救治Ⅲ度烧伤面积≥90%TBSA患者12例

Ⅲ度烧伤面积≥90%TBSA的患者治疗时间长、并发症多、病死率高,是临床救治的难点。1977—2003年,笔者单位救治此类患者12例,现总结如下。一、资料与方法1.临床资料:本组患者男9例、女3例,年龄19～33岁[(25.33±5.01)岁]。均为深Ⅱ度和Ⅲ度烧伤,总面积95%～100%,其中Ⅲ度90%～94     

成功抢救100%TBSA深度烧伤患者2例

目前我国特重度烧伤的治愈率不断提高,但对于Ⅲ度烧伤面积>50%TBSA的100%TBSA烧伤患者,抢救仍很困难。我院抢救2例100%TBSA深度烧伤患者均获得成功,报告如下。     

老年糖尿病患者深度烧伤治疗体会

笔者单位 1985年 10月～ 2 0 0 2年 10月 ,收治 6 0岁以上老年烧伤患者共 2 13例 ,其中合并Ⅱ型糖尿病 2 8例 ,治愈 2 1例 ,现小结如下。临床资料 :糖尿病诊断标准采用 1985年WHO诊断及分型标准[1 ] 。本组合并Ⅱ型糖尿病的老年烧伤患者共 2 8例 ,病程 3～ 2 5年。治愈 2 1例 ,其中男 9例 ,女 12例。 6 0～ 70岁9例 ,71～ 80岁 7例 ,80岁以上 5例 ,最大年龄 91岁 (女 ,Ⅲ度烧伤面积 4 %TBSA),平均 76岁。火焰烧伤 12例 ,热液烫伤 9例 ,烧伤面积为 4 %～ 73%TBSA,均伴有Ⅲ度烧伤 ,面积>1%TBSA,其中最大Ⅲ度烧伤面积为 30 %TBSA。入院…     

喷洒法皮粒播植术治疗大面积深度烧伤六例

自体皮源不足一直是治疗大面积深度烧伤的一大难题 ,微粒皮移植技术的运用可大大节省自体皮源 ,是烧伤创面修复的有效方法之一。 2 0 0 0年 9月～ 2 0 0 2年 6月 ,笔者采用喷洒法皮粒播植术[1 ,2 ] 治疗大面积深度烧伤患者 ,取得良好效果 ,现报告如下。临床资料 :本组 6例 ,其中男 4例 ,女 2例 ,年龄 11～ 5 8岁 ,平均 39岁。烧伤总面积均 >70 %TBSA,其中烧伤总面积>90 %TBSA 3例 ,Ⅲ度烧伤面积 >5 0 %TBSA 4例。 6例患者四肢创面均为深Ⅱ～Ⅲ度烧伤。异种皮的准备 :(1)新鲜条状猪皮的制备 :选用 12 0kg左右健康纯白猪 ,处死后 ,用肥皂…     

严重烧伤后皮肤蛋白复合物的变化及其意义

严重烧伤后由于机体免疫功能的紊乱，易并发严重感染甚至死亡。有研究报道［1］，烧伤后皮肤脂蛋白复合物（Lipid-protein complex, LPC）吸收入血是引起细胞免疫下降的主要物质之一。尽管如此，严重烧伤患者外周血水平的变化特征尚不清楚。本研究通过测定严重烧伤患者外周血LPC水平的动态变化，分析LPC的变化特征及意义。资料与方法1.临床资料：1997年1月～1998年12月在本院住院治疗的烧伤面积≥30%TBSA患者共12例，其中男性9例，女性3例；最大烧伤面积为78%，平均烧伤面积46.8%。其中III度烧伤面积平均为20.5%，II度烧伤面积平均…     

成批烧伤中重度患者长途转送后的救治

目的:分析成批烧伤中的危重患者长途转运后并发症及总结其救治经验.方法:两批烧伤中的重度烧伤患者13名,分别于伤后3d和4d由外地长途空运转入,烧伤面积75%土25%,Ⅲ度烧伤面积63%士34%且有中度吸入性损伤;入院时所有患者已出现创面溶痂,大部分患者分别或同时有休克、严重高钠血症、白细胞总数低、低蛋白血症、应激性溃疡出血等并发症.治疗措施包括:①入院后尽快行相关检查,掌握病情;尽快处理休克和严重高钠血症等危及生命并发症.②尽快手术封闭创面.③加强抗感染治疗的同时,积极实施器官功能及免疫支持.结果:入院后并发症得到迅速纠正,大部分患者顺利恢复.5例Ⅲ度烧伤面积≥95%患者伤后2周左右始出现脓毒症和器官功能不全.经积极对症处理和器官支持等治疗3例治愈,2例分别因自体皮极度匮乏和急性乙型肝炎而死亡.结论:成批烧伤中的危重患者长途转运后极易出现危及生命的并发症;掌握并发症发生特点并及早处理是成功救治的关键.     

重大事故中成批黄磷烧伤患者的救治

目的 总结成批黄磷爆炸致烧伤的特点及救治经过,为今后应急抢救积累经验. 方法 收集整理与本次特大黄磷烧伤事故相关的资料,分析总结成批黄磷烧伤患者的伤情特点及处置经过. 结果 本次事故共造成81人受伤,其中男72人、女9人,年龄5～42岁[(24±13)岁],烧伤面积0.4%～70.0%[(9±11)%],Ⅲ/Ⅳ度烧伤面积为0.4%～60.0%TBSA[(7±10)%TBSA].大部分患者伴有磷中毒表现;27例肝功能异常占33.3%,15例肾功能异常占18.5%;42例电解质紊乱占51.9%.烧伤面积＞10%且≤20%TBSA的8例患者中,有6例伴心肌酶谱升高;6例出现贫血,其中3例为进行性贫血;1例于伤后48 h出现窒息;1例发生消化道应激性溃疡.72例患者于伤后4 d内行切削痂植皮手术.部分患者遗留瘢痕及手部功能障碍,3例患者部分截指.无一例患者死亡. 结论 黄磷爆炸易导致周围人员头、手等暴露部位深度烧伤,并造成严重的中毒和内脏损伤.立即组织足够的专业医疗力量对成批患者进行急救,尽早清除创面坏死组织、促进毒素排泄等,是抢救成功的关键.     

自体网状皮移植修复大面积深度烧伤患者四肢关节创面32例

临床资料:笔者单位收治大面积深度烧伤合并上、下肢关节部位烧伤(不含严重的开放性关节损伤)的患者32例,其中男23例、女9例.年龄1岁半～72岁,平均31.5岁.烧伤面积50%～60%TBSA 12例,61%～70%TBSA 10例,71%～80%TBSA 7例,>80%TBSA 3例,均为深Ⅱ、Ⅲ度烧伤,其中Ⅲ度面积为(24±15)%TBSA.关节部位创面共计65个,包括深Ⅱ度创面23个,混合深Ⅱ、Ⅲ度创面32个,Ⅲ度创面10个, 其中感染创面12个.     

舌骨固定法颈部皮片移植术

本组患者19例,其中男13例、女6例,年龄2~60岁。致伤原因:火焰烧伤10例,热液烫伤1例,硫酸烧伤2例,热排气筒烫伤1例,颈部瘢痕5例。颈部均为Ⅲ度烧伤创面,面积1%~2%TBSA,见图1。移植部位供皮区为侧胸壁、腹部、大腿。图1颈部瘢痕手术前手术方法:患者在全身麻醉下取平卧位,颈部后仰     

整形修复治疗在手部烧伤瘢痕挛缩畸形患者中的应用效果

探究对手部烧伤瘢痕挛缩畸形患者实施整形修复治疗的效果。方法 选取我院2020年 8月-2023年8月收治的52例手部烧伤瘢痕挛缩畸形患者为研究对象,随机分为参照组和观察组,各26例。 参照组给予常规手术治疗,观察组给予整形修复治疗,比较两组临床疗效、生活质量及外观满意度。 结果 观察组治疗总有效率为92.31%,高于参照组的69.23%,差异有统计学意义（P ＜0.05）;观察组治 疗后生活质量各项评分均高于参照组,差异有统计学意义（P＜0.05）;观察组外观满意度为88.46%,高于 参照组的57.69%,差异有统计学意义（P ＜0.05）。结论 整形修复治疗在手部烧伤瘢痕挛缩畸形患者中的 应用效果确切,可有效减轻瘢痕,恢复患者的手部功能,有利于提高外观满意度,对于改善患者的生活质 量具有积极作用。     

Patient‐reported scar quality of adults after burn injuries: A five‐year multicenter follow‐up study

Scar formation is an important adverse consequence of burns. How patients appraise their scar quality is often studied shortly after sustaining the injury, but information in the long‐term is scarce. Our aim was, therefore, to evaluate long‐term patient‐reported quality of burn scars. Adults with a burn center admission of ≥1 day between August 2011 and September 2012 were invited to complete a questionnaire on long‐term consequences of burns. We enriched this sample with patients with severe burns (>20% total body surface area [TBSA] burned or TBSA full thickness >5%) treated between January 2010 and March 2013. Self‐reported scar quality was assessed with the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS). Patients completed this scale for their—in their opinion—most severe scar ≥5 years after burns. This study included 251 patients with a mean %TBSA burned of 10%. The vast majority (91.4%) reported at least minor differences with normal skin (POSAS item score ≥2) on one or more scar characteristics and 78.9% of the patients’ overall opinion was that their scar deviated from normal skin. Patients with severe burns had higher POSAS scores, representing worse scar quality, than patients with mild/intermediate burns, except for color, which was high in both groups. A longer hospital stay predicted reduced scar quality (both mean POSAS and mean overall opinion of the scar) in multivariate analyses. In addition, female gender was also associated with a poorer overall opinion of the scar. In conclusion, this study provides new insights in long‐term scar quality. Scars differed from normal skin in a large part of the burn population more than 5 years after burns, especially in those with severe burns. Female gender is associated with a poorer patients’ overall opinion of their scar, which may be an indication of gender differences in perception of scar quality after burns.     

烧伤整形术后感染的危险因素与对策分析

目的:探讨烧伤整形术后感染的危险因素及预防对策。方法:选取烧伤整形术后感染者53例作为感染组及50例未感染者为对照组,分析术后感染的危险因素及预防对策。结果:多因素Logstic回归分析表明,联合使用2种及以上抗生素(OR=2.622,P0.05),手术时间≥200min(OR=2.800,P0.05),术后有瘢痕(OR=3.433,P0.05),术后有残余创面(OR=2.703,P0.05)均为烧伤整形术后院内感染的独立危险因素。烧伤整形术后感染的主要病原菌为金黄色葡萄球菌(26.42%)、铜绿假单胞菌(30.19%)及大肠埃希菌(20.75%)。结论:烧伤整形术后感染的危险因素主要包括抗生素使用种类过多、手术时间过长及瘢痕及残余创面,合理使用抗生素、缩短手术时间及消除瘢痕及残余创面可作为烧伤整形术后感染的预防对策。     

微信式延续性护理对青年女性头面部烧伤后瘢痕整形患者体象认知及应对方式的影响分析

目的:探究微信式延续性护理对头面部烧伤后瘢痕整形青年女性患者体象认知及应对方式的影响。方法:选取笔者医院2017年1月-2018年3月收治的面部烧伤后瘢痕整形青年女性患者96例,随机分为对照组和观察组,每组48例。观察组采用微信式延续性护理;对照组采用常规护理。两组均随访6个月。比较两组患者心理状态、体象认知、生活质量、应对方式及满意度。结果:干预后,两组患者的焦虑自评量表(Self-rating anxiety scale,SAS)、抑郁自评量表(Self-rating depression scale,SDS)、体象障碍自评量表(Body image rating scale,BIRS)评分均较干预前降低,且观察组患者的SAS、SDS及BIRS评分均低于对照组,差异有统计学意义(P<0.05)。干预后,两组患者的面对得分较干预前均升高,回避、屈服得分较干预前均降低,且观察组患者的面对得分高于对照组,回避、屈服得分均低于对照组,差异均有统计学意义(P<0.05)。随访结束后两组患者生活状态、心理功能、躯体功能、社会功能得分均较干预前升高,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组的手术效果、护理工作、生活质量、自信心满意度均高于对照组,差异有统计学意义(P<0.05)。结论:微信式延续性护理可有效提高头面部烧伤后瘢痕整形青年女性患者出院后体象认知及对面部烧伤的应对能力,进而改善其心理状态及生活质量,取得患者认可,值得临床推广应用。     

The use of a polylactide‐based copolymer as a temporary skin substitute in deep dermal burns: 1‐year follow‐up results of a prospective clinical noninferiority trial

Deep dermal burns can be covered with different kind of materials and techniques; one of them is a polylactide‐based temporary skin substitute. The aim of this study was to intraindividually compare its 1‐year outcome with the results obtained by use of autologous skin grafts in patients suffering from deep dermal burns. A prospective noninferiority trial was designed in order to assess skin quality and scar formation by use of subjective (Vancouver Scar Scale; Patient and Observer Scar Assessment Scale) and objective (noninvasive cutometry) burn scar assessment tools. All items of the Patient and Observer Scar Assessment Scale, except vascularity, were found to be noninferior in the areas covered with the temporary skin substitute vs. autologous skin. Results of objective scar evaluation showed comparable viscoelastic parameters without reaching noninferiority. Overall, the outcome of deep dermal burns covered with a polylactide‐based temporary skin substitute revealed satisfactory results in terms of scar formation and skin quality as compared with autologous skin. This paper supports its use in deep dermal burns, where autologous skin donor sites require either to be reserved for coverage of full‐thickness skin defects in severe burns or to be saved for reduction of additional morbidity in selected patient collectives.     

Assessment and determinants of global outcomes among 445 mass-casualty burn survivors: A 2-year retrospective cohort study in Taiwan

PurposeTo study outcomes among survivors of the mass-casualty powder explosion on 27 June 2015, at Formosa Fun Coast Waterpark, New Taipei City, Taiwan.MethodsUsing retrospective data on Taiwanese survivors, we analyzed prehospital management, burns assessment and prognosis, functional recovery, and medical costs, followed-up through 30 June 2017. We related outcomes to burn extent, categorized according to the percentages of total body surface area with second/third-degree burns (%TBSA) or autologous split-thickness skin grafts (%STSG), and an investigational scale: f{SASG} = (%TBSA + %STSG)/2, stratified by %STSG. Analyses included casualty dispersal, comparisons between %TBSA, %STSG and f{SASG}, and their relationships with length of hospitalization, times to rehabilitation and social/school re-entry, physical/mental disability, and medical costs. We also investigated how burn scars restricting joint mobility affected rehabilitation duration.Results445 hospitalized casualties (excluding 16 foreigners, 23 with 0% TBSA and 15 fatalities) aged 12–38 years, had mean TBSA of 41.1%. Hospitalization and functional recovery durations correlated with %TBSA, %STSG and f{SASG} – mean length of stay per %TBSA was 1.5 days; more numerous burn scar contractures prolonged rehabilitation. Females had worse burns than males, longer hospitalization and rehabilitation, and later school/social re-entry; at follow-up, 62.3% versus 37.7% had disabilities and 57.7% versus 42.3% suffered mental trauma (all p ≤ 0.001). Disabilities affecting 225/227 people were skin-related; 34 were severely disabled but 193 had mild/moderate impairments. The prevalence of stress-related and mood disorders increased with burn extent. Treatment costs (mean USD-equivalents ∼$48,977/patient, ∼$1192/%TBSA) increased with burn severity; however, the highest %TBSA, %STSG and f{SASG} categories accounted for <10% of total costs, whereas TBSA 41–80% accounted for 73.2%.ConclusionsBesides %TBSA, skin-graft requirements and burn scar contractures are complementary determinants of medium/long-term outcomes. We recommend further elucidation of factors that influence burn survivors’ recovery, long-term physical and mental well-being, and quality of life.     

Release of burn scar contractures of the neck in paediatric patients

Burn scar contractures of the neck represent a continuing problem for plastic surgeons. A review of 143 neck-release procedures performed at the Cincinnati Shriners Burns Institute documented a high rate of contracture recurrence. This was especially true in those patients who had previously suffered burns to the entire anterior neck. Treatment of this condition with Z-plasties, or releasing incisions with split thickness skin grafts, had a recurrence rate of 81 per cent and 62 per cent, respectively. The use of a neck hyper-extension brace for over 1 year following skin grafting decreased the recurrence rate to 17 per cent. In patients who were not compliant in wearing a brace, the best result was obtained by using a full thickness skin graft in the release site. Contractures resulting from smaller burns were successfully handled by a variety of techniques.     

Flaminal® versus Flamazine® in the treatment of partial thickness burns: A randomized controlled trial on clinical effectiveness and scar quality (FLAM study)

Although partial thickness burns are the most frequently reported burn injuries, there is no consensus on the optimal treatment. The objective of this study was to compare the clinical effectiveness and scar quality of Flaminal® Forte to silver sulfadiazine (Flamazine®) in the treatment of partial thickness burns. In this two‐arm open label multicenter randomized controlled trial, adult patients with acute partial thickness burns and an affected total body surface area of less than 30% were randomized between Flaminal® Forte and Flamazine® and followed for 12 months. Dressing changes in the Flamazine® group were performed daily, and in the Flaminal® group during the first 3 days post burn and thereafter every other day until complete wound healing or surgery. Forty‐one patients were randomly allocated to Flaminal® Forte and 48 patients to Flamazine®. The primary outcome was time to wound healing, which did not differ between the groups: median 18 days with Flaminal® Forte (range 8–49 days) versus 16 days with Flamazine® (range 7–48 days; p = 0.24). Regarding the secondary outcomes during hospital admission, there were no statistically significant differences between the groups concerning need for surgery, pain scores, pruritus, or pain‐related and anticipatory anxiety. More patients in the Flaminal® group developed wound colonization (78% versus 32%, p < 0.001), but the treatment groups did not differ regarding the incidence of local infections and use of systemic antibiotics. In terms of scar quality, no statistically significant differences between both treatment groups were found regarding subjective scar assessment (Patient and Observer Scar Assessment Scale (POSAS)), scar melanin and pigmentation (DermaSpectrometer®), and scar elasticity and maximal extension (Cutometer®) during 12 month postburn. In conclusion, time to wound healing did not differ, but the use of Flaminal® Forte seemed favorable because less dressing changes are needed which lowers the burden of wound care.     

早期整形手术治疗手部深度烧伤的临床效果

目的 分析对手部深度烧伤患者应用早期整形手术治疗的临床效果。方法 选取我院2021年 4月-2023年2月收治的50例手部深度烧伤患者为研究对象，随机分为常规组和研究组，每组25例。常规组 给予延期手术，即在创面溶痂后行整形手术，研究组给予早期整形手术，即在烧伤后48 h内行整形手术， 比较两组临床疗效、手部恢复情况、愈合指标、生活质量及并发症发生情况。结果 研究组治疗总有效率 为92.00%，高于常规组的64.00%（P＜0.05）；研究组术后瘙痒评分低于于常规组，功能及外观评分均高 于常规组（P＜0.05）；研究组愈合时间、VAS评分及手功能改善时间均优于常规组（P＜0.05）；研究组 术后精神健康、社会功能、日常生活及躯体功能评分均高于常规组（P＜0.05）；研究组并发症发生率为 20.00%，低于常规组的48.00%（P＜0.05）。结论 针对手部深度烧伤患者应在烧伤后48 h内立即进行早期整 形手术，能有效改善患者手部功能及外观，促进手部恢复，有利于缩短手功能改善时间，促进愈合，减轻 疼痛，同时有效提升了患者预后的生活质量，且并发症发生几率较低，安全性较高。     

Paediatric burns caused by other children.

OBJECTIVE: Children with burns inflicted by other children represent a small proportion of referrals to our paediatric burns unit. The aim of this paper is to investigate any differences between them. DESIGN: Prospective observational audit. PARTICIPANTS: Children admitted between January 1998 and December 2003. RESULTS: Forty-seven patients were admitted to our paediatric burns unit with burns inflicted by other children, of which 38 were male. Scalds were the cause of 53% of all the injuries. Two distinct groups were identified; one group had their burns inflicted by other children accidentally (Group A) and another reported their burns as inflicted by other children intentionally (Group B). The majority had less than 10% total body surface area (TBSA) burns sustained at home. Thirteen patients (27.7%) were reported as deliberate (Group B). The majority in Group B were males (90.9%, P>0.0001) with a median age of 12 years (P>0.0001) who sustained flame burns (P>0.0001) outdoors with a greater %TBSA (mean 12.1% versus 3.8% for Group A) and higher percentage of full thickness burns (38.5% versus 20.6% of group A). More children from Group B had separated parents (53.9% versus 5.9%) and came from poorer socioeconomic backgrounds (69.2% versus 8.8%). All the cases that required ITU admission came from this category. These patients required more surgery as compared to the accidental group (61.5% versus 26.4%). Children from Group B required prolonged periods of outpatient follow up (53.8% versus 14.7% from Group A) and a greater proportion of these children failed to keep outpatient follow-up appointments as compared to the accidental group (38.5% versus 23.5% of Group A, P=0.0007). CONCLUSION: Older male children sustained significant burns outside their homes. They reported them as being deliberate assaults, although on closer inspection of the circumstances it was difficult to support their account of the events.     

植皮手术联合瘢痕整形对烧伤患者美容效果的影响

目的 分析植皮手术联合瘢痕整形术对烧伤患者美容效果的影响。方法 选取我院2018年 9月-2022年9月收治的80例深度烧伤患者为研究对象，借助随机数字表法分成对照组（自体中厚片移植 术，40例）与观察组（植皮手术+瘢痕整形，40例），比较两组临床手术指标、美容满意度、瘢痕恢复情 况、瘢痕增生程度。结果 观察组二次手术率为2.55%，低于对照组24.00%，皮片存活率为97.50%，高于 对照组的85.00%，差异有统计学意义（P＜0.05）；观察组美容满意度为92.50%，高于对照组的70.00%， 差异有统计学意义（P＜0.05）；观察组术后血管分布、色泽、皮肤弹性、平整度、柔软度、厚度等恢复 情况均优于对照组，差异有统计学意义（P＜0.05）；观察组瘢痕增生程度低于对照组，差异有统计学意 义（P＜0.05）。结论 烧伤患者接受植皮手术与瘢痕整形术联合治疗后，可提高美容效果，确保瘢痕组织 恢复良好，降低增生程度，一次性手术成功率较高，更符合患者对身体美观度的需求，满意度较高，是一 项值得临床应用的手术方案。