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Abstract
Acute acalculous cholecystitis (AAC) is an acute inflammatory disorder of the gallbladder, which can complicate the recovery of burn patients. No formal literature review has been performed about this uncommon but potentially fatal complication in burn care. A Pubmed search from 1950 to 2015 was performed using MESH terms: "acalculous cholecystitis," "burns or thermal injuries or thermal damage," and "cholecystitis or gallbladder inflammation." The articles were analyzed and data collected individually on the incidence, presenting symptoms or signs, risk factors, investigations, and treatment modalities used. An International Burns Injury Database (IBID) search was additionally performed to identify the incidence of AAC in burn patients between 2005 and 2015 in the United Kingdom. Nineteen articles were identified which described 90 cases of AAC and thermal injuries. The incidence of AAC in burns ranges between 0.4 and 3.5%, typically affecting males (82.4%) with a mean age of 35 (range 13-89), and 97.8% of burns were >30% total body surface area (range: 22-80%). The majority of patients had established known risk factors for acquiring AAC, including blood transfusion (56.6% of patients), sepsis (52.2%), mechanical ventilation (45.5%), prolonged fasting or total parenteral nutrition administration (44.4%), and use of narcotic medication (10%). The IBID search identified one case of AAC among 145,227 burn injuries during 2005 to 2015 in the United Kingdom. AAC is a rare life-threatening condition that is associated with large thermal burns. Improvements in burns critical care have probably improved the management of known risk factors and reduced the incidence of this condition over recent decades.
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Affiliation(s)
- Karl Walsh
- Plastic Surgery Registrar, Royal Preston Hospital, Preston, Lancashire, UK
| | - Ioannis Goutos
- Consultant Burns and Plastic Surgeon, Blizard Institue, Queen Mary University, Whitechapel, London
| | - Baljit Dheansa
- Consultant Burns and Plastic Surgeon, East Grinstead, UK
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2
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Abstract
INTRODUCTION Administration of botulinum toxin is an increasingly popular procedure in the medical and aesthetic field. There is emerging evidence that it can influence fibroblast activity and minimise tension around the scar by virtue of muscular chemoimmobilisation. This review aims to explore the current evidence base behind the treatment of keloid scars with botulinum toxin. METHODS A detailed literature review was conducted using PubMed Medline, Embase and Web of Science databases. Manuscripts were appraised and classified in accordance with the Joanna Briggs Institute Levels of Evidence by an independent consultant in evidence synthesis. The results of this search are presented in descending order of evidence for botulinum toxin as a primary management agent as well as a secondary adjunct following extralesional keloid excision. DISCUSSION On the basis of level 1 evidence, botulinum toxin appears to be equivalent to triamcinolone in producing a short-term reduction in keloidal volume, height and vascularity. A number of level 1 and 2 studies also suggest that botulinum toxin may be particularly helpful in alleviating symptoms of keloid associated pain and itch. There are currently limited studies appraising the value of botulinum toxin in the postoperative management of keloid scars. CONCLUSION Botulinum toxin may represent a promising agent in the management of keloid scars. However, further research involving large-scale studies with comparative designs and long-term follow-up is warranted to delineate the value of this therapeutic modality in scar management protocols.
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Affiliation(s)
- Catrin Sohrabi
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ioannis Goutos
- Centre for Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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3
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Abstract
INTRODUCTION Keloid scars are a particularly challenging clinical entity and a variety of management approaches have been described in the literature including intralesional surgery. The current literature lacks a summative review to ascertain the evidence base behind this surgical approach. METHODS A comprehensive English literature database search was performed using PubMed Medline, EMBASE and Web of Science from their individual dates of inception to March 2018. We present the different rationales proposed for the use of this technique, the clinical outcomes reported in the literature as well as the scientific basis for intralesional excision of keloid scars. DISCUSSION A number of arguments have been proposed to support intralesional excision including avoiding injury to neighbouring non-keloidal skin and the deep layer of the dermis, removal of the most proliferative fibroblastic group as well as debulking to facilitate the administration of injectable steroid. The most current literature does not provide sufficient support for the adoption of intralesional excisions based on data emerging from basic science as well as clinical outcome studies. CONCLUSION Emerging evidence supports the extralesional excision of keloid scars based on current mechanobiological, histological as well as clinical outcome data. Further trials comparing extralesional and intralesional surgical practices are eagerly awaited to ascertain the role of intralesional excisions in the keloid management arena.
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Affiliation(s)
- Ioannis Goutos
- Centre for Cutaneous Research, Blizard Institute,
London, UK
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4
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Theodorakopoulou E, Goutos I, Mason K, Ghanem AM, Myers S. London calling Gaza: The role of international collaborations in the globalisation of postgraduate burn care education. Scars Burn Heal 2019; 5:2059513119830519. [PMID: 30815281 PMCID: PMC6381431 DOI: 10.1177/2059513119830519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/15/2022] Open
Abstract
Burn injuries represent a significant epidemiological problem, with the vast majority occurring in low- to middle-income countries. These regions also represent areas where lack of socioeconomic growth and geopolitical instability pose additional barriers not only to healthcare provision but also to the acquisition of continuing professional development. Long-distance, web-based learning programmes ('tele-education') have been identified as a successful and powerful means of propagating up-to-date medical education and training in poor-resource, isolated or conflict-ridden regions. This report evaluates the role of tele-education in delivering a distance-learning Master's degree in Burn Care to a group of 11 healthcare professionals working in the occupied Palestinian territories (OPT), which was funded as part of a collaboration between Queen Mary University of London and IMET-Pal (International Medical Education Trust - Palestine). We present our experience in delivering the programme in a conflict-ridden part of the world, which includes the specific adaptations to tailor the programme to regional needs as well the unique challenges faced by students and faculty in enhancing the educational value of this unique initiative. The academic achievements of this group of healthcare professionals were found to be comparable to historical student cohorts from privileged socioeconomic backgrounds and the majority of students felt that participation in the programme contributed to a direct improvement to their daily burn care practices. The successful outcomes achieved by our students support the constantly emerging evidence that targeted, well-delivered, long-distance learning programmes can become powerful tools in combating inequalities in global healthcare and health education.
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Affiliation(s)
- Evgenia Theodorakopoulou
- Health Education East of England, Colchester, UK
- The Blizard Institute, Centre for Cutaneous Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ioannis Goutos
- The Blizard Institute, Centre for Cutaneous Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Katrina Mason
- The Blizard Institute, Centre for Cutaneous Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ali M Ghanem
- The Blizard Institute, Centre for Cutaneous Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Simon Myers
- The Blizard Institute, Centre for Cutaneous Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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5
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Abstract
INTRODUCTION Percutaneous collagen induction (PCI) or needling techniques are increasingly popular in the reconstructive and aesthetic arena. The underlying mechanisms of action rest on producing a pattern of non-ablative and non-confluent puncture wound pattern to the dermis with a resulting regenerative effect to the skin. METHODS A detailed English literature review was conducted using PubMed Medline, Embase and Web of Science; the manuscripts were appraised and classified according to level of evidence as well risk of bias. Results are presented in descending order of evidence for non-atrophic scars. DISCUSSION On the basis of level 1 evidence currently available, the combination of needling and silicone gel can improve the short-term pliability, height and vascularity of hypertrophic and keloid scars. According to level 2 evidence, needling alongside spray keratinocytes can produce a statistically significant improvement to patient/observer scar ratings and improve pigmentation in hypopigmented burn scars at 12-month follow-up. Results from mixed cohort studies also point towards needling having a beneficial effect on fat graft retention. Level 3 data suggest that needling can render significant resurfacing effects to both mature and actively hypertrophic burn scars at 12-month follow-up based on objective scar scales; furthermore, favourable histological changes are seen, including better collagen alignment in the dermis and increased epidermal thickness. CONCLUSION Needling techniques are promising adjuncts to non-atrophic scar management. Further research with long-term follow-up and comparative design protocols incorporating other resurfacing modalities is warranted before the exact value of needling is delineated in scar management protocols.
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Affiliation(s)
| | - Ioannis Goutos
- Ioannis Goutos, Queen Mary University of
London, 4 Newark St, Whitechapel, London E1 2AT, UK.
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6
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Abstract
Introduction Autologous platelet-based concentrates represent increasingly popular adjuncts to a variety of medical, surgical and aesthetic interventions. Their beneficial potential rests on the ability to deliver a high concentration of growth factors to the target tissues. There are currently no reports in the literature appraising the evidence behind the use of platelet-rich plasma (PRP) in scar management. Methods A detailed English literature review was conducted using PubMed Medline, Embase and Web of Science; the manuscripts were appraised and classified according to the Joanna Briggs Institute Levels of evidence. The results are presented in descending order of evidence separately for atrophic, keloid, surgical and traumatic scars. Discussion On the basis of level 1 evidence currently available, it appears that PRP can improve the quality of atrophic acne scars treated with ablative fractional CO2 laser and decrease the duration of laser-related side effects including oedema and erythema. Regarding surgical scars, the current data suggest that PRP may improve wound healing and early scar quality; furthermore, incorporation of PRP in fat-grafting procedures undertaken in conjunction with non-ablative, fractional laser can contribute to better wound healing as well as a significant improvement in texture, colour and contour in traumatic scar resurfacing. There are no high level studies at present to support the incorporation of autologous platelet-based concentrates in the management of keloid scars. Conclusion PRP is a promising adjunct in scar management practice. Further research with long-term follow-up is warranted to delineate the value of this modality in different subtypes of scars.
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Affiliation(s)
- Osaid H Alser
- Centre for Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, UK
| | - Ioannis Goutos
- Centre for Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, UK
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7
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Abstract
INTRODUCTION Autologous platelet-based concentrates represent increasingly popular adjuncts to a variety of medical, surgical and aesthetic interventions. Their beneficial potential rests on the ability to deliver a high concentration of growth factors to the target tissues. There are currently no reports in the literature appraising the evidence behind the use of platelet-rich plasma (PRP) in scar management. METHODS A detailed English literature review was conducted using PubMed Medline, Embase and Web of Science; the manuscripts were appraised and classified according to the Joanna Briggs Institute Levels of evidence. The results are presented in descending order of evidence separately for atrophic, keloid, surgical and traumatic scars. DISCUSSION On the basis of level 1 evidence currently available, it appears that PRP can improve the quality of atrophic acne scars treated with ablative fractional CO2 laser and decrease the duration of laser-related side effects including oedema and erythema. Regarding surgical scars, the current data suggest that PRP may improve wound healing and early scar quality; furthermore, incorporation of PRP in fat-grafting procedures undertaken in conjunction with non-ablative, fractional laser can contribute to better wound healing as well as a significant improvement in texture, colour and contour in traumatic scar resurfacing. There are no high level studies at present to support the incorporation of autologous platelet-based concentrates in the management of keloid scars. CONCLUSION PRP is a promising adjunct in scar management practice. Further research with long-term follow-up is warranted to delineate the value of this modality in different subtypes of scars.
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Affiliation(s)
- Osaid H Alser
- Centre for Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, UK
| | - Ioannis Goutos
- Centre for Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, UK
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8
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Abstract
Introduction: Intralesional steroid administration is a popular adjunct to scar management
with numerous reports in the literature appraising this modality in
hypertrophic and keloid scars. The percutaneous delivery of steroids using
adhesive tape is an alternative modality, which was first described in the
dermatological literature in the 1960s. It is infrequently used in most
countries apart from the Orient, where it represents one of the mainstays of
specialist scar management protocols. Methods: An English and Japanese literature review was performed and reports were
stratified using the Joanna Briggs Institute Levels of Evidence. Data were
extracted relating to the maximum dose of steroid that can be delivered
safely, the reported therapeutic efficacy, as well as the side effects
associated with the percutaneous delivery of steroids. Discussion: Steroid tape has the potential to be a safe and patient-friendly adjunct to
scar management for carefully selected cases of keloid and hypertrophic
scars. The main limitation for its widespread adoption is the lack of data
to enable the determination of safe exposure thresholds in adult and
paediatric patients. Conclusion: Despite the existing encouraging reports regarding the potential to be a
useful adjunct in scar management, steroid tape is not widely used apart
from a limited number of scar services worldwide. Further research is
warranted to delineate the role of this modality in specialist scar
management protocols. Steroid medications are frequently used to relieve symptoms as well as improve
the appearance of bulky and unsightly scars. In most cases, this treatment
involves injections; nevertheless, there is a more patient-friendly way to
deliver this type of medicine to scars, which involves a sticky tape. Steroid
tape is very popular in the East but is not commonly used in the rest of the
world. We undertook this study to find out what has been written about this
method of treatment in the skin disease literature and we focused our search on
the treatment of scars in particular. We concluded that at present there some
studies to support the safe use of steroid tape to treat carefully selected
troublesome scars. Nevertheless, further research is needed to determine the
maximum size of scar as well as duration of treatment that the steroid tape can
be used for.
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Affiliation(s)
- Ioannis Goutos
- Centre for Cutaneous Research, Blizard Institute, London, UK
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
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9
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Abstract
INTRODUCTION Radiation therapy is a well-recognised modality for the adjuvant treatment of keloid scars. It can be conventionally delivered as external beam using a large apparatus at a distance from the lesion or as brachytherapy with specialised equipment to enable the delivery of treatment in the immediate vicinity of the keloidal tissue. METHODS An English literature review was performed with keywords 'brachytherapy' and 'keloid' using the databases PubMed, Embase and Web of Science from their individual dates of inception until June 2017. Studies pertinent to the field are presented in a chronological manner to depict the evolution of different brachytherapy strategies over the last decades. We also discuss considerations relating to the risk of secondary carcinogenesis, which are relevant to shared decision-making in the clinical setting. DISCUSSION Low dose rate interstitial brachytherapy was first introduced in the English literature in 1976 and currently appears to have been superseded by more modern approaches, including high dose rate interstitial brachytherapy. This modality compares favourably to more traditional modes of radiotherapy in terms of recurrence as well as rates of symptomatic relief from keloidal symptoms. Superficial brachytherapy was introduced more recently in the relevant literature and appears to be associated with favourable therapeutic outcomes compared to external beam radiation therapy. CONCLUSION Brachytherapy is a valid modality of radiotherapy for the adjuvant treatment of keloid scars, with high dose rate interstitial and surface regimens gaining in popularity over recent years. Further research needs to focus on randomised controlled trials to further establish the role of different radiotherapy modalities in keloid scar management.
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Affiliation(s)
- Ioannis Goutos
- Centre for Cutaneous Research, Blizard
Institute, London, UK
| | - Rei Ogawa
- Department of Plastic, Reconstructive
and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
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10
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Sadideen H, Goutos I, Kneebone R. Burns education: The emerging role of simulation for training healthcare professionals. Burns 2016; 43:34-40. [PMID: 27576935 DOI: 10.1016/j.burns.2016.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 03/30/2016] [Revised: 06/10/2016] [Accepted: 07/14/2016] [Indexed: 11/18/2022]
Abstract
Burns education appears to be under-represented in UK undergraduate curricula. However current postgraduate courses in burns education provide formal training in resuscitation and management. Simulation has proven to be a powerful modality to advance surgical training in both technical and non-technical skills. We present a literature review that summarises the format of current burns education, and provides detailed insight into historic, current and novel advances in burns simulation for both technical and non-technical skills, that can be used to augment surgical training. Addressing the economic and practical limitations of current immersive surgical simulation is important, and this review proposes future directions for integration of innovative simulation strategies into training curricula.
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Affiliation(s)
- Hazim Sadideen
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London SW10 9NH, UK.
| | - Ioannis Goutos
- Centre for Cutaneous Research, Blizard institute, Queen Mary University of London, 4 Newark Street, London E1 2AT
| | - Roger Kneebone
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London SW10 9NH, UK
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11
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Goutos I, Nicholas RS, Pandya AA, Ghosh SJ. Diabetes mellitus and burns. Part II-outcomes from burn injuries and future directions. Int J Burns Trauma 2015; 5:13-21. [PMID: 26064798 PMCID: PMC4448084] [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] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/10/2015] [Indexed: 06/04/2023]
Abstract
Diabetes mellitus is an increasingly prevalent comorbidity in patients presenting to burn facilities. Diabetic patients tend to be older and present in a delayed manner with deeper injuries predominantly affecting the lower limb. Morbidity from burns is higher in this cohort including a longer length of hospital stay, greater need for surgical interventions and increased rate of infective complications. Nevertheless, there seems to be little effect of diabetes on associated mortality. The second part of this review article concentrates on the epidemiological profile of diabetic burn patients and the effect of the disease on morbidity and mortality. In addition, we present a review of therapeutic adjuncts, which may hold promise for the future management of this cohort of burn patients.
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Affiliation(s)
- Ioannis Goutos
- Department of Plastic and Reconstructive Surgery, Stoke Mandeville HospitalBucks, UK
| | | | | | - Sudip J Ghosh
- Department of Plastic and Reconstructive Surgery, Stoke Mandeville HospitalBucks, UK
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12
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Goutos I, Nicholas RS, Pandya AA, Ghosh SJ. Diabetes mellitus and burns. Part I-basic science and implications for management. Int J Burns Trauma 2015; 5:1-12. [PMID: 26064797 PMCID: PMC4448083] [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] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/07/2015] [Indexed: 06/04/2023]
Abstract
The number of diabetic patients presenting to burn services is predicted to increase significantly over the next decades. Diabetes mellitus represents an independent risk factor for sustaining burn injuries and mediates alterations to key physiological systems including the vascular, renal, nervous, gastrointestinal and immune system. The effects of the pathophysiological permutations need to be carefully considered during both the acute as well as the long-term rehabilitation phase of injury. The purpose of the first part of this review is to outline the metabolic permutations observed in diabetes mellitus pertinent to the clinical presentation and management of burn patients.
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Affiliation(s)
- Ioannis Goutos
- Department of Plastic and Reconstructive Surgery, Stoke Mandeville HospitalBucks, UK
| | | | | | - Sudip J Ghosh
- Department of Plastic and Reconstructive Surgery, Stoke Mandeville HospitalBucks, UK
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13
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Goutos I. Reply: To PMID 24401738. J Hand Surg Eur Vol 2015; 40:327-8. [PMID: 25848664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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14
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Goutos I. Reply: To PMID 24401738. J Hand Surg Eur Vol 2015; 40:106. [PMID: 25688399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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15
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Abstract
Extravasation injuries are common emergencies in clinical practice. If they are not recognized and treated promptly, they can lead to deleterious functional and cosmetic outcomes. There is a vast range of agents involved in these injuries and marked paucity of evidence to support their specific management. Following an extensive literature review, we outline management principles for clinicians involved in the care of patients with extravasation injuries. Key parameters in deciding appropriate management plans include the volume/toxicity of the agent, the necrosis interval of the injury, patient-related factors, as well as the facilities and expertise available in the setting of individual cases of extravasation.
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Affiliation(s)
- I Goutos
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Headington, Oxford, UK
| | - L K Cogswell
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Headington, Oxford, UK
| | - H Giele
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Headington, Oxford, UK
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16
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17
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McGlone ER, Goutos I, Nelson RA, Pandya A. Primus stove burns: a persisting problem in developing countries. Int J Burns Trauma 2011; 1:11-6. [PMID: 22928153 PMCID: PMC3415938] [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] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 05/10/2011] [Indexed: 06/01/2023]
Abstract
Primus stoves account for a large proportion of burn injuries in the developing world. The mechanism of these injuries is closely linked with factors relating to stove design, fuel characteristics and the socioeconomic profile of victims. We review the current literature on these injuries with particular attention to the injury mechanisms and epidemiological data available. We additionally summarize the initiatives so far developed worldwide for their prevention and define directions for further research into reducing the burden associated with Primus stove burn injuries.
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Affiliation(s)
- Emma Rose McGlone
- Department of Plastic Surgery, Queen Alexandra HospitalQUAD Building, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, United Kingdom
| | - Ioannis Goutos
- Department of Plastic Surgery, Queen Alexandra HospitalQUAD Building, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, United Kingdom
| | - Rebecca A Nelson
- Division of Plastic Surgery, Dalhousie UniversityHalifax, Nova Scotia, Canada
| | - Ankur Pandya
- Dept of Plastic Surgery, Queen Alexandra HospitalQUAD Building, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, United Kingdom
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18
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Affiliation(s)
- I. Goutos
- Plastic Surgery Department, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
| | - S.J. Ghosh
- Plastic Surgery Department, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
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19
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Goutos I, Cormack GC, Ghosh SJ. Keratin sparing dorso-ulnar split skin grafts as a reconstruction option for hand defects. J Plast Reconstr Aesthet Surg 2011; 64:137-8. [DOI: 10.1016/j.bjps.2010.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 05/17/2010] [Accepted: 05/25/2010] [Indexed: 11/16/2022]
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20
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Goutos I, Clarke M, Upson C, Richardson PM, Ghosh SJ. Review of therapeutic agents for burns pruritus and protocols for management in adult and paediatric patients using the GRADE classification. Indian J Plast Surg 2010. [DOI: 10.1055/s-0039-1699462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
ABSTRACTTo review the current evidence on therapeutic agents for burns pruritus and use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) classification to propose therapeutic protocols for adult and paediatric patients. All published interventions for burns pruritus were analysed by a multidisciplinary panel of burns specialists following the GRADE classification to rate individual agents. Following the collation of results and panel discussion, consensus protocols are presented. Twenty-three studies appraising therapeutic agents in the burns literature were identified. The majority of these studies (16 out of 23) are of an observational nature, making an evidence-based approach to defining optimal therapy not feasible. Our multidisciplinary approach employing the GRADE classification recommends the use of antihistamines (cetirizine and cimetidine) and gabapentin as the first-line pharmacological agents for both adult and paediatric patients. Ondansetron and loratadine are the second-line medications in our protocols. We additionally recommend a variety of non-pharmacological adjuncts for the perusal of clinicians in order to maximise symptomatic relief in patients troubled with postburn itch. Most studies in the subject area lack sufficient statistical power to dictate a ‘gold standard’ treatment agent for burns itch. We encourage clinicians to employ the GRADE system in order to delineate the most appropriate therapeutic approach for burns pruritus until further research elucidates the most efficacious interventions. This widely adopted classification empowers burns clinicians to tailor therapeutic regimens according to current evidence, patient values, risks and resource considerations in different medical environments.
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Affiliation(s)
- Ioannis Goutos
- Department of Plastic Surgery, Queen Alexandra Hospital, QUAD Building, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, United Kingdom
| | - Maria Clarke
- Departments of Occupational Therapy and Physiotherapy, Stoke Mandeville Hospital, Mandeville Road, Buckinghamshire, HP21 8AL, United Kingdom
| | - Clara Upson
- Departments of Occupational Therapy and Physiotherapy, Stoke Mandeville Hospital, Mandeville Road, Buckinghamshire, HP21 8AL, United Kingdom
| | - Patricia M. Richardson
- Department of Anaesthesia, St. Andrew's Centre for Plastic Surgery and Burns, East Wing, Broomfield Hospital, Court Road, Chelmsford, CM1 7ET, United Kingdom
| | - Sudip J. Ghosh
- Department of Plastic Surgery, Stoke Mandeville Hospital, Mandeville Road, Buckinghamshire, HP21 8AL, United Kingdom
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21
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Goutos I, Clarke M, Upson C, Richardson PM, Ghosh SJ. Review of therapeutic agents for burns pruritus and protocols for management in adult and paediatric patients using the GRADE classification. Indian J Plast Surg 2010; 43:S51-62. [PMID: 21321658 PMCID: PMC3038386 DOI: 10.4103/0970-0358.70721] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
To review the current evidence on therapeutic agents for burns pruritus and use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) classification to propose therapeutic protocols for adult and paediatric patients. All published interventions for burns pruritus were analysed by a multidisciplinary panel of burns specialists following the GRADE classification to rate individual agents. Following the collation of results and panel discussion, consensus protocols are presented. Twenty-three studies appraising therapeutic agents in the burns literature were identified. The majority of these studies (16 out of 23) are of an observational nature, making an evidence-based approach to defining optimal therapy not feasible. Our multidisciplinary approach employing the GRADE classification recommends the use of antihistamines (cetirizine and cimetidine) and gabapentin as the first-line pharmacological agents for both adult and paediatric patients. Ondansetron and loratadine are the second-line medications in our protocols. We additionally recommend a variety of non-pharmacological adjuncts for the perusal of clinicians in order to maximise symptomatic relief in patients troubled with postburn itch. Most studies in the subject area lack sufficient statistical power to dictate a 'gold standard' treatment agent for burns itch. We encourage clinicians to employ the GRADE system in order to delineate the most appropriate therapeutic approach for burns pruritus until further research elucidates the most efficacious interventions. This widely adopted classification empowers burns clinicians to tailor therapeutic regimens according to current evidence, patient values, risks and resource considerations in different medical environments.
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Affiliation(s)
- Ioannis Goutos
- Department of Plastic Surgery, Queen Alexandra Hospital, QUAD Building, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, United Kingdom
| | - Maria Clarke
- Departments of Occupational Therapy and Physiotherapy, Stoke Mandeville Hospital, Mandeville Road, Buckinghamshire, HP21 8AL, United Kingdom
| | - Clara Upson
- Departments of Occupational Therapy and Physiotherapy, Stoke Mandeville Hospital, Mandeville Road, Buckinghamshire, HP21 8AL, United Kingdom
| | - Patricia M. Richardson
- Department of Anaesthesia, St. Andrew’s Centre for Plastic Surgery and Burns, East Wing, Broomfield Hospital, Court Road, Chelmsford, CM1 7ET, United Kingdom
| | - Sudip J. Ghosh
- Department of Plastic Surgery, Stoke Mandeville Hospital, Mandeville Road, Buckinghamshire, HP21 8AL, United Kingdom
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Goutos I, Button MCJ, Brown AA. A novel technique to facilitate the use of circular staplers in anterior resections and reversal of Hartmann's procedures. Ann R Coll Surg Engl 2009; 90:698. [PMID: 19496220 DOI: 10.1308/rcsann.2008.90.8.698a] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ioannis Goutos
- Department of Surgery, Southend University Hospital, Westcliff-on-Sea, Essex, UK.
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Goutos I, Button MCJ, Brown AA. Authors' Response. Ann R Coll Surg Engl 2009. [DOI: 10.1308/003588409x428469] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ioannis Goutos
- Department of Surgery, Southend University Hospital Westcliffe-on-Sea, Essex, UK
| | - Matthew CJ Button
- Department of Surgery, Southend University Hospital Westcliffe-on-Sea, Essex, UK
| | - Ashley A Brown
- Department of Surgery, Southend University Hospital Westcliffe-on-Sea, Essex, UK
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Goutos I. Re: 'Scratching the surface-managing the itch associated with burns: a review of current knowledge' [Burns 34 (2008) 751-760]. Burns 2009; 35:754-5; author reply 755-6. [PMID: 19211190 DOI: 10.1016/j.burns.2008.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 10/01/2008] [Indexed: 10/21/2022]
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Goutos I. Emergency management of severe burns (EMSB) course. Assoc Med J 2008. [DOI: 10.1136/bmj.a1980] [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] [Indexed: 11/03/2022]
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Mitchell PD, Chew NS, Goutos I, Healy JC, Lee JC, Evans S, Hulme A. The value of MRI undertaken immediately after reduction of the hip as a predictor of long-term acetabular dysplasia. ACTA ACUST UNITED AC 2007; 89:948-52. [PMID: 17673592 DOI: 10.1302/0301-620x.89b7.18751] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 11/05/2022]
Abstract
Our aim was to determine whether abnormalities noted on MRI immediately after reduction for developmental dysplasia of the hip could predict the persistance of dysplasia and aid surgical planning. Scans of 13 hips in which acetabular dysplasia had resolved by the age of four years were compared with those of five which had required pelvic osteotomy for persisting dysplasia. The scans were analysed by two consultant musculoskeletal radiologists who were blinded to the outcome in each child. The postreduction scans highlighted a number of anatomical abnormalities secondary to developmental dysplasia of the hip, but statistical analysis showed that none were predictive of persisting acetabular dysplasia in the older child, suggesting that the factors which determine the long-term outcome were not visible on these images.
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Affiliation(s)
- P D Mitchell
- Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
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Sebastiani G, Wallace DF, Lioumi M, Goutos I, Mitchell WA, Bomford AB, Dhillon AP, Dooley JS, Ragoussis J, Walker AP. Non HFE-related haemochromatosis: exclusion of the 1q21 zinc-iron regulated transporter-like (ZIRTL) gene in juvenile haemochromatosis. J Hepatol 2003; 38:376-7. [PMID: 12586309 DOI: 10.1016/s0168-8278(02)00426-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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