大面积深度烧伤休克期切痂植皮

目的探讨大面积深度烧伤休克期切痂植皮的必要性和可行性。方法自１９９１年１月至１９９７年６月选择伤后及时入院的１２例病人，烧伤面积平均７８．３％±１８．３％，Ⅲ度面积平均６９．２％±２６．８％，其中６例合并吸入性损伤，３例气管切开。开始手术时间为伤后３８．４±９．６小时，一次切痂面积３９．３％±８．７％，以尿量、心率、ＳａＯ２和ＣＶＰ为主要监护指标。结果术中术后各监护指标都较平稳。与条件相似的１９例非休克期切痂病人对比表明：休克期切痂病人愈合天数缩短１４天左右，内脏并发症及菌血症发生率低，治愈率高，平均每日住院费用降低。结论休克期大面积切痂植皮是可行的     

大面积深度烧伤休克期切痂植皮

目的 探讨大面积深度烧伤休克期切痂植皮的必要性和可行性。方法 自１９９１年１月至１９９７年６月选择伤后及时入院的１２例病人，烧伤面积平均７８．３％±１８．３，Ⅲ度面积平均６９．２％±２６．８％，其中６例合并吸入性损伤，３例气管切开。开始手术时间为伤后３８．４±９．６小时，一次切痂面积３９．３％±８．７％，以尿量、心率、ＳａＯ２和ＣＶＰ为主要监护指标。结果 术中术后各监护指标都较平稳。与条件相似的１     

休克期切削痂在儿童大面积烧伤的应用

目的阻止大量血浆丢失,减轻坏死组织对机体的毒性反应,降低大面积深度烧伤儿童的死亡率以及缩短住院时间。方法对20例大面积烧伤儿童施行了休克期切痴植皮术(A 组)。年龄5个月至12岁,烧伤总面积28％±11.4％,Ⅲ度面积23.1％±6.2％,开始手术时间平均伤后33小时,一次切痂面积16.1％±4.6％。为评价休克期切痂效果,随机选择18例非休克期切痂植皮大面积烧伤儿童作为对照(B 组)。结果两组比较,休克期切痂组治疗过程相对平稳,所用抗生素种类少、时间短,输血量少,平均每例少输血780 ml,创面换药次数少,愈合时间明显缩短,且内脏并发症减少。结论儿童大面积深度烧伤休克期切痂植皮可提高大面积深度烧伤儿童治愈率,减少住院经费。休克期切痂植皮术不仅可在较大医院及研究所实旋,也可在基层医院内实施。     

休克期切削痂在儿童大面积烧伤的应用

目的阻止大量血浆丢失，减轻坏死组织对机体的毒性反应，降低大面积深度烧伤儿童的死亡率以及缩短住院时间。方法对２０例大面积烧伤儿童施行了休克期切痂植皮术（Ａ组）。年龄５个月至１２岁，烧伤总面积２８％±１１．４％，Ⅲ度面积２３．１％±６．２％，开始手术时间平均伤后３３小时，一次切痂面积１６．１％±４．６％。为评价休克期切痂效果，随机选择１８例非休克期切痂植皮大面积烧伤儿童作为对照（Ｂ组）。结果两组比较，休克期切痂组治疗过程相对平稳，所用抗生素种类少、时间短，输血量少，平均每例少输血７８０ｍｌ，创面换药次数少，愈合时间明显缩短，且内脏并发症减少。结论儿童大面积深度烧伤休克期切痂植皮可提高大面积深度烧伤儿童治愈率，减少住院经费。休克期切痂植皮术不仅可在较大医院及研究所实施，也可在基层医院内实施     

休克期切痂在儿童大面积烧伤的应用

目的 阻止大量血浆丢失，减轻坏死组织对机体的毒性反应，降低大面积深度烧伤儿童的死亡率以及缩短住院时间。方法 对２０例大面积烧伤儿童施行了休克期切痂植皮术（Ａ组）。年龄５个月至１２岁，烧伤总面积２８％±１１．４％，Ⅲ度面积２３．１％±６．２％，开始手术时间平均伤后３３小时，一次切痂面积１６．１％±４．６％。为评价休克期切痂效果，随机选择１８例非休克期切痂植皮大面积烧伤儿童作为对照（Ｂ组）。结果 两组     

休克期切痂对烧伤并发症防治作用的临床分析

目的 探讨烧伤休克期切痂可行性及对并发症的防治作用。方法 对37例大面积烧伤休克期切痂植皮及42例非休克期切痂植皮患者，在脓毒症发生率，内脏并发症，多器官功能障碍（MODS）的发生率，死亡率及愈合时间多个方面进行比较分析。结果 37例休克期切痂植皮患者术后病情均稳定。脓毒症发生率，内脏并发症，MODS的发生率，死亡率低于非休克期切痂植皮组；休克期切痂植皮组较非休克期切痂植皮组愈合时间缩短。结论 休克期切痂植皮是治疗大面积烧伤的一种有效可行的方法，对大面积烧伤的严重并发症有明显防治作用。     

影响烧伤病人疗程的相关因素分析

目的探讨如何减少烧伤病人治愈时间,缩短住院日,降低病人的治疗费用。方法通过应用主成分分析的统计方法对我科７９１例病人进行回顾,试图找出与病人治愈时间密切相关的因素。结果烧伤面积的大小及深度、吸入性损伤、脓毒症、休克、内脏并发症、复合伤或合并伤和切痂面积、切痂时间、休克期切痂与否、抗生素应用时间等均是影响烧伤病人治愈时间和住院日的主要因素,进一步分析表明,休克期切痂病人内脏并发症及脓毒症的发生率低,治愈时间短,尤其是超过３０％烧伤面积者,休克期切痂组病人治愈时间明显少于非休克期切痂组病人。结论积极防治休克、脓毒症及内脏并发症的发生发展,合理应用抗生素等,而更重要的是大面积深度烧伤创面早期切削痂植皮等均是缩短病人治愈时间的有效手段。     

影响烧伤病人疗程的相关因素分析

目的探讨如何减少烧伤病人治愈时间,缩短住院日,降低病人的治疗费用。方法通过应用主成分分析的统计方法对我科791例病人进行回顾,试图找出与病人治愈时间密切相关的因素。结果烧伤面积的大小及深度、吸入性损伤、脓毒症、休克、内脏并发症、复合伤或合并伤和切痂面积、切痂时间、休克期切痂与否、抗生素应用时间等均是影响烧伤病人治愈时间和住院日的主要因素,进一步分析表明,休克期切痂病人内脏并发症及脓毒症的发生率低,治愈时间短,尤其是超过30%烧伤面积者,休克期切痂组病人治愈时间明显少于非休克期切痂组病人。结论积极防治休克、脓毒症及内脏并发症的发生发展,合理应用抗生素等,而更重要的是大面积深度烧伤创面早期切削痂植皮等均是缩短病人治愈时间的有效手段。     

依据临床指标对大面积烧伤病人施行休克期切痂植皮

目的验证依据临床指标对大面积烧伤病人施行休克期切痂植皮的可行性。方法对３３例大面积烧伤病人在无ＳｗａｎＧａｎｚ导管监测条件下,当获得下述临床标准时开始施行休克期切痂：①尿量８０～１００ｍｌ／ｈ;②意识清楚;③口渴明显减轻;④无消化道症状;⑤心率１００～１１０次／ｍｉｎ;⑥呼吸平稳,２０～２４次／ｍｉｎ;⑦血红蛋白≤１５０ｇ／Ｌ,红细胞压积≤０．５。与另３２例非休克期切痂组病人对比,观察两组病人脓毒症、ＭＯＤＳ的发生率和炎性介质内毒素（ＬＰＳ）、肿瘤坏死因子（ＴＮＦ）、血浆白介素６（ＩＬ６）、白介素８（ＩＬ８）的动态变化。结果３３例休克期切痂病人术后病情均稳定,脓毒症的发生率低于非休克期切痂组（３４４％：５６３％）,ＭＯＤＳ的发病率及死亡率也较非休克期切痂组为低,血浆ＬＰＳ、ＴＮＦ、ＩＬ６、ＩＬ８水平显著低于非休克期切痂组。结论依据临床指标指导休克期切痂,安全可靠,可减少脓毒症和ＭＯＤＳ的发生,提高治愈率。     

慎重稳妥地开展大面积烧伤休克期切痂植皮

救治大面积深度烧伤的成功经验证明,实施早期切痴,异体加自体皮移植手术是行之有效的。但何时为“早期”?并无定论。传统的意见多指伤后4～7天开始首次切痂。可否再早些?例如在休克期内即完成首次切痂,对此许多医生尚心存疑虑。近年来一些单位对入院较早、复苏满意的大面积深度烧伤病人开展了休克期(伤后48小时内)切痂植皮手术,收到了满意的临床疗效,同时进一步探讨了休克期切痂的利弊,又通过实验研究,多方位地论证了休克期切痂的可行性和优越性。本期专题发表的几篇文章从临床与实验研究不同侧面证明休克期切痂不仅是可行的,而且是有益的。     

Post burn pruritus in pediatric burn patients

Background

Pruritus is a common problem seen in the healing process of a burn wound and gives great discomfort for the patient. Most research in this field has been done in the adult population, so evidence in the pediatric population is still lacking

Principles of microvascular reconstruction in burn and electrical burn injuries

Free tissue transplantation is a rarely indicated procedure in burn reconstruction. As the versatility and variability of free flaps have significantly developed during recent years, so have the indications for this procedure expanded. This study reports retrospectively the results of 75 free flaps in 60 severely burned patients using 20 different free flaps. This experience enabled us to establish reconstructive principles pertinent to the type of injury (burn versus high voltage injuries) and the timing of reconstruction procedures. In high voltage injuries (n = 26) early free flap coverage (<21 days after trauma) with muscular flaps was the most frequently used type of reconstruction. Reconstruction site was predominantly the upper extremity and forearm. In burn injuries (flame, contact, fluid), free flap coverage was performed during a later stage of the treatment course (3-6 weeks after trauma), or as a secondary procedure. Reconstruction with cutaneous flaps was the preferred method. In contrast to high voltage injuries, the trunk and the face were also recipient sites. In the upper extremity, the elbow and dorsum of the hand were the most frequent sites of reconstruction. Overall, the flap failure rate was 13% (n = 10). We were able to show a relationship between flap failure rate and timing of the procedure. Eight out of 10 flap failures occurred within 5-21 days after trauma, all 10-flap failures occurred between 5 days and 6 weeks. No flap failure occurred during secondary reconstruction. For the reconstruction of complex or large defects (n = 14), we recommended combined 'chimeric' flaps, pre-expansion of free flaps, or the combination of a free and local flap. Our data demonstrate that burn and high voltage injuries are distinct entities, each requiring custom tailored reconstructive solution.     

Seasonal impact in burn profiles in a dedicated burn unit

IntroductionThe number of burns in Portugal remains considerably large and therefore constitutes a major public health problem. There is a shortage of studies describing the epidemiological and clinical impact of seasonality on burn centre admissions, particularly in high income countries.MethodsThis retrospective analysis included all patients (>18 years old) with acute burns admitted to a specialized Burn Center in Lisbon (Hospital São José) between 20 of September 2010 and 19 of September 2017 (7 years). Clinical data was obtained from electronic medical records. The patients were categorized into four groups, according to each season.ResultsSix hundred and sixteen (616) patients were included in this analysis, the majority being male (55.2%). There were no significant differences between the number of patients admitted in each season nor in gender distribution. Older patients were admitted during winter. Hospitalisation time was higher for patients admitted in the winter and surface area injured was higher for those admitted during summer. Fire burns were the most common aetiology in all seasons. Work related burns and suicide attempts were more frequent in the summer. Most patients had more than one anatomical area affected (73.9%) and winter was specifically associated with more frequent isolated lower limb burns. Winter and fire burns were associated with deeper injuries. More patients underwent surgery during winter (80.7%) than in the remaining seasons (average 65%) but the average number of surgeries per season did not change significantly. The overall mortality rate was 6.8% and the need for mechanical ventilation was 28.9%. Concerning both variables we did not find major differences across seasons. Mortality was associated with older patients, deeper and more extensive burns and need for mechanical ventilation.ConclusionWinter seems to be associated with older patients and with the most severe burns (deeper and more often needing surgery). This study was designed to fill the gap in seasonal burn profile in Portugal and it helps in establishing preventive strategies and better resource allocation.     

Comparison of pathogens and antibiotic resistance of burn patients in the burn ICU or in the common burn ward

Background

This study aims to compare pathogens and their antibiotic resistances of burn patients from burn intensive care unit (ICU) or common burn ward. Of 2395 clinical samples from 63 patients in burn ICU, pathogens were detected in 1621 samples, in which 1203 strains (74.2%) were Gram negative bacteria, 248 strains (15.3%) were Gram positive bacteria, 170 strains (10.5%) were fungi. Top-4 microorganisms isolated from patients in burn ICU were Bauman's Acinetobacter (557, 34.4%), Pseudomonas aeruginosa (287.17.7%), Staphylococcus aureus (199, 12.3%) and Klebsiella pneumoniae (171, 10.5%). Of 512 clinical samples from 235 patients in common burn units, pathogens were detected in 373 samples, in which 189 (50.6%) strains were Gram negative bacteria, 150 strains (40.2%) were Gram positive bacteria, 34 strains (9.2%) were fungi. Top-4 microorganisms isolated from patients in common burn units were S. aureus (103, 27.6%), P. aeruginosa (46, 12.3%), K. pneumoniae (38, 10.2%) and Escherichia coli (32, 8.6%). Antibiotic resistance rates of pathogens isolated from clinical samples of burn patients from ICU was significantly higher than those from common units.

Conclusions

Pathogens and their antibiotic resistances are significantly different between burn ICU and common burn units. This finding has great implication for infection control in burn patients.     

Sexuality after burn in Brazil: survey of burn health-care workers

Patients who survive a major burn must live with emotional and physical sequela. In a literature review, we found that sexuality concerns of burn victims are rarely a focus of therapy. After suggestions from Rimmer et al. [12], using their questionnaire translated into Portuguese, we held a survey of burn-care professionals at the VII Brazilian Burn Congress.More than 120 practitioners from 41 centres, aged in average 41.2 years (1 standard deviation 10.96), completed the survey. A proportion of 63.7% were female, and 58.1% were Caucasians; 37.1% were physicians, 20.9% nurse practitioners and 16.9 were occupational therapists/physical therapists (OTs/PT)s. Psychologists made up 3.2%. Only 28% of the respondents felt comfortable in initiating a conversation about sexual intimacy with their patients. The vast majority believed it should be done by the psychologist. Only 38% felt their burn centre did an adequate job in that area. When compared with a study of our country's general population, we find similar results indicating that intimacy, sexuality and sexual intercourse are considered most important in a relationship.There is a significant lack of literature in sexuality after burn; most likely meaning it is ignored by most centres. There is a need for other similar surveys to be performed, as well as a collective consciousness of the need for discussions about sexuality with patients and their partners, providing counselling and treatment, when need.     

Eosinophil infiltration of burn wounds in young and older burn patients

IntroductionAdvanced age alters many physiological processes in the body, including both innate and adaptive immune responses, affecting burn wound healing. Previous findings in our lab led us to look more closely at eosinophil infiltration of burn tissues. We hypothesize that burn wounds within the older population present with an increased population of eosinophils than those in the younger population.MethodsA pilot study was performed utilizing samples collected from male and female patients 30-years-old and younger and 65-years-old and older. Samples were collected at day (PBD) 2–6 after burn. Deep partial-thickness burn tissues were collected during surgery, formalin-fixed paraffin embedded (FFPE), and assessed by H&E to confirm deep partial-thickness injury. Immunohistochemistry (IHC) was then performed for Major Basic Protein (MBP) to identify eosinophils. Eosinophils/mm burn were calculated. Welch’s Test was used to determine statistical significance of eosinophil measurements between young and old groups.ResultsThirteen samples, were divided into two groups, Young (n = 10) and Old (n = 3). The mean and median age for Young was 23yo (Max 30yo; Min. 17yo). The mean age was 81yo and the median 84yo for the Old (Max. 93yo; Min. 67yo). Other demographics included race. It was found that the Young and Old groups had a mean of 0.171 Eos/mm and 0.910 Eos/mm, respectively, which was statistically significant (p = 0.017).ConclusionOlder patients do present with increased eosinophil infiltration in the early stages of burn wound healing within our small sample set. Increased sample numbers will be required to confirm this discovery.     

Characteristics of burn patients at a major burn center in Shanghai

In China, burns are becoming a major cause of morbidity and mortality with large societal and economic implications. To date, there is little epidemiological data on burns in China to direct prevention efforts. This study describes the characteristics of burn patients admitted to a major burn center in Shanghai using a burn registry developed in Toronto, Canada. A retrospective review of burn patients discharged from the Shanghai's Rui Jin Hospital Burn Unit, between March 1st 2002 and April 30th 2003, was conducted. Of 527 patients discharged, 307 were acute burn patients and 302 (98.4%) had complete data to be included in the study. There were 214 (71%) males and 88 (29%) females with a male to female ratio of 2.4:1. The median age was 30 years, and the median total body surface area burned was 10%. The majority of burns occurred at work (58%), and the most frequent etiology was flames (39%) followed by scalds (31%) and contact with hot objects (15%). Sixteen (5%) patients had inhalation injury and six (2%) patients died. There were 70 (23%) children (0–14 years), 221 (73%) adults (15–59 years) and 11 (4%) seniors (60 years and above). Children had more scald burns (83%) and the majority (83%) occurred at home. Adults had more flame burns (46%) and the majority (79%) were work-related injuries. Seniors had more flame burns (73%) and the majority (55%) occurred in domestic incidents. Seniors had deeper burns (13%, p = 0.005), required more escharotomies (55%, p = 0.002), required more operations (2, p = 0.051) and had higher mortality (36%, p < 0.001) than other age groups. These results provide compelling evidence for performing population-based studies to identify risk factors that are susceptible to modification in each age group.     

Epidemiological characteristics of burn injuries in Iraq: A burn hospital-based study

This study was conducted to determine the epidemiological and clinical characteristics of burn injuries, estimate the case fatality rate for burn patients, and determine the main determinants of the associated death among burn patients who were admitted to Baghdad Burn Hospital, Medical City Teaching Hospitals, Baghdad, Iraq during 2015. This study involved a retrospective review of medical records of all burn patients who were admitted to Baghdad Burn Hospital in 2015. Data were collected using a special form and included information on demographic characteristics and burn characteristics and outcomes. A total of 676 patients with burn were included in this study, who constituted 75% of admitted patients. The remaining was admitted for treatment of old scars. About one third of patients (37.0%) aged 21–30 years, 67.1% were males, 34.8% were military personnel, and 60.7% of the patients had primary school education. About 71.6% of patients were burned by flame and 23.4% were burned by hot fluid. Half of patients had a second degree burns. Almost half of patients had 11–20% of their body surface area affected. About 13% of patients died, mainly due to multiple organs failure (53.3%), septicemia (44.4%), and shock (2.2%). In conclusion, young adults and children, males, and low educated patients represent the majority of admitted burn cases in Iraq. Flame and scalds were the most important causes of burn. More than one tenth of patients died mostly due to septicemia and multi-organ failure.