Burns: journal of the International Society for Burn Injuries

Published by Elsevier
Online ISSN: 0305-4179
Publications
Article
Burn sepsis is a leading cause of mortality and morbidity in patients with major burns. The use of topical anti-microbial agents has helped improve the survival in these patients. There are a number of anti-microbials available, one of which, Silvazine (1% silver sulphadiazine (SSD) and 0.2% chlorhexidine digluconate), is used only in Australasia. No study, in vitro or clinical, had compared Silvazine with the new dressing Acticoat. This study compared the anti-microbial activity of Silvazine, Acticoat and 1% silver sulphadiazine (Flamazine) against eight common burn wound pathogens. Each organism was prepared as a suspension. A 10 microl inoculum of the chosen bacterial isolate (representing approximately between 10(4) and 10(5) total bacteria) was added to each of four vials, followed by samples of each dressing and a control. The broths were then incubated and 10 microl loops removed at specified intervals and transferred onto Horse Blood Agar. These plates were then incubated for 18 hours and a colony count was performed. The data demonstrates that the combination of 1% SSD and 0.2% chlorhexidine digluconate (Silvazine) results in the most effective killing of all bacteria. SSD and Acticoat had similar efficacies against a number of isolates, but Acticoat seemed only bacteriostatic against E. faecalis and methicillin-resistant Staphylococcus aureus. Viable quantities of Enterobacter cloacae and Proteus mirabilis remained at 24h. The combination of 1% SSD and 0.2% chlorhexidine digluconate (Silvazine) is a more effective anti-microbial against a number of burn wound pathogens in this in vitro study. A clinical study of its in vivo anti-microbial efficacy is required.
 
Article
Silver sulphadiazine 1 per cent (SS), silver sulphadiazine 1 per cent plus chlorhexidine digluconate 0.2 per cent (SS + CD 0.2 per cent) and mafenide acetate 8.5 per cent (MA) were compared to assess the antibacterial effect of once daily application on experimental rat 20 per cent full skin thickness burn wounds seeded 24 h earlier with 10(8) microorganisms originally isolated from infected wounds of burned patients. Separate series evaluated Staph. aureus, Enterococcus faecalis, Enterobacter cloacae and Ps. aeruginosa. The mean concentration of all four organisms recovered after 1 week from full thickness biopsies of eschar and from separate biopsies of subjacent muscle was less in MA and SS + CD 0.2 per cent treated animals compared with those treated with SS alone. The mean concentration in muscle and eschar following treatment with MA was less for wounds seeded with Staph. aureus and Ps. aeruginosa than with SS + CD 0.2 per cent treatment, while the mean concentration in eschar application of SS + CD 0.2 per cent was less than with MA for E. faecalis seeded wounds.
 
Article
In this experimental animal study, the effects of three different topical antimicrobial dressings on Candida albicans contaminated full-thickness burn in rats were analyzed. In total 32 adult Wistar rats (body weight 200-220 g) were used. Silver-coated dressing (Acticoat™®), chlorhexidine acetate 0.5% (Bactigrass®) and Mycostatine (Nystatin®) were compared to assess the antifungal effect of a once-daily application on experimental rat 15% full-skin thickness burn wound seeded 24h earlier with a 10(8) CFU/mL standard strain of C. albicans ATCC 90028. All the animals were sacrificed at post burn day 7. The quantitative counts of seeded organism in burn eschar and subjacent muscle were determined, in addition to the cultures of left ventricle blood and lung biopsies. While there were significant differences between Acticoat™® group (4 ± 10 × 10(4)) and control group (5 ± 6 × 10(6)), and between Nystatin group (4 ± 4 × 10(4)) and control group (P=0.01, P=0.01), there were no significant differences between chlorhexidine acetate 0.5% group (2 ± 3 × 10(4)) and control group (P=0.7) respectively. Acticoat™® and Nystatin were sufficient to prevent to C. albicans from invading to the muscle and from causing systemic infection. The animal data suggest that nystatin is the most effective agents in the treatment of C. albicans-contaminated burn wounds, and Acticoat™® is a choice of treatment on fungal burn wound infection with antibacterial effect and the particular advantage of limiting the frequency of replacement of the dressing.
 
Article
Acticoat, chlorhexidine acetate 0.5%, and fusidic acid 2% were compared to assess the antibacterial effect of an application on experimental 15% BSA, full-thickness burn wounds in rats swabbed 24 h earlier with a 10(8) standard strain of methicillin-resistant Staphylococci. The swabbed organism was recovered from the eschar of all groups except the fusidic acid group. While there were significant differences between treatment groups and control group, the mean eschar concentrations did not differ significantly between the Acticoat and chlorhexidine acetate groups, but there were significant differences between the fusidic acid group and the other treatment groups. There were no statistically significant differences between treatment groups, and between control group and the chlorhexidine acetate group regarding recovery of the seeded organism from muscle, but there were significant differences between the control group and Acticoat group, and between control the group and the fusidic acid group. While no systemic spread was seen in the treatment groups, it was seen in six animals in the control group. The animal data suggest that fusidic acid is the most effective agent in the treatment of methicillin-resistant Staphylococcus aureus-contaminated burn wounds, and Acticoat is a choice of treatment with the particular advantage of limiting the frequency of replacement of the dressing.
 
Article
A standardized, reproducible animal model is a prerequisite to study concepts in the therapy of extensive burn injuries. The development of a new model makes it possible to produce predetermined burn injuries with a set temperature, time, contact pressure, and standard extent of tissue damage. For our studies we chose rats and exposed them to a temperature of 250 degrees C for 20 s and a contact pressure of 500 g/cm2 over various percentages of TBSA (total body surface area). The animals received shock prophylaxis for 3 days postburn and were kept under standardized conditions in a laminar airflow compartment. The temperature was kept at 32 degrees C and the relative humidity at 75 per cent. To reduce bacterial contamination, air was filtered through special bacteria-proof filters. Under these conditions we found burns of approximately 35 per cent TBSA to be sublethal resulting in 80 per cent mortality between days 5 and 7. This model permits the investigator to vary the burned skin area to any required extent for a reproducible study of different concepts of burn therapy.
 
Article
The anti-inflammatory agent D-myo-inositol-1,2,6-trisphosphate (1,2,6-IP3) has shown beneficial effects in experimental burns following systemic administration. The purpose of this study was to investigate the effect of topical 1,2,6-IP3 cream on a standardised full-thickness 1 cm2 burn injury in rats. The experimental cream contained a transcutaneous absorption enhancer, hexylbetaine. Five different treatment groups were used. Two experimental groups of burned rats received either 1,2,6-IP3 cream with hexylbetaine (n = 10) or without hexylbetaine (n = 10). Two burned control groups were treated either with hexylbetaine cream (n = 10) or placebo cream (n = 10), while a third control group was untreated (n = 14). The various creams (0.5 g) were administered to the experimental burn area and allowed to remain for 3 h covered with an occlusive dressing. Spectrophotometrical quantification of Evans blue albumin extravasation was used to evaluate the effect of the experimental creams on vascular permeability following the burn trauma. Results showed a significant reduction of albumin extravasation both by 1,2,6-IP3 (p<0.05) and by hexylbetaine alone (p<0.01), as compared to placebo cream-treated animals. The transcutaneous absorption enhancer hexylbetaine did not further improve the effect of 1,2,6-IP3 on burn oedema. In conclusion, both topical 1,2,6-IP3 and hexylbetaine induced a significant reduction of albumin extravasation in burned skin. The effect of 1,2,6-IP3 could be related to previously shown anti-inflammatory actions of the agent, while the mechanisms of actions of hexylbetaine remain to be investigated.
 
Article
Full-thickness burn injury results in a continuous deterioration of blood flow due to vascular sludging, thrombosis formation and oedema leading to irreversible ischaemia and tissue necrosis. D-myo-inositol-1,2,6-trisphosphate (IP3) has previously been shown to reduce burn-induced oedema formation and inflammation involved in the pathophysiology of progressive ischaemia. A full-thickness burn injury (1 cm2) was induced in the abdominal skin of anaesthetized rats using an electrically heated thermoprobe. Blood flow in the experimental area was measured by laser Doppler flowmetry during 6.5 h postburn. The experiments included five groups. Three burned groups were treated intravenously with IP3 and received respectively: a bolus dose of 4 mg/kg followed by a continuous intravenous infusion of 20 mg/kg/h, 8 mg/kg + 40 mg/kg/h or 16 mg/kg + 60 mg/kg/h. One burned and one unburned control group received a corresponding bolus dose and infusion of saline. Results showed a significant inhibition of dermal ischaemia in the burned groups receiving IP3 at all dose intervals as compared to saline-treated burned rats (all P < 0.001). We conclude that IP3 improved local dermal perfusion in burned skin. Probable mechanisms of action could be the vasodilatory and anti-inflammatory properties of the agent.
 
Article
Aberrant signal transduction processes within the diaphragm contribute to the weakness of this primary muscle involved in respiration. The importance of this report emphasizes how scald burn injury manifests distant systemic effects which impact on respiration. Scald burn injury from hot water is a common type of thermal injury in three specific patient groups: young children, the elderly, and the mentally and physically handicapped. Multivariate and vectorial analyses are presented within this paper with application to the effects of burn trauma on pharmacological signal transduction systems in the diaphragm. Multivariate equations showed the dependence of IP, on three to five independent variables. The independent variables included: burn size, glycerophosphate, and other polyinositols (inositol 1,4 biphosphate (I1,4P2), inositol 1 phosphate (I1P) and inositol). Graphic illustration of the equations used vectorial analysis. The multivariate analysis gives rise to a wider class of contributing factors than those observed using standard univariate relationships. This may be useful clinically in the identification of therapeutic agents for the treatment of respiratory problems in burn patients.
 
Article
An epidemiological study on burn patients treated in a Finnish burn center has not been published before in international literature. This study reports the results of a retrospective study on the first 1000 patients treated in Kuopio University Hospital Burn Unit (KBU) in Finland. First consecutive 1000 patients treated in KBU January 1994-April 2006. The incidence of burns treated in our burn center was 6.8 patients/100,000/year. The median (iq-range) age of patients increased by 10 years during the study period to 39 (13-54) years. The median TBSA was 3.5 (1.5-10)% and 78% of burns were smaller than 10%. The male:female ratio was 2.64:1 and it also increased during the study period. Female predominance was found only in >80 years old patients. Most burns were scalds (34%) but flame was the major etiological factor in ICU and lethal burns. Every fourth burn occurred in a sauna. Inhalation injury was diagnosed in 2.7% of patients. Most patients (60%) underwent surgical therapy and 14.3% needed intensive care. The hospital stay was 1.4%/TBSA. The overall mortality was 4% but only 2.4% in those patients who were treated actively. The median age and male predominance have increased during the study period. Every fourth burn is sauna-related therefore a target for prevention strategies.
 
Article
Electrical burn wounds are among the most devastating of burns, with wide-ranging injuries. We aimed to document the factors affecting the mortality rate of patients presenting with electrical burn wounds to our regional burn centre. This retrospective study was conducted on 101 patients from January 2009 to June 2012. Factors were classified under 11 topics and evaluated according to their relationship with the mortality rate. The major causes of death in burn victims were multiple organ failure and infection. Twenty-six percent of the 101 patients died, all of whom were male. One (1.4%) of the patients who survived was female; 73 (98.6%) survivors were male. The mean age in the deceased group was statistically higher than that of the other patients (32.7 vs. 35.6 years; P<0.05). All-cause mortality was 2.79 times higher for larger burns (>25% total body surface area). The values for creatine kinase, creatine kinase-MB, total body surface area of burn, hospitalised period in the intensive care unit and intubation rate were significantly higher in the exitus group. Renal injury requiring haemofiltration was associated with an almost 12-fold increased risk for mortality. There was no statistically significant difference between patients regarding surgical interventions. Electrical injury remains a major cause of mortality and long-term disability among young people. Our data demonstrated several risk factors associated with increased mortality rate in patients with electrical burn wounds.
 
Comparisons of the categorical variables for patients with and without visual symptoms.
Multiple regression analysis for potential factors associated with time to consultation.
Article
Background: Ocular complications from electrical burns are uncommon. Thus far, there has been no systematic review on ocular electrical trauma with emphasis on patients' ophthalmic complications and visual symptoms. Herein, we retrospectively analyzed records of patients with electrical injuries to summarize the ophthalmic characteristics and explore their relationships with visual symptoms. Methods: We collected the medical records of 102 patients who consulted from 557 electrical burn patients between 2004 and 2010. Ophthalmic, systemic and demographic factors associated with electrical burns were identified in the patient who underwent the ophthalmic consultations. Two sets of comparisons were used to determine the demographic and systemic factors that were related to ophthalmic complications and the subjective outcome of visual impairment. Results: There were 53 eyes (29 patients) with ophthalmic complication were identified. Corneal epithelial erosion was the most common ocular electrical injury and the primary reason for subjective visual symptoms. Electrical burns affecting the head and neck were significantly related to subjective symptoms of visual disturbances. Conclusion: Present study indicates that earlier involvement of ophthalmologists in the case of any patient who has suffered a facial burn is advisable. Appropriate management would be helpful to prevent future complications and alleviate visual symptoms.
 
Article
This is an epidemiological survey of 105 burned patients treated between May 1986 and May 1988 in a modern Burns Unit in Saudi Arabia. Hospitalization time ranged from 1 to 100 days with a mean of 17 days. The mean age of the patients was 9 years. Sixty (57 per cent) of the patients were males and 45 (43 per cent) were females. The main causes of injury were hot liquids (57.7 per cent) and fire (33 per cent). The mean extent of injury was 19 per cent TBSA. Burns covered less than 40 per cent TBSA in 91 out of 105 patients (87 per cent). Deep burns did not exceed 100 units of burned skin in 48 out of 55 patients (87 per cent). Urgent escharotomy was done in 14 patients. Early excision and skin grafting was carried out in 34 patients. Complications included six cases (5.7 per cent) with septicaemia, one (0.9 per cent) with disseminated intravascular coagulopathy, three (2.9 per cent) with amputation and one (0.9 per cent) with stress gastric ulcer. Seven patients discharged themselves against medical advice. Five patients died. The favourable results in this series were attributed mainly to the low severity of burns and partially to the short delay between injury and admission, early surgery and remarkably good facilities. Childhood scalds in this region of the world could possibly be reduced by changing the family habit of having tea at floor level and recommending wide-based tea-pots.
 
Article
This report describes 141 scalded children admitted from January 1993 to June 1995. The mean age of patients was 2 yr 11 months. The average burn size was 11.4 percent TBSA. The male to female ratio was 1.6:1 (87:54). One hundred and six of the children were initially diagnosed as suffering from superficial or medium partial-thickness burns. After proper evaluation and resuscitation, all of them received immediate debridement and Biobrane coverage. This biosynthetic dressing was fixed with adhesive tape and compressive dressing. No splints were used. Pain tolerance was good and these children were able to resume their daily activities as early as possible. If vital signs were stable and Biobrane adherence occurred, the patients were discharged. The dressings were easily changed on an out-patient basis; therefore, the hospital stay and ultimate cost of burn care both decreased. This experience confirmed that Biobrane is quite suitable for consideration in treating pediatric scalds. Accurate diagnosis of depth is very important. The best results can be obtained only on superficial partial-thickness burns. A high wound infection rate occurred in the medium partial-thickness burn wounds (7.8 vs. 62.1 percent).
 
Article
A total of 1063 acute burn patients were admitted to the Burns Unit of Prince of Wales Hospital, Hong Kong between March 1993 and February 1999. There were 678 males and 385 females with a male to female ratio of 1.76:1. The median age was 13.1 year-old and the median burn size was 6% total body surface area (TBSA). Pediatric patients under the age of 15 year-old accounted for 550 (51.7%) admissions and 235 (42.7%) of them were toddlers <2 year-old, while adult patients of age above 15 year-old accounted for the other 513 (48.3%) admissions. There was no seasonal variation in admission. Domestic burns resulted in 756 (71.1%) injuries followed by industrial burns that caused 175 (16.5%) admissions. The median hospital stay was 9 days and 54 patients (5.1%) had inhalation injury requiring intubation and ventilatory support. Twenty-four patients died in this series which yielded a mortality rate of 2.3%. The median age for this mortality group was 46.6 year-olds with a median extent of burns of 68% TBSA. There were 16 males and 8 females with a male to female ratio of 2:1. Eighteen (75%) patients had flame burns and 15 (83.3%) of them had inhalation injury. The mortality group had significantly larger burn size (P<0.001), higher incidence of inhalation injury (P<0.001) and older age (P<0.001) compared to the survivors.
 
Article
Campfires, bonfires and barbecues play a prominent role in outdoor activities and serve a variety of decorative and functional purposes. Given all of it's various forms, uses and benefits, the outdoor fire can turn dangerous in a matter of seconds: a stumble or fall (the child running that trips) leads to direct contact with the flames and subsequent burn injury. With it's everyday occurrence, we were surprised to find a paucity of information regarding this type of burn in the literature, including the NBIE analysis. A retrospective review of 107 patients admitted to the Maricopa Medical Bum Center, from 1987 to 1996, was conducted. Each chart was analyzed for the patient demographics, mechanism of injury, percent total body surface area burned, operative versus non-operative treatment and overall outcome. An average burn injury involved 5.7% TBSA, with a wide range from 1 to 47%. The majority of our population involved either small children or intoxicated adults and a total of 50 patients required 92 operations. Severe morbidity, including 4 amputations and 2 mortalities, were seen. The average hospital stay was 14.3 days, ranging from 1 to 52 days. Recreational outdoor burns were extremely common injuries leading to loss of functional employment and prolonged physical therapy requirements. Small children and intoxicated adults comprised the majority of our study population. The impact and severity of such outdoor fires could be greatly affected by appropriate attention to prevention.
 
Article
Motor vehicles are a major cause of morbidity and mortality. Burn injuries sustained from motor vehicles form a small but important subgroup. The authors have reviewed the case notes of 107 patients with motor vehicle-related burns over a 13-year period. The age ranged from 18 months to 65 years and the male to female ratio was 4:1. The mechanisms of injury were variable, although four major categories could be identified. These accounted for 83 per cent of the cases. Car fires following road traffic accidents was the largest group accounting for 48.5 per cent of cases. The remaining three groups were: motorcycle-related burns following road traffic accidents (6.5 per cent of cases), garage fire-related burns (15 per cent of cases) and car radiator-related burns (13 per cent of cases). Garage fire-related burns had the highest mortality of the four groups (25 per cent). This study demonstrated that garage fire burns are an important subgroup of motor vehicle-related burns.
 
Article
To assess the clinical outcomes and treatment costs of a regional adult burn service in northwest England. We retrospectively reviewed data on a five year cohort of 1075 patients treated by the Mersey Regional Burn Service between 2006 and 2010 to obtain age-stratified mortality estimates based on the lethal area 50 (LA50) measure. Treatment cost estimates were made for a one year cohort of 262 patients treated between April 2011 and April 2012. 44 (4.1%) of the five year cohort died; 36 had suffered flame burns. Our LA50 was 71.08 for the 15-44 age group, 56.64 for the 45-64 age group, and 28.82 for the 65 and over age group. Mean treatment costs associated with patients allocated to different burn-specific healthcare resource groups ranged from £2527.77 to £31,870.95. Detailed cost estimates for three patients ranged from £12,553.23 to £66,029.33. The LA50 estimates for the Mersey Regional Burn Service compare favourably with previous reports in the literature. Our treatment costs were substantially lower compared to those reported previously in the United Kingdom. This study demonstrates that high quality and cost effective care can be delivered by a service that treats relatively few major burns (>70% TBSA).
 
Article
Epidemiological investigations of burn patient series help practitioners to identify factors that affect patient survival. Our aim was to contribute to the body of knowledge in this area by determining how survival related to certain variables in burn cases. The records of 1083 burn patients who were hospitalised between August 1988 and the end of 1997 were retrospectively reviewed. Of this total, 363 (33.5%) died of burn complications, namely, multi-organ injury due to sepsis (47.1% of deaths), renal failure (44.6%), respiratory injury (5.8%) and gastrointestinal bleeding (2.5%). Mortality was higher in children/students, females, retired persons. Extent and depth of burn were important predictors of patient survival. Flame not only was the commonest burn cause but also carried the highest mortality risk. Most of the 1083 patients were referred to our hospital within 3 days of the injury. Deaths commonly occurred within 7 days. The mortality rate for patients who received medical therapy only was higher than that in the group that underwent both medical and surgical treatment (48.4 versus 10.0%, respectively). The study results highlighted various factors that are related to patient survival. These should be considered in the provision of optimal burn care. Training and experience are important elements in burn care and educational meetings should be held regularly for the staff of the burn unit.
 
Article
A total of 1083 burn cases hospitalised at a burn center between August 1988 and the end of 1997 were studied retrospectively to determine the factors and demographic features associated with burn injury in Turkey. The means for patient age and percent total body surface area (TBSA) burned were 18.1 years and 31.2%, respectively (medians were 14.0 years and 25.0%, respectively). Burn injuries were more common in winter and spring, and most occurred in the home. The majority of patients were city dwellers, and had been referred from public hospitals. There was a predominance of male patients (71.9%) in the study population, but the proportions of children and adults were equal. Almost half of the males and the majority of the females were children/students. The vast majority of female adults were housewives, and most of the men were employed outside the home. More than half of the patients suffered second-degree burns, and the others all had deeper burn injuries. The most frequent cause of burn in the study population was flame. Children mainly suffered from scalding, and adults from flame and electrical burns. There were no differences between the sexes regarding depth of burn; whereas percentage total burned surface area was higher in females. Children had a lower mean TBSA and lower rate of third-degree burns. Mortality rate of the study population was 33.5%. The study results identified various risk factors and the groups at high risk for serious burns and indicated some ways that prevention programmes can be improved.
 
Article
Burn injuries still produce a significant morbidity and mortality in Iran. This study was carried out to analyze the epidemiology, mortality, and current etiological factors of 1089 burn patients in the province of Kurdistan in the west of Iran during the 6 years from 21 March 1994 to 20 March 2000. There were two burn centers in Kurdistan, serving 1.4 million people in an area of 28,000 km(2). The incidence rate of burn hospitalization was 13.5 per 100,000 person-years. The median age was 18 years with 58% of the patients under 20 years. The median Body Surface Area (BSA) burned was 40%. Incidence rate of burns for females was 18 per 100,000 person-years and 9.1 per 100,000 person-years for males (P((2))<0.000001). Also there was a statistically significant association between mortality rate and age groups/gender/BBS (P((2))<0.000001). Flame was the most common type of burn (694/1089, 63.7%). There was also a significant correlation between the age groups and types of burn (P((2))<0.000001). Ninety-one percent (991/1089) of the burns were unintentional (12.3 per 100,000 person-years), while suicide attempts by burning for the population aged 13 and older accounted for 12.7% (98/771) (2 per 100,000 person-years). The mortality rate was 4.5 per 100,000 person-years. The study results provide a valuable baseline by which to assess future efforts directed toward the prevention of burn injuries in Kurdistan.
 
Article
A retrospective study was performed at the Yorkshire Regional Burns Centre from 1994 to 2004 inclusive to determine the changes in treatment and clinical outcomes of patients admitted with hot beverage burns and the effect of changes in referral patterns over this period. Although children under the age of 3 years accounted for 77.5% of all cases of hot beverage scalds, this injury was represented in all age groups. Children from 1 to 2 years of age had the highest incidence of this injury. Changes in referral patterns over this period resulted in a decrease in the mean total body surface area of injury, an increase in the number of admissions and an increase in the time interval from injury to admission to the Burns Centre for this period. The total body surface area given by referring facilities was often times inaccurate, as reported previously by this Burns Centre. The introduction of Biobrane in 2002 was effective in reducing the length of hospitalisation for patients with superficial partial thickness burns. Hot beverage burns remain a significant public health problem deserving of continuing efforts to maintain public awareness.
 
Article
The Coroners Department (CD) records hold important demographic, injury and death details for victims of burn injuries derived from various sources yet this rich source of data has been infrequently utilised previously in describing the epidemiology of burn related mortality. The aim of this study was to use CD data to comprehensively investigate burn related mortality in the Greater Manchester region of United Kingdom. A retrospective study design was used to collect data for deceased demographics, injury details, site of death and cause of death from four CD offices in GM over an 11-year period (2000-2010 inclusive). Office of National Statistics (ONS) population metrics were used to calculate age- and gender-specific population denominators and mortality rates. Index of Multiple Deprivation (IMD) was used to correlate mortality with deprivation. Linear regression and Pearson's/Spearman's rank correlation were used to calculate trends and correlations. Poisson regression was used to calculate relative risk (IRR) between age- and gender groups. There were 314 recorded deaths in the region over the study period and thermal injury was 3-times less likely to result in death in 2010 compared to 2000. The largest proportion of these deaths (24.8%) was comprised of individuals ≥75 years in age. The relative risk of mortality in males was nearly 1.5-times higher and a significant majority of victims (77%) sustained their burn injury at their own home/residence. Inhalation injury without cutaneous burns was the most frequent type of injury (33%) and accidental house fires caused nearly half (49%) the injuries resulting in death. Sixty-five percent of deaths during this period were recorded to have occurred outside of regional burn service (RBS) hospitals and the commonest cause of immediate death on the death certificates was "inhalation of products of combustion" (32.1%). Within the >75 years age group the risk of death significantly increased with every quintile reduction in deprivation. Our data shows that despite reducing overall mortality, certain age groups and causation patterns are associated with significantly higher risks of mortality in our region. Further reduction in burn mortality should focus on the use of prevention efforts with established effectiveness in these high-risk groups. In addition, as a significant proportion of deaths occur outside a burn service environment hence epidemiology data based solely on mortality statistics from burn services will underestimate true burn related mortality. Copyright © 2014. Published by Elsevier Ltd.
 
Article
The principal aim of this study was to describe infection related characteristics of blood stream infections (BSI) in patients with burns. We sought to determine the organisms that caused BSI and factors that could predict the outcome of BSI. Data was collected on admitted patients with burns from January 1998 to December 2008. Selected information from databases was analysed using SPSS version 17 (SPSS Inc., Chicago). Descriptive, univariate and multivariate analysis was undertaken to determine factors predictive of clinical outcome. The factors analysed by univariate analysis were selected on clinical plausibility. Multivariate analysis used a crosstabs procedure initially to estimate maximum likelihood. Factors that were associated with a p value <0.15 were entered into a binary logistic regression to detect which factors were independent predictors of mortality in BSI and outcome according to specific organisms. Ninety-nine out of 2364 (4%) patients developed 212-documented BSI. The median time from burn to BSI was 7 (interquartile range 3-16) days. Gram-positive organisms, in particular Methicillin resistant Staphylococcus aureus and Coagulase negative Staphylococci, were the most common bacteria associated with BSI in the first week of hospital admission. The mortality rate for all admissions over the data collection period was 3%. Of the 99 patients with BSI, 13 died giving a mortality rate, in the presence of BSI, of 13%. Univariate analysis found that the factors predictive of P. aeruginosa mortality were inhalational injury, higher total body surface area burns, total days of antibiotic treatment and elevated Acute Physiological and Chronic Health Evaluation (APACHE) II scores. Multivariate analysis identified inhalational injury to be the only factor associated with BSI-related mortality. Whilst the overall mortality in our cohort was low, the presence of BSI increased this four-fold. Whilst infections caused by Gram-positive pathogens occurred earlier in the patient stay than Gram-negative organisms, the highest mortality was associated with P. aeruginosa infections. This study highlights the negative effects of BSI on clinical outcomes in burn patients.
 
Article
In the United Kingdom, the incidence of assault by burning and of self inflicted burns increased significantly over the last decade. This has major implications both for service providers and society as a whole. Our aim was to investigate the differences in patients' characteristics, management and outcome following a burn sustained by either an assault or self immolation. Acute admissions to a tertiary Burn Centre were retrospectively reviewed over an 11 year period (1994-2005). Demographic data and information regarding the circumstances surrounding the incident, burn severity, treatment and outcomes of the patients were collected. Over an 11 year period, 1745 patients were admitted to the tertiary Burn Centre. Of this total, 41 patients (mean age 29 years+/-16) sustained burns following an assault, a further 86 patients (mean age of 37 years+/-12) had self inflicted burn injuries; males were preponderant in both groups. In this series, a history of alcohol or substance abuse was present in 25% of both cohorts, 63% of the patients with self inflicted injuries having a previously diagnosed psychiatric disorder. Petrol, accelerants and other flammable liquids were the main agents chosen to inflict injury in both the assault and self inflicted groups. The burn depth and surface area distribution was greater in the self inflicted group compared to those assaulted (29% versus 21%). A difference was also noted in the pattern of distribution of burns between the two groups, as well as between genders although this difference was not significant. Two-thirds (67.4%) of the self immolated patients and 56% of the assaulted group required surgery. The length of hospital stay was similar for both groups, averaging 20 days. The crude mortality for the self inflicted group was 29%, whereas in the assaulted patients, the overall mortality was 4.9%. Although the incidence of burns caused either by assault or attempted suicide is low, the affected patients require a multidisciplinary approach. Their management requires significant medical, psychological occupational and social support. Increased awareness and education of those vulnerable individuals maybe of benefit to help prevent self inflicted injuries by burning.
 
Article
Burned patients suffer significant immunosuppression during the first 3 or 4 weeks after hospitalization. Herpes simplex virus (HSV) infections are commonly seen in immunosuppressed patients and may account for considerable morbidity and some mortality. We studied retrospectively 11 patients with severe burn injury who became infected with HSV. We determined the prevalence of viral infection in this group of patients. Serological testing and viral culture was used to diagnose HSV infection. No general complications appeared in these 11 patients in association with HSV but two patients died of multiorgan failure. Locally, areas of active epidermal regeneration were most commonly affected. Acyclovir therapy was not used and the duration of hospitalization was normal in these 11 patients.
 
Article
We present an 8-year analysis (1993-2000) of 11,196 burn admissions with an average of 116.6 patients per month. Patients were largely treated by conservative techniques. The mean burn percentage was 50.35. Almost 80% of admissions were in the 16-55 years age group. Paediatric and geriatric burns were 17.1 and 3.1%, respectively. Flame burns accounted for 82.15% of admissions and of these 77.5% were sustained in the kitchen. A total of 35.32% of flame accidents were due to malfunctioning kerosene pressure stove. The overall mortality was 51.80%. These figures need further qualification because 46.8% of patients had more than 50% BSA burns and 50.72% patients reported to the hospital more than 6h after sustaining burns. Patients with <60% BSA burns, and who were received within 6h of injury had a mortality of 23% only. Significantly, 1078/1952 deaths (55.23%) of patients <60% BSA burns took place in first 6 days of admission when 3639 patients with <60% BSA injury were received more than 6h after burn injury. This reflects that even if economic constraints preclude one from having the best infrastructure reasonable mortality rates are still achievable with conservative line of management, even in face of a heavy work load. This also makes one question the cost effectiveness of high cost technology in burn management.
 
Article
This retrospective study of paediatric burns in the Lothian region involved a review of 1114 case notes of children up to the age of 12 years, treated for burns as inpatients and outpatients, during a 3-year period between 1988 and 1990. There were more boys than girls and 79 per cent were below 5 years of age. 71.5 per cent were treated as outpatients only, whereas 28.5 per cent were admitted. The Lothian region had the highest incidence of burns of children in Scotland. There has been a statistically significant downward linear trend in burn rates and admissions in Scotland during the 20 years but in this hospital burns admissions have significantly diminished only since 1987. The number of flame burns has declined and a high proportion of the victims were scalded. Efforts need to be made to reduce the large number of scalds by educational and legislative measures.
 
Article
The overall mortality rate at the Shriners Burns Institute, Galveston Unit, decreased from 14 per cent in 1966, to 2.8 per cent in 1980. In all, 74.8 per cent of the deaths were associated with sepsis, and pulmonary lesions were the most frequent fatal complications (75.6 per cent). The burn wound was the major source of sepsis (62.7 per cent). Pseudomonas, E. coli, Klebsiella, Candida spp. and Staphylococcus aureus were the most common cultured bacteria. After a new standard fluid resuscitation programme, tangential excision and surgical management of the burn wound sepsis were adopted, the fatalities decreased from an average annual mortality rate of 11.5 per cent in the years 1966-75, to an average annual mortality rate of 2.8 per cent in the period 1976-80. After the routine antacid and milk diet were adopted (1970), the percentage of stomach and duodenal ulcers found at autopsy decreased from 2.0 per cent to 0.8 per cent, and from 3.5 per cent to 0.5 per cent respectively. The morphological alterations in the lymphoid tissue, reflecting a defect in T-cell function and stimulation of B-cell function, were present up to 114 days post burn.
 
Article
This article reports a chemical burn incident that occurred on August 7th, 2005, when a Matsa typhoon hit Shanghai, China. This is the largest chemical burn incident reported in the literature for 20 years in China, involving 118 alkali burn patients who were rescued by the Burn Department of Shanghai Changhai Hospital independently. The scene of the incident was investigated, and the clinical, emergency and hospitalized data of the patients were summarized. The main injurious chemical was a water solution of sodium hydroxide and ammonium chloride. The 118 victims were mostly young men with 5%TBSA deep thickness burn of both lower extremities, including 31 patients who had additional light coughing. Of 58 patients who were finally hospitalized, 42 patients received surgical treatment. Most of these patients recovered within 1 month. There were no deaths. Retrospective analysis of the therapeutic data of the incident demonstrates that pre-designed disaster planning for emergency management of mass burn patients, an effective command group, accurate assessment of pathological conditions, and correct allocation of different casualties are key elements in successful management in a mass casualty even involving burn patients. In addition, it is essential for specialized personnel to take part in emergency treatment of chemical burns.
 
Article
This study described the epidemiological characteristics of the 12,381 admitted burn patients in Taiwan. The data was from 43 contracted hospitals of the Childhood Burn Foundation, in the years from 1997 to 2003. This descriptive study included 8172 males and 4206 females, with a male to female ratio of 1.94 and an average age of 29.3 years. There were 3993 (33.4%) patients under 18 years old; and 26.4% of the patients were children under 7 years old. First and second years of life were the peak of incidence. The mean extent of burn was 14.0% total body surface area with 950 patients (7.7%) suffering from a burn extent >/=40% TBSA. Scalds resulted in 5085 admissions (43.2%) and flame burns accounted for 3825 admissions (32.5%). In patient group under 18 years old, 76.8% were scald burn and 14.1% were flame burn. The majority of the burn injuries (53.3%) occurred in the dwelling place; 1122 patients had inhalation injuries and required admission to the burn center for pulmonary support. In addition, suicide attempts were recorded in 2.4% (300 cases) of all burn patients with a mean burn size of 40.7% total body surface and mortality rate of 29.3%. The overall mortality rate is 381 out of 12,381 patients (3.1%). The LA(50) was around 80% TBSA. The significant effects of risk factors, such as old age, large burn extent, combined inhalation injury and suicide were demonstrated. Adequate first aid by water cooling affected the outcome of the patient group with burn extent less than 30% TBSA, which was shown by the decrease of length of stay. These results showed some unique distributions that reflected certain socio-economic and cultural background of Taiwan.
 
Article
This is a retrospective study analysing 12,423 patients treated at our institution from 1 July 1988 to 30 June 1990. Burn incidence and mode of treatment were classified according to age and sex, as well as causative agent, place of the accident, length of treatment and outcome. 96.6 per cent of the patients were surgically treated, about 41 per cent of the patients were under 14 years of age. The most frequent cause of injury was related to meal preparation, with more than two-thirds of the accidents occurring at home. Only large or complicated burns (1094-8.8 per cent) were admitted, with 49 deaths occurring during this period. We conclude that children and younger adults are at greater risk of being burned and preventative measures should be oriented towards the prevention of such accidents.
 
Article
Background: The aim of this study was to map out some epidemiological aspects of unintentional burn injuries among Iranian victims using a national injury registry data. Methods: Injury data were taken from a national injury surveillance system over the period 2000-2002. The study population comprised 31.5% of Iran's population. Burn-injury cases were retrieved and analysed. Results: Of all the grossly 307,000 home injuries reported during the years 2000-2002 in Iran, about 125,000 cases (41%) were unintentional burn injuries. Women comprised 58% of the unintentional burn victims. The mean age among burn victims was 19.18±19 (standard deviation, SD) years. The age-adjusted incidence and mortality rates showed that children had a much higher incidence of domestic burns but the elderly suffered higher fatality in spite of lower incidence in this age group. Overall, 65.2% of the domestic burn injuries occurred in the living rooms or bedrooms followed by 27% in the kitchen. The hands and fingers were injured in 43.6% followed by the lower limbs in 37.6%. According to injury mechanism, scalds were the most common type of burn injuries comprising 77.7% of all burns. Of all the burn victims, 791 died, 48 victims became disabled and the remaining improved or were undergoing therapy when reported. Conclusion: Burns form a major health problem in Iran. Due to high mortality rate, the elderly need specific attention regarding burn prevention and treatment in this age group. Moreover, in spite of lower fatality, any prevention programme should have a focus on childhood burns mainly due to the overwhelming distribution of burns in children and the young population of Iran.
 
Article
In previous studies we found that miR-125b was down-regulated in denatured dermis of deep partial thickness burn patients. Moreover, miR-125b inhibited tumor-angiogenesis associated with the decrease of ERBB2 and VEGF expression in ovarian cancer cells and breast cancer cells, etc. In this study, we investigated the expression patterns and roles of miR-125b during the recovery of denatured dermis and heat-denatured human umbilical vein endothelial cells (HUVECs). Deep partial thickness burns in Sprague-Dawley rats and the heat-denatured cells (52°C, 35s) were used for analysis. Western blot analysis and real-time PCR were applied to evaluate the expression of miR-125b and ERBB2 and VEGF. The ability of angiogenesis in heat-denatured HUVECs was analyzed by scratch wound healing and tube formation assay after pri-miR-125b or anti-miR-125b transfection. miR-125b expression was time-dependent during the recovery of heat-denatured dermis and HUVECs. Moreover, miR-125b regulated ERBB2 mRNA and Protein Expression and regulated angiogenesis association with regulating the expression of VEGF in heat-denatured HUVECs. Taken together our results show that the expression of miR-125b is time-dependent and miR-125b plays a regulatory role of angiogenesis during wound healing after burns. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.
 
Article
A dramatic improvement in full skin thickness burn wounds in rats treated intravenously with the non-ionic surfactant Pluronic F-127 (F-127) has been demonstrated. In this study the F-127 was given 30 min postburn to simulate conditions encountered in a clinical setting. Anaesthetized male rats (300-320 g) received full skin thickness burns by immersion of the anterior chest wall (8 per cent body surface area in a 70 degrees C water-bath for 12 s). Burn wound area was measured immediately and after 48 h. Thirty minutes after the burn, half the animals received equal volumes (8 ml/kg body wt) of either saline or F-127 (12 mM/l concentration) via the tail vein. The animals autopsied at 48 h showed a significant (P < 0.05) reduction in the degree of wound contraction and the wound appeared grossly less damaged in the F-127-treated animals. Histologically, skin biopsies showed less of the microscopic damage usually associated with full skin thickness burns in the F-127-treated animals than in the saline controls. We also used thermography to measure skin temperature of the burn area at 90 min and 48 h postinjury demonstrating alterations in the F-127-treated animals (P < 0.05). In animals followed for 30 days postinjury, there was a significant (P < 0.01) improvement in the wound closure rates in the F-127-treated animals. These observations show a positive therapeutic effect of F-127 on the inflammatory process in the area of a burn that may improve wound healing.
 
Article
The aim of this study was to evaluate the epidemiology of burns due to gunpowder explosions in fireworks factories. Three hundred and fifty-one patients having burns caused by gunpowder explosions in a fireworks factory were admitted to our center from 1 January 1987 to 31 December 1999 and the clinical notes of 339 patients were available for review. Data on age, sex, size, depth and sites of burn, incidence by month, inhalation injury, associated injuries, number of operations, length of hospital stay, morbidity, mortality, and causes of explosions were recorded. The majority of the patients were male, with a mean age of 36.7 years. The mean total burn surface area was 40.9%, mostly deep burns. The commonest areas of the body to be injured were the head and neck. One hundred and eighty-five patients (55%) were injured in December, November, and January. Sixty-five patients (19%) had an inhalation injury, 35 having tracheotomies and mechanical ventilation. Thirty-five patients (10%) had associated injuries, the commonest being the fracture of limbs (25 patients). Two hundred and thirty-two patients (68%) required operations while the number of operations including debridement and grafting, or tracheotomy, per patient were 2.7. The mean time in hospital of the survivors was 32 days with a range of 1-94 days. Acute respiratory distress syndrome (ARDS) and sepsis were the commonest complications during the early post-burn period (7 days or less) and the later period (>7 days), respectively. Forty-four patients died in this series giving a mortality rate of 13%. The commonest cause of death was sepsis (27 patients), followed by multiple organ dysfunction syndrome (MODS) (11 patients). Most accidents (71%) were caused by too much gunpowder put in at one time and accidents resulting from carelessness while making fireworks. Prevention measures are also discussed.
 
Article
Burns are noteworthy causes of morbidity and mortality in India. Community-based interventions in the forms of multi-strategic and multi-focussed preventive programs are, however, lacking. This study, undertaken in the remote corner of Northeastern India, aims at reducing the incidence of burns through focussed attention towards sensitising the community with well-structured preventive programmes. Participatory community seminars, shop floor visit to industrial locations, use of print and electronic media and lectures and demonstrations in schools were the tools used in the preventive programmes. Analysis of inpatient and outpatient records of burn-injured patients treated in the Burn Unit and a scoring system in the school education programme helped in the assessment of the impact of Burn Preventive Programs (BPPs). For convenience of assessment, a comparative analysis of the results in early (block I) and later part (block II) of the study period was made. Results showed reduction of admission and also reduction in percent total body surface area (%TBSA) burn in the majority of the patients in block II in comparison to block I. Water was used to extinguish fire in 36.1% patients in block I and 73.4% patients in block II. Water was also used to cool burn wounds by 31% patients in Block I, and by 72% patients in block II. While 80% of the patients made inappropriate topical applications on the wounds in block I, only 34.4% did so in block II. Increased awareness amongst the general population was reflected by reduction of average reporting time in hospital after injury and significant reduction of firecracker burns from 21.5% (block I) to 14.6% (block II). Similarly, improved awareness amongst the students was evident from the improved scoring by the majority of the students and reduction in burns amongst them in the later part of block II. The results indicate that BPP has made a positive impact in society.
 
Article
Analyses were made of 1368 patients who attended Kilpauk Medical College Hospital, Madras with burns between 1 May 1987 and 30 April 1988. Nine hundred and sixty-five patients were admitted, of whom 505 died. The peak age incidence was in young adults (11-30 years; 58.9 per cent of all burns). Three quarters of the patients came from the low family income group, 39.5 per cent were illiterate and 86.2 per cent of burns occurred in the home. Of those admitted 81 per cent of the injuries were flame burns; in 31.3 per cent the burn affected more than half of the body surface. Of the 505 deaths 94.8 per cent were the result of flame burns (at least 323 being caused by kerosene), and 20.4 per cent were suicide. Most of the deaths (91 per cent) occurred in the first 5 days. The urgent need for burn prevention in the Madras area is discussed.
 
Article
A new approach for the analysis of hepatic metabolism after burn injury is introduced. Relative anaplerotic, pyruvate recycling and gluconeogenic fluxes were measured by 13C NMR isotopomer analysis of blood glucose from rats with 40% body surface area injury, and from rats exposed to sham injury. A short chain fatty acid, [U-13C] propionate which is avidly extracted by the liver, was infused intravenously to deliver 13C into the citric acid cycle. There was no difference in the multiplets detected in the glucose carbon-2 (C-2) anomer from blood or liver after 45 or 60 min of infusion of propionate, indicating that steady-state isotopic conditions were achieved. Gluconeogenesis relative to citric acid cycle flux was not altered by burn injury; in both sham and burn groups the rate of glucose production was about equal to flux through citrate synthase. In the sham group of animals the rate of entry of carbon skeletons into the citric acid cycle was about four times citric acid cycle flux in animals after thermal injury. Similarly, flux through pyruvate kinase (again relative to citrate synthase) was significantly increased in burn injury.
 
Article
Despite the fact that early excision and grafting have significantly improved burn outcomes, the management of severely burned patients whose burn size exceeds 70% total body surface area (TBSA) still represents a big challenge for burn surgeons all over the world. During the period of 1997-2010 at our centre, aggressive excision and microskin autografting were performed in 63 severely burned patients. Their burn sizes ranged from 70% to 98% TBSA with a mean of 84.9%. The average full-thickness burn was 66.3% (range, 29-94%). Thirty patients had concomitant inhalation injury. Two to 7 days after burn, these patients underwent aggressive excisions ranging from 25% to 60% TBSA and transplantation of microskin autograft overlaid with allograft. The ratios of donor-site to recipient-site surface area were between 1:6 and 1:18. Signs of epithelialization were shown within 35-55 days. The wound healing rate was 74.9% (176/235), with 51.1% of cases (120/235) healing completely and 23.8% (56/235) improving. Microskin autografting yielded an overall survival rate of 63.5%; only 23 patients died. Our clinical experience in using the microskin autografting for burn coverage suggests that the technique is very effective in covering extensive burns, and that it is particularly useful when graft donor sites are very limited due to its high utilization rate of donor site. The factors affecting the outcome of microskin autografting are discussed herein.
 
Article
Skin-graft preservation for the purpose of delayed autografting to burn patients is a basic tool of plastic and burn surgery. This study was undertaken to evaluate the efficacy of the two-layer (physiological saline/perfluorochemical (PFC)) cold-storage method for skin preservation. In Wistar rats, a full-thickness skin graft, 3 cm in diameter, was harvested from the back, and separated from the dermis to obtain the epidermal sheet. This epidermal sheet was preserved at 4 degrees C using physiological saline (group 1, n = 15), physiological saline bubbled with a 95 per cent oxygen, 5 per cent carbon dioxide mixture (group 2, n = 15) or a two-layer method with bubbling with 95 per cent oxygen and 5 per cent carbon dioxide mixture (group 3, n = 15). The epidermal skin sheets were then autotransplanted to the backs of the original donor rats 7, 10 and 14 days after the start of preservation. The success rate of the skin autotransplantation was determined by measuring the ratio of viable area to total graft area 7 days after grafting. In group I, the success rates after 7, 10 and 14 days' perservation were 56.4, 47.4 and 0.09 per cent, respectively. In group 2, the corresponding success rates were 62.0, 48.4 and 0.8 per cent respectively, showing no improvement with oxygenated saline. In clear contrast, the success rates were significantly improved by the two-layer method, the values being 92.1, 87.9 and 77.6 per cent after 7, 10 and 14 days of perservation, respectively (P < 0.01 vs. groups 1 and 2 for all preservation durations). Based on these results, we concluded that the two-layer method is useful for not only improving the quality of the skin graft but also extending the preservation time of the skin graft up to 14 days.
 
Article
Scalds are a common injury in children and a frequent reason for hospitalization despite being a preventable injury. This retrospective 2 year study reports data from 730 children aged 14 years or younger who sustained a scald between 2009 and 2010 and were admitted to a burns center in Australia or New Zealand. Data were extracted from the Bi-National Burns Registry (Bi-NBR), comprising 14 burns centers in Australia and New Zealand. Scald injury contributed 56% (95% CI 53-59%) of all pediatric burns. There were two high risk groups: male toddlers age one to two, contributing 34% (95% CI 31-38%) of all scalds, and indigenous children who were over 3 times more likely to experience a scald requiring admission to a burns unit than their non-indigenous peers. First aid cooling by non-professionals was initiated in 89% (95% CI 86-91%) of cases but only 19% (95% CI 16-23%) performed it as recommended. This study highlights that effective burn first aid reduces hospital stay and reinforces the need to encourage, carers and bystanders to deliver effective first aid and the importance of targeted prevention campaigns that reduce the burden of pediatric scald burns in Australia and New Zealand.
 
Article
Fourteen cases suffering full-thickness burns of more than 70 per cent total body surface area (TBSA) have been successfully treated during the last 8 years (1988-1995). Among these patients, 10 cases suffered from burns of more than 90 per cent TBSA. Five cases had full-thickness burns of 80-90 per cent TBSA. Escharectomy, followed by coverage of wounds with a homograft to the lower surface of which, adjacent to the wound bed, microautoskin grafts had been attached was employed to close wounds in the early stages after burn. The remaining non-surgically treated wound was treated by exposure and topical silver sulfadiazine. The temperature and humidity of the ward was controlled by air conditioning and dehumidification. Aggressive excision of eschar and auto-skingrafting was carried out 3 weeks post-injury. Strictly limiting the uncovered wound to less than 5 per cent appeared to be the major effective measure in preventing burn infection.
 
Article
Although there have been great advances in the treatment of electrical injuries in the last 20 years, the extremity loss ratio in electrical injuries remains at an unacceptably high level. The primary cause is due to the progressive tissue necrosis which results in the continuous extension of necrosis in the wound, leading to loss of the whole injured extremity. This study reports attempts to break the dangerous tissue necrosis circle and save the form and function of damaged extremities. After 14 years of systematic experimental and clinical studies a successful comprehensive urgent reconstruction alternative (CURA) for electrical injuries is proposed. CURA includes: debriding the wound as early as possible after injury; preserving the vital tissue structures as much as possible, such as nerves, vessels, joints, tendons, bone, even though they have undergone devitalization or local necrosis; repairing these vital tissues during the first surgery if functional reconstruction requires it; protecting the wound bed by covering with tissue flaps of rich blood supply; improving flap survival through moist dressings supported by continuous irrigation beneath the flaps for a 24-72h period after surgery with measures to control local infection; and last, giving general systemic treatment with vasoactive agents and antibiotics. Four hundred and fifty nine wounds in 155 patients suffering from electrical injuries have been successfully treated with this technique between 1986 and 2000 and are reported in this paper. Satisfactory results were obtained with the extremity loss proportion reduced to less than 9% compared with 41.5% during the 10 years before 1984 in the same hospital. The authors suggest that CURA is an effective and workable method for treatment of electrical injuries.
 
Article
The incidence and cause of burns in Portugal are unknown. The present study seeks to collect these data as a basis for future studies in prevention and development of treatment regimes. The data used in this work was obtained from the registries existing in The Direcção Geral de Saúde (General Health Administration) and relates to burn patients admitted to 91 Portuguese hospitals--that serve all the territory--during the period of 1993-1999. All patients selected had at least one diagnosis of burn (ICD-9: 94.###) among all the diagnoses motivating an admission. A total of 14,797 burn patients were obtained. Among all the patients admitted to hospitals, 8731 (59.0%) were male and 6066 (41.0%) were female, with a male/female ratio of 1.44:1. The mean length of in-hospital stay was 15.5+/-21.0 days. Throughout this period, 553 (3.7%) patients died in Portuguese hospitals as a result of burn injury. There were no significant differences in the number of deaths in each year, P=0.45, in contrast to the decrease of burn mortality rates reported in other studies. It is likely that the reason for this situation is the lack of investment in the last years in this area and the delay in opening new Burn Centres.
 
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David N. Herndon
  • University of Texas Medical Branch at Galveston
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  • American University of Beirut
David  Andrew Ross Burd
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Shady N Hayek
  • University of Minnesota Twin Cities
Fiona M Wood
  • University of Western Australia