[Value of cutaneous allografts in the treatment of severe burns]

Skin allografts are essential for survival in patients who have suffered major third degree burns over more than 50% of the body surface in order to maintain covering until autografts from less severely wounded areas can be performed or until keratinocyte cultures have grown. Allografts have thus been increasingly used for severe burn patients. It has been estimated that 150 m2 are grafted per year in France. Both fresh and frozen tissue can be used thanks to the organization of graft banks and safe storage.

Use of random amplified polymorphic DNA as a typing method for Candida albicans in epidemiological surveillance of a burn unit

Burn patients are particularly exposed to deep-seated nosocomial infections caused by Candida species. Superficial carriage of C. albicans is a potential source of infection and dissemination, and typing methods could be useful to trace the different isolates. We report the use of random amplified polymorphic DNA to type isolates of C. albicans in the Hôpital Cochin burn unit. This molecular typing method, which is based on PCR with arbitrary short primers, was evaluated on a panel of 32 C. albicans strains isolated from various anatomical sites of unrelated patients, and the strains showed 22 different patterns. Random amplified polymorphic DNA was then used in the epidemiological surveillance of the patients in the burn unit over a 9-month period. Seven patterns were identified among 84 isolates from 18 patients. One pattern (pattern A) corresponding to isolates from 7 of the 18 patients (68% of isolates) predominated throughout the 9-month study, while some strains with other profiles were isolated only once. Some profiles appeared to show a particular geographic pattern within the unit, suggesting transmission from room to room. These results underline the importance of fungal surveillance in such patients and the need to inform nursing staff of measures to prevent the spread of Candida spp. from patient to patient.

Use of topically applied silver sulphadiazine plus cerium nitrate in major burns

All patients hospitalized between May 1987 and June 1988 suffering from burns covering over 50 per cent of the body surface area were treated by topical application of a cream containing cerium nitrate (0.05 M) and silver sulphadiazine (0.03 M) (CN + SSD). Eleven patients were included in this series, with a mean age of 35 years (range 22-65), a mean total burn size of 78 per cent (range 50-96 per cent) and full skin thickness covering a mean of 48 per cent (range 10-91 per cent). Eight patients survived (73 per cent) (mean age 36 years; mean total burn surface 73 per cent; mean full skin thickness burn surface, 38 per cent). These results are far better than those obtained in our Unit where a survival rate of 34 per cent was obtained in a comparable series of patients treated before 1987. Sixty positive blood cultures were obtained, which included a large variety of organisms with a slight predominance of Staph. aureus, Candida albicans and Ps. aeruginosa. Wound cultures were positive in 72 per cent of swabs and showed a predominance of Ps. aeruginosa (59 per cent of all the strains isolated). Even if CN + SSD appears in this series not to be very efficient in preventing wound colonization and septic complications, it permitted a very high survival rate in the treated patients, taking into account the extreme severity of the injuries. This beneficial effect is probably the consequence of the protective action of the yellow-green eschar formed by CN + SSD.(ABSTRACT TRUNCATED AT 250 WORDS)

Survival rates of patients hospitalized in French burns units during 1985

This survey analyses data from 17 French burn units with respect to age, severity of injury and survival of patients admitted to hospital during 1985. Of the 2398 patients treated, more than half were between 15 and 50 years old. About 90 per cent of the patients had burns covering less than 50 per cent of the body surface area. The overall mortality rate was 11.8 per cent. The LD50 for the 2398 patients was a burned surface area of approximately 60 per cent of the total body surface area. The LD50 for patients less than 30 years old was a burn covering just over 80 per cent of the total body surface. The survival rate as a function of the Baux index was also analysed.

Preliminary clinical studies of a biological skin equivalent in burned patients

The possibility of covering large areas of full thickness skin loss with 'living skin equivalent' produced by a modification of Bell's method was studied. Living skin equivalents, composed of a dermal equivalent (fibroblasts plus collagen) covered by epithelial cells were grafted, meshed or non-meshed, onto granulation tissue and, in one patient, onto fascia. Eight patients with full skin thickness burn wounds covering over 15 per cent of the body surface area were thus partially covered. The graft 'take' was evaluated every 48 h. In every patient grafted, an extensive lysis (60-90 per cent) of the skin equivalent graft was observed at the first dressing (48 h). In one patient only, a significant percentage of 'take' (40 per cent) was observed 14 days after grafting. These disappointing results were probably related to the presence of collagenases or proteases produced on the wound bed either by bacteria or by surrounding human cells. It appears that at the present time the biochemical nature of the dermal equivalent used is not yet completely appropriate to serve routinely as a substitute for human skin.

Systematic utilization of an antipseudomonas aeruginosa vaccine in a severe burn unit

The biological and clinical results of vaccination against pseudomonas aeruginosa infection have been analyzed for a group of 287 burned patients having over 25% surface burnt. The vaccine used was a cellular one inactivated by heat and containing 10 different strains. The effectiveness has been judged on the one hand by the increase in the antipseudomonas antibody count and on the other by comparing a group of vaccinated patients with a non-vaccinated group. After vaccination, the antipseudomonas aeruginosa antibodies increased from the 4th-5th day and reached an impressive increase after the 10th day. Clinically, protection is almost complete if one considers that pseudomonas aeruginosa positive blood cultures appear 15 days after vaccination, and above all the prognosis of these late infections. Both locally and generally, this vaccine has always been perfectly tolerated.

[Evolution of blood fatty acid levels in severe burns]

During the first ten days following the burn, there is no significant increase in serum FFA for the surviving patients. This shows a good balance between production and use by the cells. The glucose that is brought allows their oxydation in tricarboxylic Kreb's cycle and the albumine allows for them transport in the circulating liquids, probably helping to maintain this good balance. On the other hand for 70 p. 100 of the patients who died this equilibrium does not exist and the serum FFA increased significantly. Later on and in all cases, the value of serum FFA decrease significantly below that of the control group. This fact can be explained by the exhaustion of the lipidic reserves and/or a decrease of serum proteines particularly albumin, and consequently of transport in the blood of the fatty acids.