. However, patients can suffer serious scarring from this type of injury. CASE DESCRIPTION We present two cases involving young patients who were referred to the burns unit with lesions sustained through nitrous oxide use. Upon inspection we observed deep frostbite wounds, which necessitated operative treatment. The patients had to undergo multiple operations and remained under our care for management of their scars. CONCLUSION It is important to recognize this injury and to consult one of the burns units to treat these patients in a timeline and appropriate manner.
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Affiliation(s)
| | - Kiran C Baran
- Rode Kruis Ziekenhuis, afd. Brandwondencentrum, Beverwijk
- Contact: Kiran C. Baran
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13
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Pijpe A, Ozdemir Y, Sinnige JC, Kwa KAA, Middelkoop E, Meij-de Vries A. Detection of bacteria in burn wounds with a novel handheld autofluorescence wound imaging device: a pilot study. J Wound Care 2020; 28:548-554. [PMID: 31393796 DOI: 10.12968/jowc.2019.28.8.548] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the detection of bacteria in burn wounds between an bacterial fluorescence imaging device MolecuLight i:X, (Canada), and standard microbiological swabs. METHODS Wounds were swabbed three times on one occasion; once with a standard swab, once with a high-fluorescent area swab, indicating a bacterial load >104 colony-forming units (CFU)/gram and a finally with a non-fluorescent (nF) area swab. Proportion agreement of the microbiological results was calculated and the accuracy of the device to detect relevant bacteria was assessed. RESULTS A total of 14 patients with 20 wounds participated in the study. Median post-burn day at sampling time was 21 days. Of the 20 wounds, nine had a positive swab result in either of the three swabs, and 11 showed a highfluorescent area. Overall, positive and negative proportion agreement between standard swab and high-fluorescent swab sample results were 100%. Sensitivity, specificity, positive and negative predictive values of presence of high-fluorescence were 78%, 64%, 64%, and 78%, respectively. For Pseudomonas aeruginosa detection, these results were 100%, 70%, 44% and 100%, respectively. CONCLUSION The diagnostic accuracy of the bacterial fluorescence imaging device to detect relevant bacteria in burn wounds was moderate and the reliability was equal to standard swabbing. Further research in larger sample sizes and on the relevance of minimal bacterial load and its potential to help with Pseudomonas aeruginosa management is needed.
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Affiliation(s)
- Anouk Pijpe
- Burn Center, Red Cross Hospital, PO Box 1074, 1940 EB, Beverwijk, the Netherlands
| | - Yildiz Ozdemir
- Burn Center, Red Cross Hospital, PO Box 1074, 1940 EB, Beverwijk, the Netherlands
| | - Jan C Sinnige
- Burn Center, Red Cross Hospital, PO Box 1074, 1940 EB, Beverwijk, the Netherlands.,Public Health Laboratory Kennemerland, Haarlem, the Netherlands
| | - Kelly A A Kwa
- Burn Center, Red Cross Hospital, PO Box 1074, 1940 EB, Beverwijk, the Netherlands.,Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Esther Middelkoop
- Burn Center, Red Cross Hospital, PO Box 1074, 1940 EB, Beverwijk, the Netherlands.,Association of Dutch Burn Centers, Beverwijk, the Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Annebeth Meij-de Vries
- Burn Center, Red Cross Hospital, PO Box 1074, 1940 EB, Beverwijk, the Netherlands.,Department of Surgery, Red Cross Hospital, Beverwijk, the Netherlands
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14
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Kwa KAA, Krijnen P, Bernards AT, Schipper IB, Meij-de Vries A, Breederveld RS. Bacterial Species and Load Increase During Negative Pressure Wound Therapy: A Prospective Cohort Study. Wounds 2020; 32:74-80. [PMID: 32163041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The course of both the bacterial species and load and the incidence of infection during negative pressure wound therapy (NPWT) are unclear, with published studies presenting contradicting results. OBJECTIVE The aim of the study is to assess the changes in both bacterial species and load, as well as the incidence of infection, before and after NPWT in a patient population with a variety of wounds. METHODS Surgical patients 18 years of age or older who needed NPWT were included in this multicenter, prospective cohort study. A wound swab culture was taken before NPWT and either immediately following NPWT or 6 weeks of follow-up. The change of bacterial species, bacterial load, and rate of infection were determined before and after the start of NPWT. RESULTS In total, 104 patients were analyzed. The number of positive cultures increased from pre- to post-NPWT. The most cultured pathogenic bacterium was Staphylococcus aureus. The bacterial load was moderately higher at the end of NPWT than at the start (P ⟨ .0001). It was noted that 2 swabs contained multidrug-resistant bacteria, 1 pre-NPWT and 1 post-NPWT. Prior to NPWT, 26 patients had a wound infection, 5 of which had a persisting infection at the end of the study. Post-NPWT, 14 patients developed a wound infection. CONCLUSIONS The number of S aureus strains and overall bacterial load increased during NPWT, and the incidence of infection remained the same. Further studies should be conducted to determine whether the increase in bacterial load influences other wound outcome parameters.
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Affiliation(s)
- Kelly Aranka Ayli Kwa
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands; Burn Center Beverwijk, Red Cross Hospital, Beverwijk, The Netherlands
| | - Pieta Krijnen
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexandra T Bernards
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Inger B Schipper
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Roelf S Breederveld
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands; Burn Center Beverwijk, Red Cross Hospital, Beverwijk, The Netherlands
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15
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Carrière ME, de Haas LEM, Pijpe A, Meij-de Vries A, Gardien KLM, van Zuijlen PPM, Jaspers MEH. Validity of thermography for measuring burn wound healing potential. Wound Repair Regen 2019; 28:347-354. [PMID: 31777128 PMCID: PMC7217024 DOI: 10.1111/wrr.12786] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/13/2019] [Accepted: 11/22/2019] [Indexed: 12/16/2022]
Abstract
Accurate assessment of burn wound depth and the associated healing potential is vital in determining the need for surgical treatment in burns. Infrared thermography measures the temperature of the burn wound noninvasively, thereby providing indirect information on its blood flow. Previous research demonstrated that a small, low‐priced, handheld thermal imager has an excellent reliability, but a moderate validity for measuring burn wound healing potential. A new and more sensitive version of this convenient device has become available. The aim of this study was to evaluate the validity of thermography for measuring burn wound healing potential, compared to Laser Doppler Imaging (LDI) as a reference standard. Thermal images and LDI scans were obtained from burn wounds between 2 and 5 days postburn. Temperature differences between burned and nonburned skin (ΔT) were calculated. To evaluate validity, ΔT values were compared to the healing potential categories assessed by LDI. Two receiver operating characteristic curves were created and two ΔT cutoff values were calculated to illustrate the ability to discriminate between burn wounds that heal in a time period of less than 14 days, between 14 and 21 days, and more than 21 days. Between June and October 2018, 43 burn wounds in 32 patients were measured. ΔT cutoff values of 0.6°C (sensitivity 68%, specificity 95%) and −2.3°C (sensitivity 30%, specificity 95%) were calculated to discriminate between burn wounds that heal in <14 and ≥14 days, and burn wound that heal in ≤21 and >21 days, respectively. This study shows a good validity of the feasible thermal imager for the assessment of burn wound healing potential. Therefore, we consider it a promising technique to be used for triage in local hospitals and general practices, and as a valuable addition to clinical evaluation in burn centers.
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Affiliation(s)
- Michelle E Carrière
- Burn Center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Association of Dutch Burn Centers, Beverwijk, The Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Louise E M de Haas
- Burn Center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Anouk Pijpe
- Burn Center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Annebeth Meij-de Vries
- Burn Center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Kim L M Gardien
- Burn Center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Paul P M van Zuijlen
- Burn Center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Mariëlle E H Jaspers
- Burn Center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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16
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Hardon SF, Haasnoot PJ, Meij-de Vries A. Burn wounds after electrical injury in a bathtub: a case report. J Med Case Rep 2019; 13:304. [PMID: 31554506 PMCID: PMC6761724 DOI: 10.1186/s13256-019-2231-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/13/2019] [Indexed: 11/27/2022] Open
Abstract
Background Increased smartphone use among minors makes our population more prone to electrical injury. Despite regulations on electrical home safety standards, smartphones and chargers still pose a risk for severe injury among users. Case presentation We present a case of a patient with low-voltage electrical burns due to smartphone use in a bathtub. The 13-year-old Caucasian patient was using a smartphone plugged into the electrical grid while taking a bath. We report the burns and their treatment. We discuss the likely burn mechanism. Conclusions Burn wounds after electrical injury due to smartphone use are rare. The presented case shows the danger of smartphone use in bathtubs.
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Affiliation(s)
- Sem F Hardon
- Department of Surgery, Amsterdam UMC - VU University Medical Center, Room ZH 7F 020, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Pieter J Haasnoot
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Annebeth Meij-de Vries
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands.,Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
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17
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Meij-de Vries A, Lazarenko SV, Knol RJJ, Meijer RW, van der Plas EM, Heij HA. The independent functioning of the orchidopexied congenital undescended testis as assessed by positron emission tomography/computed tomography. World J Nucl Med 2015; 14:31-5. [PMID: 25709542 PMCID: PMC4337005 DOI: 10.4103/1450-1147.150531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Fertility after orchidopexied undescended testes (UDT) is impaired. Although fertility parameters are known to be more favorable in unilateral cases than in bilateral cases, the exact contribution of the unilateral orchidopexied UDT to fertility is unknown. We used testicular 18F-fluoro-2-deoxyglucose (18F-FDG)-uptake assessed by positron emission tomography/computed tomography (PET/CT) to investigate the function of the orchidopexied unilateral congenital UDT, compared to its normally descended counterpart. We hypothesize that the contribution of the orchidopexied unilateral congenital UDT to fertility in adulthood is low. Eleven men who underwent orchidopexy for congenital UDT at the age of 1.9 ± 1.4 (range, 4.5 months -4.0) years were seen in follow-up at the age of 24.1 ± 2.3 (20.6-28.0) years. All underwent physical examination, testicular ultrasonography and PET/CT. Testicular 18F-FDG-uptake was expressed as the peak Standardized Uptake Value (SUVpeak). The mean SUVpeak of the orchidopexied UDT was 2.74 ± 0.48 (2.13-3.47), which was significantly lower than its counterpart (P = 0.021). Besides, there was no correlation between the testicular volume and the SUVpeak. The orchidopexied congenital UDT has been shown to be less metabolically active than its contralateral counterpart. Nevertheless, we suggest that the operated testes function to some degree.
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Affiliation(s)
- Annebeth Meij-de Vries
- Department of Surgery, Chirurgen Noordwest, Medical Center Alkmaar, Amsterdam, The Netherlands
| | - Sergiy V Lazarenko
- Department of Nuclear Medicine, Medical Center Alkmaar, Amsterdam, The Netherlands
| | - Remco J J Knol
- Department of Nuclear Medicine, Medical Center Alkmaar, Amsterdam, The Netherlands
| | - Robert W Meijer
- Department of Surgery, Medical Center Alkmaar, Amsterdam, The Netherlands
| | | | - Hugo A Heij
- Pediatric Surgical Center of Amsterdam, Amsterdam, The Netherlands
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18
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Vos A, Vries AMD, Smets A, Verbeke J, Heij H, van der Steeg A. The value of ultrasonography in boys with a non-palpable testis. J Pediatr Surg 2014; 49:1153-5. [PMID: 24952806 DOI: 10.1016/j.jpedsurg.2013.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/09/2013] [Accepted: 09/11/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND In patients with a non-palpable testis (NPT) on physical examination, the testis is assumed either to be situated intra-abdominally or to be hypoplastic or absent. Diagnostic laparoscopy in these boys is considered the preferable first step. In this study the diagnostic value of pre-operative ultrasound for NPT is assessed in comparison with laparoscopy. METHODS All boys aged under the age of 17 years who were diagnosed with an NPT by a pediatric surgeon from 2000 till 2012 were evaluated. All patients of whom clinical, ultrasonographic, and operative findings were available were included. RESULTS Ninety-six boys with 117 NPTs were included. With ultrasound 67 testes were detected in the inguinal canal, which was confirmed peroperatively for 61 testes. Of the 15 testes with an intra-abdominal position on ultrasound, 10 were found intra-abdominally during surgery. The positive predictive value of the ultrasonography is 91% for inguinally located testes and 67% for intra-abdominally located testes. CONCLUSION Ultrasonography has a high positive predictive value for inguinally located testes. When ultrasound locates a testis in an inguinal location, a primary inguinal exploration can be considered, preventing an unnecessary diagnostic laparoscopy.
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Affiliation(s)
- Alexander Vos
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Annebeth Meij-de Vries
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Anne Smets
- Academic Medical Center, Radiology department, Amsterdam, The Netherlands
| | - Jonathan Verbeke
- VU University Medical Center, Radiology Department, Amsterdam, The Netherlands
| | - Hugo Heij
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Alida van der Steeg
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Box 22660, 1100 DD, Amsterdam, The Netherlands.
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van der Plas EM, Zijp GW, Froeling FM, van der Voort-Doedens LM, Meij-de Vries A, Goede J, Hack WW. Long-Term Testicular Volume After Orchiopexy at Diagnosis of Acquired Undescended Testis. J Urol 2013; 190:257-62. [DOI: 10.1016/j.juro.2013.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
Affiliation(s)
| | - Gerda W. Zijp
- Department of Pediatric Surgery, Juliana Children's Hospital/Hagaziekenhuis, The Hague, the Netherlands
| | - Frank M.J.A. Froeling
- Department of Pediatric Urology, Juliana Children's Hospital/Hagaziekenhuis, The Hague, the Netherlands
| | | | | | - Joery Goede
- Department of Pediatrics, Medical Center Alkmaar, Alkmaar, the Netherlands
| | - Wilfried W.M. Hack
- Department of Pediatrics, Medical Center Alkmaar, Alkmaar, the Netherlands
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20
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Zwaan E, Meij-de Vries A, van Deutekom AW, van der Steeg AFW, Sleeboom C, Heij HA. [The bubble-blowing neonate: a red flag for oesophageal atresia]. Ned Tijdschr Geneeskd 2013; 157:A5633. [PMID: 23328027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
When a newborn develops feeding difficulties, is blowing bubbles or has excessive saliva, it is important to consider the diagnosis of oesophageal atresia. Prenatal detection of oesophageal atresia is difficult. Postnatal bubble blowing, resulting from the inability to swallow excessive oropharyngeal secretions, is pathognomonic. These symptoms should trigger the midwife or physician to consider this diagnosis. We present three cases to illustrate the difficulties of early recognition and the consequences of a late detection of this condition. The first and third cases show that a delayed diagnosis of oesophageal atresia can lead to dangerous situations. Our second case illustrates that not every poorly drinking neonate has oesophageal atresia, and that this diagnosis may be rejected if the physician is able to pass a nasogastric tube. In every neonate who is unable to drink, we advise attempting to pass a nasogastric tube and taking a chest x-ray to distinguish between oesophageal atresia and other causes of feeding problems.
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Affiliation(s)
- Esther Zwaan
- Kinderchirurgisch Centrum Amsterdam (Emma Kinderziekenhuis AMC & VUmc), Amsterdam, the Netherlands
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21
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Meij-de Vries A, Goede J, van der Voort L, Heij HA, Meijer RW, Hack WWM. Long-term testicular position and growth of acquired undescended testis after prepubertal orchidopexy. J Pediatr Surg 2012; 47:727-35. [PMID: 22498388 DOI: 10.1016/j.jpedsurg.2011.10.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 09/29/2011] [Accepted: 10/23/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of the study was to determine long-term testicular position and growth of acquired undescended testis (UDT) after prepubertal orchidopexy. METHODS Patients who had undergone prepubertal orchidopexy for acquired UDT at our hospital between 1986 and 1999 were recruited to assess long-term testicular position and volume. Testis position was assessed by physical examination. Testis volume was measured with Prader orchidometry and ultrasound and was compared with normative values reported in the literature. RESULTS A total of 105 patients (aged 14.0-31.6 years) were included with 137 acquired UDT (32 bilateral, 33 left sided, and 40 right sided). All but 1 of the orchidopexied testes (99.3%) were in low scrotal position. The mean volume of the orchidopexied testes in unilateral UDT (n = 73, 10.57 ± 3.74 mL) differed significantly from the size of the testes at the contralateral side (14.11 ± 4.23 mL) (P = .000). The operated testes (10.28 ± 3.45 mL) were smaller than the mean adult testis volume reported in the literature (13.4-13.6 mL; cutoff, 13.2 mL). CONCLUSION Testis position after prepubertal orchidopexy for acquired UDT was nearly always low scrotal. The volume of the orchidopexied testes was smaller than both the volume of the contralateral testes and the normative values reported in the literature.
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Affiliation(s)
- Annebeth Meij-de Vries
- Department of Surgery Wilhelminalaan, Medical Centre Alkmaar, 12 1815 JD Alkmaar, The Netherlands.
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Meij-de Vries A. Reply to Letter to the Editor. J Pediatr Surg 2011; 46:787. [PMID: 30021264 DOI: 10.1016/j.jpedsurg.2010.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 12/13/2010] [Indexed: 11/16/2022]
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Meij-de Vries A, Hack WWM, Heij HA, Meijer RW. Perioperative surgical findings in congenital and acquired undescended testis. J Pediatr Surg 2010; 45:1874-81. [PMID: 20850635 DOI: 10.1016/j.jpedsurg.2010.02.121] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 02/02/2010] [Accepted: 02/26/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Perioperative surgical findings in congenital and acquired undescended testis (UDT) were prospectively assessed. METHODS We included all boys with congenital or acquired UDT who underwent orchidopexy at our hospital between January 2006 and August 2009. Perioperatively, we scored the position and volume of the testis, the insertion of the gubernaculum, the patency of the processus vaginalis, and the obtained position. RESULTS We included 69 boys (aged 0.9-14.6 years) with 76 congenital UDT and 28 boys (aged 2.2-18.5 years) with 30 acquired UDT. In the congenital group, the testis was in intracanalicular position in 55 cases (72%), whereas in the acquired UDT group, this was in 11 cases (37%; P < .001). The insertion of the gubernaculum was at the bottom of the scrotum in 13 cases (17%) of the congenital UDT group and in 12 cases (40%) of the acquired UDT group (P < .05). The processus vaginalis was open in 63 cases (83%) of the congenital and in 9 cases (30%) of the acquired UDT group (P < .001). CONCLUSION Compared to congenital UDT, acquired UDT are more likely to be situated in the superficial inguinal pouch, to have a normal insertion of the gubernaculums, and to have a closed processus vaginalis.
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