Epidemiology and outcome of 121 cases of chemical burn in East Azarbaijan province, Iran

AIM: To explore the epidemiology, mechanisms, complications, morbidity and mortality associated with chemical burns. METHODS: Data from 121 cases of chemical burn treated in our department over a 5-year period were compared. Data were obtained by prospective proforma. RESULTS: A mean 7.98% of total body surface area was burned. This series had a male:female ratio of 10:1, with a mean age 35.3 years. Young men experiencing work-related accidents were the most frequent victims. The majority of chemical burns occurred away from home (98.3%), particularly in the working environment (78.5%); 111 (91.7%) burns were accidental and 10 (8.3%) constituted criminal assault. Tar was the most frequent agent involved, followed by acid, and the hands were the most frequent site of injury. Most burns were small and of second degree; 10.7% of cases involved serious ocular damage. The mean hospital stay was 10 days, and the mortality rate was 1.7%. CONCLUSIONS: Constant safety education for the public and professional training for workers would reduce the incidence of chemical burns. Prevention strategies must be coordinated on a national level.     

Surgical treatment of burns in elderly patients

This study evaluates our experience with surgical treatment of burns in the elderly. Forty-two patients more than 59 years old were treated from 1982 to 1986. The mean age was 73, and the mean TBSA burned was 29%. The patients were divided into three groups. Group I had 22 patients with less than 20% TBSA burn (mean of 11%, with a mean of 6% full-thickness burns). Their survival rate was 91%. Group II had 11 patients with 21-40% TBSA burns (mean of 32%, with a mean of 17% full-thickness burns). Their survival rate was 82%. Group III had nine patients with burns greater than 40% TBSA (mean, 71%). None of these patients survived. Twenty of 29 (68%) survivors required a total of 36 operations. The mean area grafted per procedure was 8%. Each procedure required a mean of 2U packed red blood cells, and a mean of 2 1/4 hours. The complication rate was 33%, with partial graft loss (14%) being the most frequent. The average hospital stay was 27 days in Group I and 45 days in Group II. Only 25% of the patients required nursing home assistance at discharge.     

Epidemiological study of 3341 burns patients during three years in Tehran, Iran

A retrospective study was conducted on 3341 burn patients hospitalized in a burn care center in Tehran, Iran during 1995-98. The mean age was 20.4 years, and 43.5% of patients were children under 15 years old. The mean body surface area burned was 30.6%. There were statistically significant correlations between age groups and total burn surface area (TBSA) burned with mortality rate (p<0.006). Flame was the most common etiology of burns. There was also significant correlation between age groups and causes of burns (p<0.0001). The mean hospital stay was 16.7 days. The overall mortality rate was 19.6. Most of the injuries requiring hospital admission occurred during the winter months. Parents can play an important role in prevention of burns in children who are most susceptible to burns. People with causes identified could be educated in burn prevention, through news and other media.     

The use of the skin substitute “omiderm” in the Bashkyrian train catastrophe: a useful adjunct for mass burn casualties Report of 15 cases

Summary In June 1989, two trains exploded when passing over the trans-Ural natural gas pipeline. Eight hundred people were badly burned and between 1500–3000 people died. International assistance was requested by the Soviet government, and the Israel Army Medical Corps assistance delegation treated 40 burned patients who were transferred to the Sklifosovsky Trauma Center in Moscow. Fifteen of them suffered second degree burns with a BSA between 15% to 60%, and were treated with the skin substitute omiderm. Ten days after the application of the dressing, the wounds were epithelized and the patients discharged. The advantages of the omiderm as a skin substitute in second degree burns are described and its usefulness in mass burn casualties emphasized.     

Tandir burns: a severe cause of burns in rural Turkey

Tandir is the name given to an oven used for baking bread in the eastern and south-eastern part of Anatolia. Tandir burn is a special kind of burns in which primarily women and small children fall in it and have deep extensive burns (TBSA %). The records of 60 patients with tandir burn who were treated in our Burn Center from September 1999 to January 2006 were reviewed. The patients consisted of 9.2% of all burned patients. The mean age was 17.10 years (1-60 years) and 61.50% of the patients were female. The mean total body surface area (TBSA) burned was 21.09% (6-58) and 88% of the patients had third-degree burns. Eight of the patients underwent amputation of an extremity, 10 had fasciotomies, and 25 partial thickness skin grafts. The mean hospitalization period was 31.64 days (3-73 days). Fifteen patients (25%) died. Tandir burn is a severe kind of burn with a higher morbidity and mortality.     

Extensive scalds following accidental immersion in hot water pools

The scalds produced by immersion in hot water pools were extensive, usually of superficial depth on the upper parts of the body and deep dermal or full thickness skin loss on the lower parts. Blisters appeared rather slowly, within 2 days post-burn and often dispersed spontaneously. The estimated burned area on admission may thus be smaller than found subsequently. This study showed that the volume of fluid required for adequate resuscitation during the first post-burn day may be only 1.5 ml/kg/% BSA burned. Deep dermal burns were treated preferably by early tangential excision and grafting. The full thickness skin loss was treated by escharectomy and skin grafts.     

Corneal calcification after chemical eye burns caused by eye drops containing phosphate buffer

PURPOSE: Chemical burns with calcium containing corrosives as well as irrigation with phosphate buffer solutions after eye burns bear the risk of corneal calcification. The aim of this study was to evaluate the correlation between the occurrence of corneal calcification after chemical injuries and the usage of phosphate buffer containing local therapeutics. METHODS: We reviewed the data of 179 patients who have been treated in the University Eye Clinic Aachen, Germany, between 1941 and 2000. Only when the corrosive did not contain calcium and when the initial irrigating solution did not contain phosphate buffer, respectively, were patients included in the study. The cases were analyse, if the patient was treated with phosphate buffer containing eye drops/ointment during the first 7 days of hospitalization or as an out-patient, and if corneal calcification was visible by slit-lamp examination during the follow-up. Statistical analysis was performed using Fischer's exact test. RESULTS: 152 eyes were included. From 63 eyes treated with phosphate buffer containing eye drops, 31 eyes (49%) developed corneal calcification. From 89 eyes treated without phosphate buffer containing eye drops, only 23 eyes (26%) developed corneal calcification. The two-sided p-value of Fischer's exact test is 0.0036. CONCLUSION: During follow-up after chemical eye burns, eye drops containing phosphate buffer double the risk of corneal calcification. We recommend avoiding these agents in order to prevent the burned cornea from additional opacity. Substances containing phosphate buffer are listed in this article.     

Acute renal failure in severely burned patients

Acute renal failure (ARF) is a well known complication of severe burns and is an important factor leading to an increase in mortality. In order to analyze possible pathogenetic and prognostic factors associated with ARF in burned patients we reviewed in a retrospective study the files of 328 patients with burns > 10% body surface area (BSA), admitted to our burn unit between 01.01.94 and 01.05.98. We found 48 patients with acute renal failure corresponding with an incidence of 14.6%. Patients with ARF had a mean burned surface area of 48% (13-95) and an abbreviated burn severity index score (ABSI) of 9.8 (4-15). Thirty eight (79%) of these patients had an inhalation injury diagnosed. Renal insufficiency was divided in a late and an early form depending on its time of onset and we found 15 (31%) patients with ARF occurring within the first 5 days of the hospital stay and 33 (69%) patients with ARF developing >5 days following the thermal injury. The incidence of myoglobinuria and hypotension during the resuscitation phase was significantly higher in the group with early ARF, whereas patients with late ARF presented sepsis more frequently than patients with early occurring renal failure. Accordingly, potential nephrotoxic antibiotics were administered more often in patients with late ARF. Patients with ARF were treated by continuous arteriovenous hemofiltration (CAVH) for a mean period of 10.5 days (1-47) and CAVH was associated with a complication rate of 10%. Most of the complications were associated with the vascular access in the femoral artery. The mortality rate in patients with ARF was 85% and death was due to multiple organ failure in 83% of the cases. Only burned BSA and inhalation injury proved to be significantly correlated with the development of ARF, whereas age, third degree burn or electric injury were not significantly different between the two groups. Neither age, TBSA, day of onset of ARF nor duration of the renal replacement therapy proved to be significantly different comparing survivors with non-survivors, and thus predictive for the survival rate.     

Osteomyelitis in burn patients requiring skeletal fixation

Deep and severe burns often present with the exposure of musculoskeletal structures and severe deformities. Skeletal fixation, suspension and/or traction are part of their comprehensive treatment. Several factors put burn patients at risk for osteomyelitis, osteosynthesis material being one of them. In order to determine the safety of skeletal fixation, we reviewed all pediatric patients treated with pin insertion during the past 10 years. Forty-one severely burned children (61+/-3% TBSA full thickness burns), had a total of 357 skeletal fixation procedures. Pins were maintained an average of 25.3+/-1.7 days. Thirteen pins (3. 6%) were loose before the expected time of removal, two patients (4. 8%) presented with cellulitis of the pin site and two patients (4. 8%) presented with osteomyelitis. Loose pins, pin site cellulitis, burn wound infection and sepsis were not associated with osteomyelitis. Skeletal fixation in severely burned patients presents with a low incidence of infectious complications. Its use should be considered in patients affected by severe burns that present with exposed deep structures and for positioning purposes. The exact timing for pin removal in burned patients is still to be defined.     

Effect of constituents of burned skin and in vivo skin burning on the respiratory activity of rat liver mitochondria.

The formation of toxic substances in the skin, due to the influence of thermal energy, is supposed to be one possible mechanism responsible for the high mortality rate after severe burns covering large areas of the body surface. The effects of low-molecular-weight volatile substances (dry distillates) generated after burning mouse skin were investigated. They led to reductions of the respiratory activity of rat liver mitochondria. Among other substances carbon disulphide, methylethylketone and pyrrole were isolated and characterized using gas chromatography. All of them had strong uncoupling effects on mitochondrial respiration. In a second study respiratory measurements were made on mitochondria from rats with 20-30 per cent TBSA full skin thickness burns. A decreased respiratory control ratio and thus uncoupling of mitochondrial respiration was found on days 1, 2 and 5 postburn. The basal mitochondrial respiration was significantly decreased on day 5, which could be important for the mortality mentioned above. Finally after cross-transplantations rats having burned skin grafted showed a reduction of the RCR when compared with rats with the unburned graft. Thus it can be concluded that toxic substances must have been present in burned skin.     

Child abuse by burning--an index of suspicion

Although general awareness of child abuse is increasing, abuse by burning is often unrecognized. Seventy-one consecutive children admitted with inflicted burns were studied. Mean age was 1.8 yrs and mean burn size was 13.5%. Mean length of stay was 18.9 days. Scalds (83% from tap water) were the most frequent cause of injury. An immersion pattern was present in 59%; six patients had a classic forced immersion injury. Fourteen children had nonburn trauma. Four patients died: all had tap water immersion burns. Inflicted burns are usually manifested by characteristic patterns of injury, which must be correlated with the given history. When compared with accidentally burned children, abused children were significantly younger, had longer hospital stays, and had a higher mortality. A team approach to child abuse with the addition of a specially trained group is important to insure prompt recognition, more objective appraisals, and further followup.     

Initial general management and surgery of six extensively burned children treated with cultured epidermal autografts

PURPOSE: The aim of this study was to document the surgical and intensive care methods used in six extensively burned children (EBC), ie, total body surface area (TBSA) burned over 70% or TBSA with deep burns over 60%, treated with cultured epidermal autografts (CEA). METHODS: Six EBC, with a mean age of 7.5 years (range, 2.5 to 12) received CEA. Their mean TBSA burned was 82% (range, 70-94) with 74% (range, 60-90) of TBSA with deep burns. All sustained flame burns and inhalation injuries. RESULTS: The survival rate was six of six. The average initial and final engraftment rates of CEA were, respectively, 79% (range, 70 to 95) and 84% (range, 72 to 100). CEA definitively covered 45% (range, 18 to 57) of TBSA for a mean cost per child of $80,000 (range, 55,000 to 110,000). CONCLUSION: Even if CEA are expensive, such engraftment rates and survival ratio results make them an excellent alternative wound covering method for EBC when donor sites for widely meshed autografts are exhausted.     

Analysis of Reasons and Locations of Burns on Hands

During the period 1971–76, 1055 patients with fresh burns were treated at our hospital. Of these, 461 (88 females, 373 males) had sustained burns on altogether 783 hands. This amounts to 45% of the total number of fresh burns. In 322 cases both hands were involved, amounting to 31% of all cases of fresh burns, or 70% of all patients with burned hands. Whereas 82% of patients with hand burns had injuries to both hands, only 10% had sustained an injury to the right hand alone and 8% to the left hand alone. Cases of burns limited to the hands alone accounted for only 4.7% of all burn injuries. The main cause of burn injuries was thermal accident—most often steam explosions and the spraying of scalding liquids. The total number of hands injured by thermal agents totalled 707. i.e. 90% of all burned hands. Most of these were deep skin burns. Chemical agents were mainly responsible for this type of burn, whereas electrical burns were chiefly full thickness skin injuries. Analysis of the location of burns showed that 643 (82%) hands of the altogether 783 injuries sustained involved the wrist, 620 (79%) the metacarpus. 684 (87%) of the fingers. Some 321 hand burns (41%) were of a circumferential nature. A majority of burned hands were injured on the dorsal surface. The burn injuries of hands in 246 (53%) persons were connected with their professional work.     

严重烧伤患者人白细胞抗原DR定量表达的临床意义

目的探讨严重烧伤患者人白细胞抗原DR（HLA—DR）定量表达的变化规律及其临床意义。方法采集77例烧伤大于体表总面积30％的患者的血样,通过流式细胞技术对患者烧伤后不同时段CD14^＋单核细胞表面HLA—DR结合量进行动态的定量分析。结果严重烧伤患者伤后第1天开始CD14^＋单核细胞表面HLA—DR结合量明显低于正常对照组（P〈0．05）,其表达均值与烧伤面积呈显著负相关（r=-0．7232,P〈0．05）。并发多脏器功能障碍综合征（MODS）者其CD14^＋单核细胞表面的HLA—DR表达量持续下降,其中伤后第3、14、21、28天显著低于非MODS组（P〈0．05）。随着CD14^＋单核细胞HLA—DR表达水平的下降,MODS发生频率增加,患者预后不良。结论大面积烧伤可导致机体CD14^＋单核细胞HLA—DR表达严重受损和免疫功能障碍,动态观察其表达水平有助于烧伤后MODS的病程监测及患者预后判断。     

The epidemiology of burns in a medical center in the Caribbean

A retrospective study on burns patients admitted to the Sint Elisabeth's Hospital on Curacao was conducted during the 11-year period from the years 1992 to 2002. This is the first such study performed in Curacao. Curacao does not have an established burn center, therefore severe burns cases are treated in a general hospital. Only the very severe cases are referred to burn centers abroad.Data were collected on incidence, gender, age, cause, total body surface area (TBSA burned), degree, localization, case fatality, length of hospital stay (LOS), and seasonal variation. A total of 336 burns patients were admitted. This represented an annual admission of 31 patients, and an annual cumulative incidence of 2.3 episodes per thousand persons for burns admissions. The male to female ratio was 1.6:1, and the mean age of admission was 24.3 years. Most burned patients were observed in the age group ranging from 0 to 4 years old (29.2% of all burns cases). The mean TBSA of burn was 13.6%, range 0.5–80%. The most common cause of burn was scald (47.9%) followed by flame (22.3%). The overall mean LOS and case fatality were 15.8 days and 3.3%, respectively. Second and first degree combined, and second-degree only burns were the most frequent. Most frequent localizations burned were the arms, thorax, and legs. Most burns occurred at the end and at the beginning of each year (comparable to winter and spring period in other studies), being the seasons with the most public holidays and other festivities.We conclude that the incidence, age and gender distribution, LOS and TBSA of burns on Curacao were very similar to data from other international studies from the US, Europe and Asia. Scald and fire were the major causes of burns, being preventable injuries. Especially in young children the need for a prevention program is essential. Also, there is a need to inform people from all ages on the danger of fire injuries, especially during public holidays and other festivities when the incidence is the highest.     

Management of genital burns: A review

We review the etiology and the management strategy of genital burns. The incidence of genital burns ranges from 2.8 to 13%. Most are part of larger injuries. Scald burns are typical for children, whereas flame and chemical burns happen more often in adults. For first and second‐degree genital burns, a conservative approach with physiological dressings and topical antimicrobials is advised. Only third degree burns need to be treated with removal of necrotic tissue and grafting. Indwelling catheters or suprapubic drainage systems must be avoided whenever possible.     

The burned hand: a planned treatment program.

A planned treatment program for burned hands has been developed and was used in 72 burns of the dorsum of the hands. Treatment was individualized on the basis of whether hand burns were superficial or deep. In the former, there was evidence of spontaneous reepithelialization within 14 to 21 days. In the latter, immediate or delayed excision, followed by resurfacing with autografts was done. Both groups received topical antibiotic creaming, elevation, an exercise program as soon as they were able, and splinting of the burned hand in the antideformity position. Hypertrophic scars and unacceptable epithelium were excised when they interfered with function. Initially, this program allowed us to avoid unnecessary surgical procedures in 94% of the second-degree burns of the dorsum of the hand. The third-degree burned hand needed excision and autografting in 100% of the burned hands. This treatment program has as its goals: prevention of deformity by early motion and protection of the unburned and regenerating epithelium by creaming with topical antibiotic ointment.     

Serotonin kinetics in patients with burn injuries: a comparison between the local and systemic responses measured by microdialysis-a pilot study

OBJECTIVES: To investigate serotonin (5HT) locally in burned and uninjured skin (intracutaneous) by microdialysis, and simultaneously record urinary and blood values in the same subjects. For comparison, serotonin values were also measured in skin of healthy controls. DESIGN AND SETTING: An experimental study in burned patients with of more than 25% TBSA (total burn surface area) % in an 8-bed tertiary burns unit, serving about 3.5 million persons. PATIENTS AND METHODS: Six subjects with a median TBSA% of 59% (range 33.5-90), and five healthy controls were examined by intracutaneous microdialysis of the skin. RESULTS: 5HT was increased in burned patients, compared with controls. This increase was tenfold in skin and was noted both in uninjured and burned skin. The highest values were recorded on day 1 (median 16.1nmol in uninjured and 9.5nmol in burned skin) and day 2 (15.6nmol in uninjured and 13.4nmol in burned skin). A rapid reduction was noted on day 3 (4.9nmol in uninjured and 3.8nmol in burned skin). The corresponding value for control subjects was 1.3nmol. The 5HT in blood was twice normal on day 2, and gradually reduced on days 3 and 4 (3189, 3035 and 2573nmol, respectively). Urinary 5HT concentrations were increased only on day 2 at 1755nmol and thereafter returned to the normal range on days 3 and 4 (1248 and 1344nmol, respectively). CONCLUSIONS: We showed that microdialysis may be used in the critical care of burns, and local skin serotonin concentrations examined continuously for several days. The findings of significantly raised tissue serotonin concentrations, compared to that in blood and urine, suggests that serotonin may be important in local vascular control and formation of oedema.     

Mortality and morbidity among elderly people with burns--evaluation of data on admission

People aged >or=65 years represent a growing population within burns units in the Western world. In 2001, this group was reported to rise to 20% of such admissions. We reviewed the records of 265 burn cases with complete admission and discharge histories, from January 1990 to December 2003 in an A-level regional burns centre. The predictive value of age, gender, total body surface area burned (TBSA), inhalation trauma (IT), premorbid conditions and currently used burn scores (Baux, ABSI, Ryan) for haemodynamic or respiratory complications, mortality and morbidity were analysed. Additionally a subset of patients with diabetes mellitus and >30% total body surface area burned were reviewed. About 16% of all admissions with burns were >or=65 years of age, with a mortality rate of 30.6% (81/265). Only gender and premorbid conditions did not influence mortality. Haemodynamic and respiratory complications were significantly related to TBSA, presence of I and any of the three scores (all p<0.001). Among survivors (184/265), the median duration of hospital stay was 26.0 days. Factors contributing to a significantly increased length of stay were, in decreasing order, total body surface area burned, high levels of burn scores, inhalation trauma, flame injury and certain premorbid conditions (cardiovascular disease, alcoholism). About 77.7% of all patients were discharged either to a rehabilitation centre or back to their previous form of housing. This study showed that among burned people aged >or=65 years a good outcome as evaluated on discharge can be achieved. Studies pooling different centres' results are needed to improve the significance of conclusions drawn from these data.