Τρίτη, 12 Μαρτίου 2019

Burns

Skin bank – the need of hour for burn treatment
Vijay Kumar

Indian Journal of Burns 2018 26(1):1-2



Burns management in India: The way ahead
Arun Kumar Singh

Indian Journal of Burns 2018 26(1):3-5



Restoring hope: The Burn Unit, KEM Hospital
Vinita Puri, Raghav Shrotriya

Indian Journal of Burns 2018 26(1):6-8



Reconstruction of postburn crippled hands: A study of functional outcome
Narayanan Chandramouli Hariharan, Rajagopal Sridhar, B Sankari, VS Valarmathy, Ebanesar Asirvatham, Krishnamurthy Geetha

Indian Journal of Burns 2018 26(1):9-14

Introduction: In postburn survivors, quality of life depends on the functional ability of one's hands. However, restoring useful function in crippled hands is a formidable challenge. Understandably in such cases, there are no standardized rules regarding the sequence of release, the type of skin cover, the duration of immobilization by K wires, and the intensity of hand therapy. Patients and Methods: We formulated a protocol and evaluated the outcome for cases of severe contractures with a total loss of hand function and distorted hand architecture. It is a cross-sectional study of 10 consecutive patients and 14 hands operated in our department from January 2014 to June 2017. The patients were operated in two stages. At the first stage, contractures of the wrist, dorsum, and thumb web space were released. Extension contractures of the fingers and thumb were also released. During the second stage, the contractures of the palm, volar aspect of the fingers, and web spaces were released. In both the stages, the fingers were maintained in released position for 3 weeks by K wires and the raw areas were covered with split skin graft/skin flap. Results: Patients were assessed for the improvement of hand function by the disabilities of the arm, shoulder and hand (DASH) scores of the 10 patients operated, four returned to the original employment/school. Four found meaningful employment. Conclusion: The aim in crippled hands is to restore useful function in the least number of stages rather than improving the range of movement in individual joints. Maintaining the release achieved by surgery with K wires, coupled with aggressive therapy, prevent the recurrence of the contractures. 


Role of autologous fat grafting in burn wounds
M Rahul, Sunil Sharma

Indian Journal of Burns 2018 26(1):15-19

Introduction: The role of autologous fat grafting in burn wound healing was not studied adequately although there are few references in favor of the same. Autologous fat grafting was used in the treatment of burn wounds showing no signs of healing even after 3 weeks of injury. This study was done to study the role of autologous fat grafts in the treatment of burn wounds and to assess outcome in terms of healing or production of granulations suitable for skin grafting. Materials and Methods: The study was conducted in a tertiary burn care center. It was a prospective case–control study. The study was done on 30 cases and 30 controls. Burn wounds of duration >21 days with size <40 cm2 were selected for the study. The study group underwent wound debridement followed by autologous fat grafting, whereas controls underwent wound debridement only. The results were assessed on day 3, 6, 10, and 14. Chi-squared test was used; P < 0.05 was statistically significant. Results: Statistically significant differences were noted in the early appearance of healthy granulation tissue, epithelialization from margins, and reduction in size of the wounds, leading to early healing. All patients in the study group developed healthy granulations by day 3, whereas only 6.7% of the control group developed healthy granulations. All the cases among the study group showed epithelisation from margins on day 6, whereas only 3.3% of the controls showed epithelialization from margins. On day 14, 10% of cases in the study group were healed with statistically significant reduction in size of the wounds compared to those on the control group. Discussion: The cases undergoing autologous fat grafting showed significantly improved healing with respect to faster appearance of healthy granulations, epithelialization from margins, and thereby reduction of wound surface area and healing, proving the usefulness of autologous fat grafting in burn wounds. The autologous nature of fat grafts is remarkable considering the solution to the longing problem found inside the body itself. 


Exfoliative diseases of the integument and mucous membrane that mimic deep 2nd-degree burns with or without sepsis
K Mathangi Ramakrishnan, Bala Ramachandran, KG Ravikumar, K Ravikumar, R Ramkumar, V Jayaraman, T Mathivanan

Indian Journal of Burns 2018 26(1):20-23

Introduction: Exfoliative skin diseases in children can mimic burns in many ways and require early diagnosis and management. Here we enumerate the different skin conditions with four case based examples and their management. Clinical Presentation: Varying degrees of skin involvement may be seen with severe involvement in DRESS syndrome and milder involvement in Stevens-Johnson syndrome. Management: The management of this exfoliative lesion is the application of collagen membrane to the wound as we treat burns. Although systemic symptoms can produce mortality (e.g., dress), collagen dressing heals the wound well with good epithelialization. Early and appropriate antibiotic therapy is mandatory. Conclusion: Careful attention to correct diagnosis, early intervention and use of collagen dressing have improved outcome in these children. 


Correlation of burn injury and family history of burns among patients hospitalized at a public hospital in Nairobi, Kenya: A case–control study
Joseph Kimani Wanjeri, Mary Kinoti, Tom H. A. M. Olewe

Indian Journal of Burns 2018 26(1):24-28

Introduction: Burn injuries are physically and psychologically devastating types of trauma and are common among children especially in the home environment. They are more prevalent and are a public health problem in developing countries principally because of poor socioeconomic conditions. Effective prevention programs should be tailored for specific geographic locations and guided by the results of well-designed studies aimed at investigating local risk factors for burns. Studies targeting households can result in the identification of risk factors operating within family setups. Study Objective: To determine the association between occurrence of burn injury and family history of burns among patients hospitalized at a large hospital in a developing country in Africa. Methodology: This was age- and gender-matched case–control study comprising 202 patients admitted with burns (cases) and 202 nonsurgical patients (controls) admitted into the pediatric and medical wards. The study site was Kenyatta National Hospital, an 1800-bed national referral and teaching hospital in Kenya. The dependent variable was burn injury whereas the independent variables were family history of burn injury, history of hospitalization, and presence of a burn injury scar in the burnt family member. History of hospitalization following burn injury was termed as an indicator of severe burn injury having been sustained. Data Analytical Methods: The Chi-square test was used to identify the differences between the cases and control group variables, and logistic regression analysis and odds ratio were done to determine the relationship between the dependent and independent variables. Results: The male:female ratio was found to be 1:1, and burn injuries were found to be most common in the 0–4 years age bracket (n = 86, 42.6%), with the second most common age bracket being 20–40 years (n = 78, 38.6%). The injuries were mainly sustained in homes (n = 161, 80.9%) and the remainder at work (n = 15, 7.5%) and other places (n = 23, 11.6%). There was no significant difference between the two groups with regard to family history of burns (odds ratio [OR] = 0.689, 95% confidence interval [CI]: 0.443–1.073, P = 0.062) and presence of a burn scar in previously burnt family members (OR = 1.083, 95% CI: 0.308–3.805, P = 1.0). There was, however, a statistically significant higher incidence of postburn injury hospitalizations among the cases than the controls (OR = 2.354, 95% CI: 1.064–5.208, P = 0.033). Conclusion: Family history of burn injury with hospitalization of those affected is an indicator of households at a higher risk for burn injuries. More of the cases had history of hospitalization for burn injury among their family members, indicating that they had more risk factors operating within their environment, or their practices made them more prone to burn injuries. Identification of the specific risk factors involved is key in the prevention of burn injuries in homes. 


Nanocrystalline silver gel versus conventional silver sulfadiazine cream as topical dressing for second-degree burn wound: A clinicopathological comparison
Gouranga Dutta, Nandini Das, Abhishek Adhya, Kinkar Munian, Bijay Kumar Majumdar

Indian Journal of Burns 2018 26(1):29-37

Background: The use of topical chemotherapy is fundamental to prevent infections thereby reducing local inflammation, pain and early healing in superficial, and deep dermal burns. Among the whole gamut, choice of topical agents became an important decisive factor. Silver sulfadiazine (SSD) cream has been an important part of burns management for many years. The major complications attributed to silver compounds are due to the complex or anion sulfadiazine, not the silver itself. With better understanding of the physical and chemical properties, nanocrystalline silver particles have emerged as the most studied material for burn wound dressing recently. Having in mind the difficulties experienced, the aim of the present study is to compare SSD with nanosilver (nano-Ag) gel dressing to treat second-degree burn wounds. Materials and Methods: Over a period of 24 months, a total of 90 cases were studied. 45 patients randomly included in each group, further divided into two subgroups depending on depth (superficial and deep) and involvement of total body surface area (10%–20% and >20%–30%) to minimize bias. Clinical, microbiological, and histological parameters were analyzed. Results: In NS group, significantly less pain observed throughout the study period in both superficial and deep dermal burn patient. Pseudomonas was the predominant flora. Nano-Ag gel was effective in controlling most of the microorganisms except Klebsiella and Proteus sp. Healthy granulation tissue appeared faster (P = 0.0009) in deep dermal burns in nano-Ag group and confirmed histologically. Overall wound healing was more satisfactory in nano-Ag group for both superficial and deep dermal wounds, clinically as well as by histological examination. Conclusions: Clinical and histological studies showed that nano-Ag gel has a positive impact on overall healing process of the patients and proved more beneficial for the management of partial thickness burn as compared to SSD. 


Oxidative stress in major thermal burns: Its implications and significance
Ranjith James Babu, Mary Babu

Indian Journal of Burns 2018 26(1):38-43

Introduction: Thermal burns could prove dreadful to humankind. The morbidity and mortality is the interplay of intraneous and extraneous factors. Multidisciplinary approach plays a cardinal role in managing this catastrophe. This study is carried out to analyze the oxidative stress in thermal burns, its implications in management, and the significance it carries with it. Materials and Methods: This prospective study was carried out in 30 patients from January 2016 to December 2016. Quantitative analysis of oxidative stress and total antioxidant capacity was done on postburn day 3 and every 5 days thereafter. Results: The quantitative oxidative stress level was high, and antioxidant capacity was low in patients who had higher percentage total body surface area burn and predominant deep burn with temporal analysis. The patterns were strikingly different in patients who had mortality with patients who survived. Discussion: Thermal burn releases reactive oxygen species which causes profound changes in internal and external milieu. This alters the physiological response to treatment and impresses on the morbidity and mortality of the patient. Conclusion: Thereby, it could be construed that oxidative stress along with tailored intervention, timing of treatment, and recalcitrant attitude to treatment methodology has a significant role in determining the outcome of burn patients. 


Early burn team consultation in the emergency department improves efficiency and patient throughput
Paige L Myers, Alap U Patel, Derek E Bell

Indian Journal of Burns 2018 26(1):44-47

Objective: The objective of the study is to assess the relationship between expedited burn surgery evaluation and total length of stay (LOS) in the emergency department (ED) in a high-volume tertiary burn care institution and extrapolate these results to the efficiency and cost-effectiveness of patient care. Methods: A retrospective review was performed of all patients evaluated by the burn surgery team and discharged from the University of Rochester Medical Center ED between November 2012 and June 2013. One hundred and three primary patients were identified and their time from arrival to discharge and the timing of burn surgery consultation were analyzed. Patients were stratified into two groups, early and late, based on how soon after arrival they were seen by the burn surgery service. Tests of statistical significance were performed, comparing total time in the ED, time to evaluation by ED provider, and time to evaluation by the burn surgery service. Results: Burn surgery was consulted and evaluated the early group significantly sooner than the late group (early mean: 63 min, late mean: 191 min; P < 0.001). Total ED stay (arrival-to-discharge time) was significantly lower for the early burn evaluation group (early mean: 181 min, late mean: 285 min; P < 0.001). Conclusions: Early burn surgery consultation is associated with a significantly reduced total ED LOS, arguing for immediate burn surgery consultation irrespective of ED provider contact so that patient throughput can be increased. Furthermore, the reduced LOS may translate into higher patient satisfaction, improved patient care, and lower opportunity cost of ED space. 


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