A clinico-epidemiological study of rescuer burns

Rescuer burn is a relatively newer terminology introduced to define the burns sustained by a person attempting to rescue a primary burn victim. Few studies have been published thus far on this peculiar type of burns. Due to the general neglect of the rescuer burns victim and discontinuation of treatment in most cases, once the primary victim dies, the rescuer often ends up in badly infected wounds and has a delayed return to work. A prospective study was conducted at the B J Medical College and Civil Hospital, Ahmedabad from January 2009 to December 2012 on the rescuer burns patients treated in its burns and plastic surgery department. 3074 patients of burns received treatment during the period of study. Of these, 48 patients gave the history of sustaining burns while trying to rescue a burns victim. Male to female ratio of rescuers was approximately 7:1. It was significantly higher as compared to the ratio of 1:0.8 of females to male burn victims observed at our centre (p ≤ 0.01). Average age of the rescuers was higher in males as compared to females but the difference was not significant (p ≥ 0.05). Of the 45 cases of female primary burns victims, male rescuer was husband of the primary victim in 41/45 cases (91.1%), mother was rescuer in three cases (6.6% cases) and sister was rescuer in one case. Though multiple people came to rescue a burns victim, in all cases, it was seen that it was the first rescuer who sustained burns himself or herself. None of the rescuers had any knowledge of the techniques and precautions to be taken while performing a rescue operation irrespective of their education status, indirectly pointing to the lack of any teaching on burns rescue in the school education curriculum.     

Epidemiological analysis of patients with burns in third‐line hospitals in Turkey

Burns are a major health problem worldwide. Burn injury resulting from making contact with hot objects, direct or indirect contact with flame, and exposure to chemical agents or electric current is usually preventable. In this study, epidemiological data of the patients who had been hospitalised in the burn unit was assessed. The records of 1453 patients who were admitted to the burn unit of Diyarbakir Gazi Yaşargil Training and Research Hospital between July 2008 and April 2018 were retrospectively examined. Out of 1453 cases, 81.7% (1187) were children and 18.3% (266) were adults, 58.3% of the cases were male (847) and 41.7% (606) were females. Patients had a mean age of 11 ± 5 years (1‐81 years). The most common cause of burns was contact with hot liquids (82.86%) while other causes were flame burns (12.04%), electrical contact burn (3.02%) contact with chemical substances (2.06%). Most of the cases were found to have burned 10% to 20% of the body surface. Localization was most frequently seen in the lower extremity and less frequently in the upper limb, trunk, head and neck, and perineal regions. The majority of burn injuries are preventable. Therefore, epidemiological studies in the field of burns will provide vital preventive information to develop strategies to reduce injury frequency and spend on health. Because burns are a social problem, prevention efforts require social co‐operation. Promotional meetings in schools are important to increase family‐school cooperation to inform children of school age, to give lectures and first aid measures to rural areas.     

Flow-through anterolateral thigh flap for reconstruction in electrical burns of the severely damaged upper extremity

Background

Many surgeons have to face the challenge of the sophisticated management of catastrophic high-voltage injuries to upper extremities. These patients present with both vast soft tissue defects and varied segmental main artery defects with compromised circulation of the distal limb. This study is a first attempt to analyze the outcome of the flow-through anterolateral thigh flap for reconstruction in acute electrical burns of the severely traumatized upper extremity.

Method and patient

From March 2001 to February 2012, five men were enrolled in the study. All in this series suffered from high voltage current (higher than 1000 V) electrical burn and had the presence of wide segmental soft tissue defects, exposure of underlying vital structures and segmental artery injury with compromised circulation. Flow-through anterolateral thigh flaps were used for limb salvage.

Result

Follow up for all patients was present from 6 months to 7 years. The mean age was 37.8 years old. The mean timing of free flap transfer was 5.8 days after injury. The mean flap sizes were 31.6 cm × 16.5 cm. The mean artery defect was 14.2 cm in length. Venous thrombosis occurred 1 day post-operatively in one patient. No donor site morbidity was noted. In the postoperative period, no infection, no hematoma, nor deaths were noted. Successful limb salvage rate was 80% in this series.

Conclusion

In electrical injuries of the severely damaged upper extremity, flow through anterolateral thigh flaps provide for reconstruction of both the vessels and soft tissue simultaneously. Although the risk of flap failure is higher than with other etiologies of burn, the data shows that the above reconstruction technique is useful for upper extremity salvage.     

Five-year epidemiology of liquefied petroleum gas-related burns

Background

The incidence of liquefied petroleum gas (LPG)-related burns has increased over recent years, and it has become a serious public health issue in developing countries such as India and Turkey. This paper aims to investigate the epidemiological characteristics of LPG-related burns to provide assistance and suggestions for planning prevention strategies.

Antibiotic ointment versus a silver-based dressing for children with extremity burns: A randomized controlled study

IntroductionAntibiotic or silver-based dressings are widely used in burn wound care. Our standard method of dressing pediatric extremity burn wounds consists of an antibiotic ointment or nystatin ointment-impregnated nonadherent gauze (primary layer), followed by rolled gauze, soft cast pad, plaster and soft casting tape (3M? Scotchcast?, St. Paul, MN). The aim of this study was to compare our standard ointment-based primary layer versus Mepitel Ag^® (Mölnlycke Health Care, Gothenburg, Sweden) in the management of pediatric upper and lower extremity burn wounds.MethodsChildren with a new burn injury to the upper or lower extremities, who presented to the burn clinic were eligible. Eligible children were enrolled and randomized, stratified by burn thickness, to be dressed in an ointment-based dressing or Mepitel Ag®. Study personnel and participants were not blinded to the dressing assignment after randomization. Dressings were changed approximately once or twice per week, until the burn wound was healed or skin-grafted. The primary outcome was time to wound healing and p-value < 0.05 was considered significant.ResultsNinety-six children with 113 upper or lower extremity burns were included in the analysis. Mepitel Ag® (hazard ratio [HR] 0.57 (95% Confidence Interval (CI) 0.40–0.82); p = 0.002) significantly reduced the rate of wound healing, adjusting for burn thickness and fungal wound infection. The incidence of fungal wound infections and skin grafting was similar between the two groups. Children randomized to standard ointment dressings were significantly less likely to require four or more burn clinic visits than those in the Mepitel Ag^® (4% versus 27%; p = 0.004).ConclusionOur study shows that our standard ointment-based dressing significantly increases the rate of wound healing compared to Mepitel Ag^® for pediatric extremity burn injuries.Level of evidenceTreatment study; Level 1.     

Explosive burns during abusive inhalation of butane gas.

Explosion burns during abusive inhalation of butane gas rarely occurred in the past, but recently it has become a social problem among groups of teenagers. This cause constitutes 1.6% of admissions due to flame burn at the burn unit of Hallym Medical Center. A retrospective review during a five-year period identified 48 patients. The male to female ratio was 3:1. The mean age of patients was 16 years and 8 months. The places where the accidents occurred were commonly bedrooms or motel rooms. There were nine group settings of 27 patients at the time of the accident. Inhalation injury (n = 12) was noted on admission. The average burn size was 28.5 percent of the total body surface area. All patients sustained burn injury on the face, arms and hands and 24 patients among them had extended burn areas on the trunk and/or lower extremity. 22 patients (mean hospital stay; 51.6 d) required skin grafting and 12 patients (mean hospital stay; 22.3 d) were treated with conservative management. The mortality rate was 10.4 percent. Explosion burns during abusive inhalation of butane gas can result in mortality as well as major burn injuries.     

Children's post-burn scars in Mongolia

This study aimed to identify some risk factors for post-burn scarring in children aged 0–18 years. One hundred and eighty two participants were involved in this cohort study. Under the age of 18 who were admitted to the Department of Burn Reconstructive Surgery with a diagnosis of upper and lower extremity burns were followed for 6 months. A total of 182 participants (62.1% male, and 37.9% female participants) enrolled in this study. Age ranged from 1 to 17 and the average age was 3.95 ± 3.35. The degree of burn and the anatomical location of the burn had a statistically significant effect on the development of hypertrophic scars. The length of the patient's hospitalisation days and the area of ​​the burn were statistically correlated with wound healing (P = 000, P = .074). For example, the average length of hospitalisation days was 8 ± 5 days in the hypertrophic scars group of patients, and in the group with normal scars, average bed days were 6 ± 3 days (P = .000). Grade IIIb burns increased the risk of hypertrophic scar development by 4.9 times and grade IV burns increased it by 2.5 times. In addition, when the area of burns was 11% or more, the risk of hypertrophic scar development was increased by 58.8%. In the case of wound swab infection, the risk of hypertrophic scar development was 12.4% higher (B = 1.124, 95 EI = 0.55; 2.28, P = .748). Participants' age, burn area and degree of burn are statistically significant risk factors for post-burn scarring in children aged 0–18 years.     

The last 10 years in a burn centre in Ankara, Turkey: an analysis of 5264 cases

This is a retrospective study analysing 5264 patients treated in the burn centre at Gülhane Military Medical Academy from 1 January 1986 to 31 December 1995. Our burn centre is not only the firs, but one of the best established and supported in Turkey. Our present study has the largest patient group of other previously published studies from Turkey. Of the total patients studied, 4464 patients had minor burns and were treated on an outpatient basis and 800 patients had moderate to major burns. Although our centre is in a military area in Ankara, only 1047 (20 per cent) patients were military personnel and the military-related burn causes comprised only 6 per cent of the total. The remaining 4217 (80 per cent of the total patients) were civilians. Flame injuries were also more frequent in military patients than civilians. Minor burns were most common in the age group 0–10 years old (40 per cent) and moderate to major burns in the age group 21–30 years (54 per cent). Scalds were the main cause of paediatric burns. Male patients were dominant. The overall mortality among inpatients was 18.2 per cent and mean total body surface area (TBSA) was 57.6 per cent in patients who died. 134 patients demonstrated inhalation injury and 82 per cent of these patients died. The epidemiological pattern of our patients is similar to that in other studies from developed countries, although some ethnic causative factors could be found. Our study indicates that emergency measures should be taken to prevent flame injuries at military barracks and industrial workplaces and scalding accidents to children at home and throughout the country.     

Pediatric burns in military hospitals of China from 2001 to 2007: A retrospective study

BackgroundChildhood burns are a global health problem. To date, no epidemiological study with a large sample size of hospitalized pediatric burn patients from the Chinese mainland has been conducted. This study retrospectively analyzed pediatric burn cases to identify the characteristics of pediatric burns and their risk factors in China.MethodsData for pediatric burn inpatients younger than 14 years were retrieved from the Chinese Trauma Databank (CTDB). The epidemiological characteristics of pediatric burns and risk factors for mortality were analyzed.ResultsA total of 61,068 cases were included in the study. Children under 3 years old were at the highest risk of injury. Scalds were the commonest burns (87.59%). Flame burns occurred more in winter, and electrical burns occurred mainly in July and August. Age, etiology, depth of injury, total body surface area (TBSA), site of injury, and outcome were correlated with length of hospital stay. Risk factors for pediatric burn mortality included being male, having third degree burns, ≥30% TBSA, and having multi-site burns.ConclusionThe results showed the epidemiological characteristics of pediatric burns in China, which differ from those reported for other countries and regions. These characteristics can be used to develop measures to prevent pediatric burns.     

Subeschar clysis in deep burns

Six hundred thirteen patients with deep burn of up to 50% total body surface area (TBSA) were treated with 0.25% povidone iodine subeschar clysis (PVP-SEC) in addition to surface application of povidone iodine + Neosporin in the form of “crust”. The results were compared with those of 595 age, sex and percentage of burn, matched patients treated only by “crust application”. The quantitative bacterial count showed significantly less incidence of infection on the 7th and 8th days post treatment (P<0.001). The organisms identified were predominately Staphylcocous aureus and Pseudomonas aeroginosa. Significantly more number of patients, with burns up to 50% TBSA, could be grafted within 20 days in the SEC group. The graft acceptance rate in this group was 90%.     

Epidemiological study of burn patients hospitalised at a burns centre,Manipal

Burn injuries constitute a major public health problem and account for a significant cause of mortality and morbidity amongst the Indian population. This 2‐year prospective study was undertaken to find out the exact epidemiological determinants of 737 patients admitted with burn injuries and, thus, to try and formulate effective preventive strategies. This study was conducted in the department of plastic surgery and burns from September 2011 to June 2013. All consecutive patients with major burns admitted for in‐hospital treatment during the study period were included in the study. The data collected included age, gender, cause and mode of burns, total burn surface area (TBSA), microbiological profile and outcome. More than 55% of the patients were female (58.61%). The mean age was 31.3 years ranging from 8 months to 89 years. A higher number of females (97.5%) sustained burn injuries at home compared with 36.11% males sustaining injuries outdoors. (P = 0.000). Almost one third of injuries (40.36%) occurred between 4 pm and 8 pm, followed by 28% between 7 am and 12 noon. Synthetic garments were worn by 70% of females at the time of injury, whereas 40% of males had worn mixed clothing (P = 0.000). Flame injuries contributed to 80.1% of burns in females (P = 0.006). The rate of electrical injuries (9.8%) was significantly higher in males (P = 0.005). In almost 40% of males, TBSA was <19%, whereas in 40% of females, TBSA was >68%. (P = 0.004). Microbial profile showed that pseudomonas aeruginosa (n = 260; 35.3%), Klebsiella pneumoniae (n = 209; 28.5%), and Escherichia coli (n = 145; 22.6%) were the most frequent types of Staphylococci bacterial growths. The cause for burn injury was ignition of clothes in 68.74% females, and in 35.48% males, it was because of an attempt to save other burn injury victims (P = 0.013) The case fatality rate was 29.3%. A majority of the males (60.7%) recovered, whereas 45.89% of females succumbed because of their burn injury. (P = 0.001). As the aetiological factors of burn injuries vary considerably in different communities, careful study of the pattern in every community is needed before a sound prevention programme can be planned and implemented. Hence, this study was conducted to assess epidemiological, modes, causes, and risk factors and the microbial profile of burn injuries and to study the outcomes.     

Epidemiology of childhood burns in the burn unit of Ain Shams University in Cairo, Egypt

Childhood burns in Egypt are a significant problem, especially in families of low socioeconomic status. These families live in overcrowded flats, which lack proper hygiene and tend to use kerosene stoves, which lack any safety measures. Three hundred and five burned children presented to the burn unit of Ain Shams University over a 20 month period. Proportionately more boys than girls were injured. There was an increase in the incidence between the ages of 4 to 6 years. Scalds formed 56.7% of the cause of burns, while 38.6% were due to flame. In 3 and 1.6% the cause of burn was electrical and chemical, respectively. 20 patients were victims of industrial accidents showing a major problem of entrance of children between 8–15 years of lower socioeconomic class into the labor force. 87.2% of the patients had minor burns while 13 children (4.3%) died of the consequences of burns during the period of the study.     

Pattern of burns in child abuse

Cases of burns from child abuse are low because of under-reporting, low index of suspicion, or lack of verity proof. Although the reported incidence of child abuse by burns is 4 to 39 per cent, less than one-half are substantiated. We retrospectively reviewed all burns in children less than 6 years old admitted to our burn center within an 8-year period (1997-2003). Of the 155 children less than 6 years old admitted with burns within the study period, only six cases (3.8%) were confirmed as occurring from abuse. Scald injury was the most common cause of accidental and abuse burns. Burns by child abuse occur mostly from tap water (50%) and usually in children less than 2 years old. Whenever the extremities were involved, the left side was always included. In extreme cases, however, multiple areas of the body were involved with intervening spared sites. The perpetrator was the mother's boyfriend in all cases. Burns in children less than 2 years old left in the care of the mother's boyfriend, involving the left extremity (or extremities), and caused by tap water should prompt the clinician to more actively confirm or exclude abuse.     

Self-inflicted burns

During the last few years, a unique group of patients was recognized among the burn patients treated in our institution. They were all young men with small, isolated, lower-extremity burns that, in appearance, were not compatible with the claimed etiology. In an attempt to characterize these patients, we retrospectively screened the charts of all isolated lower extremity burn patients in our Plastic Surgery Department during a 2-year period, comparing the suspicious burns to our other patients. We found that there were 25 patients out of 56 that were suspected of having self-inflicted burns. All the patients in this group were male soldiers, with a mean age of 19.5 years. The length of hospitalization per percentage of burn was longer in these patients than in the other patients. We feel that this group of patients is a recognizable subunit that should be treated both by physicians and psychologists.     

Pediatric instant noodle burns: A ten-year single center retrospective study

IntroductionChildren are particularly vulnerable to scald injuries, and hot beverages/foods are often implicated in this subset of pediatric burns. Burns from instant noodles are common and thus an attractive target for burn prevention. The purpose of this study is to characterize the frequency, demographics, outcomes, and circumstances of pediatric instant noodle burns to guide future educational and prevention efforts.MethodsThis is a retrospective review of all pediatric patients (<18 years) admitted to the University of Chicago Burn Center with a diagnosis of scald injury between 2010 and 2020. Burns caused by instant noodles were identified and compared to all other scald burns over this period.ResultsAmong 790 pediatric scald burns, 245 (31.0 %) were attributed to instant noodles. Compared to other scalds, patients with instant noodle burns were older (5.4 vs. 3.8 years, p < 0.001), equally likely to be male (51 % vs. 54 %, p = 0.488), and more likely to be Black/African American (90.6 % vs. 75.2 %, p < 0.001). Patients with instant noodle burns lived in zip codes with a lower average childhood opportunity index score (9.9 vs. 14.6, p < 0.001). In terms of circumstances, children with instant noodle burns were more likely to be unsupervised at the time of injury (37 % vs 21 %, p < 0.001). Instant noodle burns were smaller (3.6 % total body surface area (TBSA) vs. 5.8 % TBSA, p < 0.001) and less likely to require operative intervention (29 % vs. 41 %, p < 0.001). Instant noodle burns had a shorter length of stay (4.2 days vs. 6.4 days, p < 0.001), but similar adjusted length of stay (1.7 days/%TBSA vs. 1.5 days/%TBSA, p = 0.18) and experienced similar complication rates (10 % vs. 15 %, p = 0.06).ConclusionInstant noodle burns comprised nearly one-third of all pediatric scald burn admissions at our institution, a higher proportion than previously reported. While less severe than other scald burns in this series, instant noodles injuries still demonstrated a need for hospitalization and operative intervention. Instant noodle burns disproportionately affected Black/African American patients, as well as from neighborhoods with lower socioeconomic status. These findings suggest that focused burn prevention efforts may be successful at reducing the incidence of these common, but serious injuries.     

Intramuscular pressure in the burned arm: measurement and response to escharotomy

Using a wick catheter technique, sequential measurements of intramuscular pressure were obtained in 31 burned arms in 18 patients. Abnormally high pressures were recorded in 90 percent of extremities and exceeded the potentially harmful level of 30 mm Hg in 42 percent. Correlation of intramuscular pressure with signs and symptoms of extremity compression, including Doppler pulses, was poor. Intramuscular pressure elevation appeared to parallel edema formation beneath the burn wound. A high incidence of pressure measurements in excess of 30 mm Hg was found in patients who had 30 percent or greater total body surface area injury (67 percent), 10 percent or greater full-thickness burns (75 percent), and extremities with circumferential involvement (57 percent). In every case escharotomy produced a dramatic decrease in intramuscular pressure, while a randomized group of extremities that were not decompressed developed sustained pressures as high as 64 mm Hg despite the presence of intact Doppler pulses. Extremities treated in this manner appeared slower in resolving edema and regaining motion and strength. Measurement of intramuscular pressure beneath the burn eschar is recommended in evaluating all patients at risk from extremity burns.     

An epidemiological analysis of paediatric burns in urban and rural areas in south central China

Objective

This study aims to analyse the epidemiology of paediatric burns in south central China, illustrate the differences between rural and urban areas, and discern prevention measures to reduce paediatric burns.

Methods

Data were obtained from all paediatric patients admitted to Department of Burns unit of Xiangya Hospital during 2009–2012. A retrospective review was performed, including cause of burn, pre-hospital treatment, place of burn occurrence, anatomical areas involved, extent of burn, date of injury, number of operations, complications, length of hospital stay, hospitalisation cost and cure rate.

Results

A total of 278 hospitalised paediatric patients were admitted in this study. The majority (56.47%) were 1–3 years old. Rural patients accounted for 67.99% in total; the ratio of boys to girls was 2.05. Scalding with hot fluids was the most common cause of burns in children (62.59%), followed by flame (17.63), fireworks (9.71%), electricity (5.76%) and other factors such as contact and chemical (4.32%). The living room was the location with the highest frequency of burns in children (53.24%). Burns were more likely to happen in winter and the upper extremities were the most involved anatomic site (53.24%). Total burn surface area (TBSA) ranging from 0% to 9% accounted for 55.4% in total. Rural patients underwent more operations and had longer and costlier hospital stays than urban patients.

Conclusion

Compared with treatment in urban areas, rural burn patients received less first-aid treatment, underwent more surgery, had more complications and longer and more costly hospital stays. This finding strongly suggests that it is necessary to make more efforts to prevent burns, especially in rural areas.     

Cryopreserved cadaveric allografts for treatment of unexcised partial thickness flame burns: clinical experience with 12 patients

Partial thickness burns (PTB) usually heal within 3 weeks. Prevention of infection and desiccation of the wounds are crucial for optimal healing. Early tangential excision of the burn eschar and allografting prevent deepening of the burns, and are therefore advocated for treatment with the best functional and aesthetic results. For superficial partial thickness burns (SPTB) conservative use of topical antimicrobial agents with frequent dressing changes are implemented. We compared the conservarive treatment for PTBs and SPTBs to grafting cryopreserved cadaveric allografts with no prior excision.

Twelve patients with flame PTB areas were allografted after mechanical debridement without excision of the burn wounds. The allografts were cadaveric skin cryopreserved by programmed freezing and stored at −180°C for 30–48 months. Matching burns for depth and area were treated with silver sulfadiazine (SSD) one to two times daily until healing or debridement and grafting were required.

It was found that 80 per cent of the cryopreserved allografts adhered well and 76 per cent of the treated areas healed within 21 days, whereas only 40 per cent of the SSD-treated burns healed within 21 days.

Partial thickness burns can be treated successfully with viable human allografts (cryopreserved cadaveric skin) with no prior surgical excision. The burn wounds heal well within 3 weeks. For deep partial thickness burns (DPTB) treatment with allografts has no advantage if they have not been previously excised.     

Sociodemographic and culture results of paediatric burns

Paediatric burn wounds are challenging conditions to manage for both the doctors and patients and can cause several complications entailing a complicated treatment and recovery process. This study aims to evaluate sociodemographic conditions and antibiogram culture results of paediatric burn wounds. Our study retrospectively evaluated 419 paediatric patients with burns regarding age, gender, burn area and degree, total days spent in hospital, surgical history, final condition, additional disease history, previous attempts, and culture results with their antibiotic resistances, haemogram results, C‐reactive protein results, sociocultural conditions, burned region of the body, and structure of the burn. The prominent observations were an increased rate of incidence in male patients and patients with low socioeconomic conditions, the highest incidence of burns from scalding and domestic accidents, and the highest incidence of third‐degree burns. Furthermore, even though the most encountered burn types were extremity burns, the burn types with the highest culture growth ratio were the perineum burns. The dominant culture growth bacterial group was coagulase‐negative staphylococcus, and the ratio of medication resistance was 67.8%. It is imperative to raise awareness regarding domestic accidents to prevent paediatric burn wounds. The mortality risk can be reduced by carefully monitoring multiple organ involvement and providing timely treatment. Moreover, appropriate wound care is warranted to avoid infection from skin flora.     

Patterns of grease burn injury: development of a classification system

Grease burns occur commonly in the home during food preparation. It has been our observation that grease burns follow a particular pattern of injury. The purpose of this study was to review our institutional experience in the management of these burns to develop a classification scheme. We performed a retrospective review of patients admitted to our burn center with grease burns. Subjects were identified through our database and their charts were reviewed with particular attention to burn distribution, TBSA and need for grafting. We excluded workplace burns and children under the age of six. A total of 249 patients who fit the above criteria were admitted with grease burns to our burn center from 1993 to 2003. The sequence of events leading to burn and its distribution followed a consistent pattern. The majority of patients (86%) had an isolated upper extremity burn or upper extremity burn in combination with a face, trunk or lower extremity burn. Forty percent of patients required at least one excision and grafting procedure. Grease burns associated with cooking at home follow predictable patterns of injury. Based on these patterns we proposed a classification system for domestic grease burns.