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Purpose: To describe the pattern of hand functional recovery in the first six months following the discharge of children with burn injury, and to identify the predictors affecting this recovery.Materials and Methods: This was a prospective, comparative, follow-up cohort study in which hand functional outcome, was assessed during 9 months follow-up on 37 children with burn injuries involving the upper extremity with total body service area (TBSA<35%). Thirty-six matched healthy children were participated to compare the differences between children with burn and healthy children regarding the hand functional outcome. Hand function assessments included total active motion (TAM), grip strength and Jebsen Hand Function Test (JHFT) were conducted at hospital discharge, 3, and 6 months follow-up after discharge.Results: We found a trend towards an increase in the TAM scores over time (P<0.001), and were excellent in 5.41%, at discharge and increased to 18.92% and 40.54% at 3 and 6-month following discharge. The hand grip strength and JHFT showed significant improvement over time after 6 months (P<0.001). Regression analysis revealed that time to surgery, engagement in rehabilitation services, hand dominance, age and TBSA were the predictors of hand functional recovery and accounted 74% for TAM, 0.79 and 0.86 for total JHFT scores and grip strength.Conclusions: the TAM, grip strength and JHFT were significantly improved after 3-month and these improvements were more evident at 6-month following discharge. Identification of the predictors may help therapists in the development of an effective rehabilitation programs. [ABSTRACT FROM AUTHOR]

Autologous skin cell suspensions (ASCS) can treat burns of varying depths with the advantage of reduced donor site wound burden. The current standard primary dressing for ASCS is a nonabsorbant, non-adherent, perforated film (control) which has limited conformability over heterogeneous wound beds and allows for run-off of the ASCS. To address these concerns, a novel spray-on polymer formulation was tested as a potential primary dressing in porcine deep partial thickness (DPT) and full thickness (FT) wounds. It was hypothesized that the polymer would perform as well as control dressing when evaluating wound healing and scarring. DPT or FT wounds were treated with either a spray-on poly(lactic-co-glycolic acid) (PLGA) and poly(lactide-co-caprolactone) (PLCL) formulation or control ASCS dressings. Throughout the experimental time course (to day 50), we found no significant differences between polymer and control wounds in % re-epithelialization, graft-loss, epidermal or dermal thickness, or % dermal cellularity in either model. Pigmentation, erythema, elasticity, and trans-epidermal water loss (TEWL), were not significantly altered between the treatment groups, but differences between healing wounds/scars and un-injured skin were observed. No cytotoxic effect was observed in ASCS incubated with the PLGA and PLCL polymers. These data suggest that the novel spray-on polymer is a viable option as a primary dressing, with improved ease of application and conformation to irregular wounds. Polymer formulation and application technique should be a subject of future research. [ABSTRACT FROM AUTHOR]

Introduction: Amputation outcome after heat press injury is associated with insufficient perfusion. We aimed to determine other risk factors for heat press injury and mechanisms of insufficient perfusion associated with amputation.Methods: We retrospectively classified 120 inpatients into the emergency and clinic groups, with arrival time before and after 48 h of injury, respectively. We performed propensity score-match to identify significant variables and combine them with those previously identified. Patients with or without amputation were categorized in different subgroups according to arrival time and perfusion with receiver-operator-characteristic (ROC) curves.Results: In the emergently insufficient perfusion subgroup, red blood cell distribution width of standard deviation (RDW-SD) was statistically different between patients without and with amputation (cutoff = 43 fL; specificity = 0.909). In the urgent group, neutrophil-lymphocyte-ratio (NLR) and relative lymphocyte count (L%) showed no association with perfusion, but was associated with amputation (NLR cutoff value = 3.12; sensitivity = 0.846). Differential leukocytes and related ratios (both groups), D-dimer (emergency group), and creatine kinase (CK) (clinic group) were also associated with insufficient perfusion.Conclusion: The study showed some correlations. Inflammation variables, D-dimer, and CK were associated with amputation and perfusion after heat press injury. Several factors were associated with amputation, including RDW-SD increase in insufficiently perfused patients within 48 h of injury, and NLR increase and L% decrease in patients after 48 h post-injury. [ABSTRACT FROM AUTHOR]

Objective: This analysis includes pooled safety data from 2 clinical trials (NCT01437852; NCT03005106) that evaluated the safety and efficacy of StrataGraft in patients with deep partial-thickness (DPT) burns.Methods: The study enrolled 101 adult patients with thermal burns covering 3-49% of total body surface area. Patients were followed for up to 1 year. The pooled safety events included: adverse events (AEs), adverse reactions (ARs), serious AEs (SAEs), discontinuation, and deaths; immunological responses (reactivity to panel reactive antibodies [PRA] and human leukocyte antigen [HLA] class 1 alleles); and persistence of allogeneic DNA from StrataGraft.Results: Eighty-seven (86.1%) patients experienced 397 AEs. Thirty patients (29.7%) experienced ARs; 16 patients (15.8%) experienced SAEs. The most frequent AEs were pruritus (n = 31; 30.7%), and blister, hypertension, and hypertrophic scar (n = 11 each; 10.9%); the most common AR was pruritus (n = 13; 12.9%). One patient discontinued the study; 2 patients experienced SAEs (unrelated to StrataGraft) leading to death. PRA and HLA allele reactivity was ≤ 25% at Month 3, with no persistent allogeneic DNA from StrataGraft.Conclusions: StrataGraft was well tolerated by patients, with a safety profile similar to autograft. StrataGraft may offer a safe alternative to autograft for DPT burns. [ABSTRACT FROM AUTHOR]

Background: Burn care is centralized in highly specialized burn centers in Europe. These centers are of limited capacity and may be overwhelmed by a sudden surge in case of a burn mass casualty incident. Prior incidents in Europe and abroad have sustained high standards of care through well-orchestrated responses to share the burden of care in several burn centers. A burn mass casualty incident in Romania in 2015 sparked an initiative to strengthen the existing EU mechanisms. This paper aims to provide insight into developing a response plan for burn mass casualties within the EU Civil Protection Mechanism.Methods: The European Burns Association drafted medical guidelines for burn mass casualty incidents based on a literature review and an in-depth analysis of the Romanian incident. An online questionnaire surveyed European burn centers and EU States for burn mass casualty preparedness.Results: The Romanian burn mass casualty in 2015 highlighted the lack of a burn-specific mechanism, leading to the late onset of international transfers. In Europe, 71% of respondents had existing mass casualty response plans, though only 35% reported having a burn-specific plan. A burns response plan for burn mass casualties was developed and adopted as a Commission staff working document in preparation for further implementation. The plan builds on the existing Union Civil Protection Mechanism framework and the standards of the WHO Emergency Medical Teams initiative to provide 1) burn assessment teams for specialized in-hospital triage of patients, 2) specialized burn care across European burn centers, and 3) medevac capacities from participating states.Conclusion: The European burn mass casualty response plan could enable the delivery of high-level burn care in the face of an overwhelming incident in an affected European country. Further steps for integration and implementation of the plan within the Union Civil Protection Mechanism framework are needed. [ABSTRACT FROM AUTHOR]

Introduction: Low- and middle-income countries account for over 90% of burns worldwide. Though mission trips, public health interventions and educational strategies have been introduced in recent years, a disparity remains in treatment provided between high- and low -income countries. This analysis aims to review available literature pertaining to strategies for training in burns management, with a focus on those applicable to low-income countries.Methodology: Mesh terms including "burns", "burns care", "burns management", "training", "teaching" and "education" were inputted into Medline and EMBase. Studies were included on the basis that they include an educational intervention to train doctors to provide surgical burns care in low-income countries. Included literature was analysed using scoring tools then a critical appraisal was performed.Results: Fourteen studies were included in this analysis. These describe e-learning (n = 1), video-based teaching (n = 1), lecture-based teaching (n = 1), simulation training (n = 8) and hospital-based training achieved through collaborative efforts between high and low-income countries such as mission trips and fellowship programmes (n = 3). The strategies described have been summarised and presented.Conclusion: Burns care training should be accessible at a global scale and so, involve training methods including simulation, courses and fellowship programmes that are affordable and accessible to surgeons in low-income countries. [ABSTRACT FROM AUTHOR]

Background: Emerging evidence suggests that the pathophysiological impact of acute burn injuries may have chronic health consequences. We conducted a systematic review and meta-analysis to investigate the association between burn injuries and long-term mortality in patients surviving to initial discharge from hospital.Methods: Medline and Embase databases were searched on 22 October 2021. Studies were eligible for inclusion if they compared long-term mortality amongst burn survivors to non-injured controls from the general population. When the same output metrics related to mortality were reported, meta-analyses were undertaken using a random effects model. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool.Results: Following an extensive literature search, six studies (seven articles) were identified for inclusion. They were predominantly based in high-income countries, with each comparing burns' survivors to matched non-injured controls from the general population. The four studies included in the meta-analysis had a combined unadjusted odds ratio of 2.65 (1.84 - 3.81; 95 % confidence interval) and adjusted mortality rate ratio of 1.59 (1.31 - 1.93; 95 % confidence interval). Thus, burn survivors demonstrated greater mortality rates when compared to their non-injured counterparts. Similar findings were illustrated in the remaining studies not included in the meta-analysis, with the exception of one study which found no significant difference between the two groups.Conclusions: Our review suggests that acute burn injuries may be associated with greater long-term mortality rates (unadjusted and adjusted). The underlying mechanism is unclear and further work is required to establish the role of certain factors such as biological ageing processes, to improve outcomes for burn patients. [ABSTRACT FROM AUTHOR]

Introduction: Delays in treatment of burn injuries can lead to significant morbidity, loss of function, and poor aesthetic appearance. Preventing conversion from partial- to full-thickness burns may help mitigate these sequelae. The pathophysiology of burn wound conversion remains unknown, but an overactive immune response is thought to be implicated. The purpose of this study was to determine whether downregulating the immune response via tacrolimus can decrease burn wound conversion.Methods: Assembly of the microfluidic hydrogels was achieved by embedding microfibers within a hydrogel scaffold composed of a gelatin-alginate blend. Tacrolimus stock solution for intraperitoneal injection was made by re-suspending powdered tacrolimus in DMSO at 10 mg/mL. 24 young (2-4 months) and 24 old (>16 months) mice were given partial thickness burns. The treatment cohort received either tacrolimus ointment with a hydrogel dressing (6 young and 6 old) or an intraperitoneal injection of a tacrolimus solution (6 young and 6 old), while the control cohort only received either only the microcapillary hydrogel dressing or an intraperitoneal injection of saline. Mice were euthanized at day 3 after injury and skin samples were taken. Burn depth was evaluated using Vimentin immunostaining.Results: In old mice, intraperitoneal injection of tacrolimus was able to significantly reduce burn wound depth compared to intraperitoneal injection of saline (p = 0.011). Similarly in old mice, topical hydrogel with tacrolimus was able to significantly reduce burn wound depth compared to hydrogel alone (p < 0.001). Topical hydrogel with tacrolimus was able to mitigate the detrimental effects of older age on wound conversion, such that burn wounds of older mice treated with tacrolimus hydrogel dressing had similar burn depths as younger mice (p = 0.240).Conclusions: Utilizing a combination treatment of tacrolimus and microcapillary hydrogel is able to rescue the negative effects of aging and prevent partial- to full-thickness burn wound conversion. Hopefully these findings will encourage deeper investigation into the possible therapeutic advantages of utilizing immunosuppressive agents to decrease morbidity after burn injuries. Future research will need to specifically investigate IL-2 as an inhibitory target in the acute inflammatory cascade of burn injury. [ABSTRACT FROM AUTHOR]

Introduction: Despite advances in burn care, large burn injuries carry significant mortality risk. Although studies examining immediate mortality are available, little data is available regarding risk after discharge from hospital. This study aimed to determine short and long term mortality rate at a UK burns centre for patients with massive burn injuries. We were particularly interested to determine whether mortality rate for self inflicted injuries was present and whether this was by suicide.Methods: The International Burn Injury Database (iBID) was interrogated to identify patients admitted with> 50% TBSA (total body surface area) injuries from January 2009- September 2019. Documented cause of death on death certificates were viewed for patients who died. General Practitioners were contacted to determine if discharged patients were alive. Descriptive statistics were generated.Results: 96 patients were identified. Mean age was 45.6 years (range 16.4-93.7) with male to female ratio of 2:1. Mean TBSA was 71.8% (range 50-99). Mortality was 71.9% and was higher in females (75.7% vs 69.8%). Overall mean revised Baux score was 130 (range 68-184). Nearly half were self-inflicted (49.0%) with higher TBSA (74.4%). Of 69 patients who died only 1 was after discharge. Coroner inquiry determined that this was caused by acute alcohol intoxication. Most of those who died did so within 60 days (91.3%), usually within 48 h (71.0%). Burn futility accounted for most deaths (71.0%) followed by multi-organ failure (14.5%).Conclusions: Large burns carry significant mortality risk. Self-inflicted large burns carry a higher mortality which may be attributed to larger TBSA. In patients surviving to discharge long term prognosis is good. Patients with self-inflicted burns seem to not make a subsequent successful suicide attempt after discharge from hospital. [ABSTRACT FROM AUTHOR]

Objective: The high levels of oxidative stress and apoptosis of pancreatic islet cells after severe burns lead to the dysfunction of islets and glucose metabolism disorders. Silent information regulator of transcription 1 (SIRT1) can decrease oxidative stress and apoptosis of islets in diabetes mellitus. This study aimed to investigate the role of SIRT1 on pancreatic islets and whether nicotinamide mononucleotide (NMN) can impact the function of pancreatic islets after severe burns.Methods: A 30% total body surface area full-thickness burn model was established using male C57BL/6 mice, and mice were randomized into sham group, burn group, burn + NMN group and burn + NMN + EX-527 group. The concentration of nicotinamide adenine dinucleotide (NAD), the expression of SIRT1, apoptosis induction, mitochondrial function and related signalling pathways of pancreatic islets at 24 h after severe burns were tested.Results: Severe burns led to decreased NAD level and SIRT1 expression of pancreatic islets, increased apoptosis rate, and mitochondrial dysfunction of pancreatic islets. NAD repletion by NMN and upregulation of SIRT1 expression reduced the phosphorylation and acetylation levels of NF-κB p65 and burn-induced apoptosis. Meanwhile, the mitochondrial function of islets was rescued by NMN treatment through the SIRT1/UCP2 axis and SIRT1/PGC1-α axis. In addition, the fasting blood glucose decreased and glucose-stimulated insulin secretion was improved with NMN treatment after severe burns. This protective effect of NMN could be abolished by EX-527, the inhibitor of SIRT1.Conclusion: NMN can increase the concentration of NAD+ of pancreatic islets and regulate SIRT1 and its downstream targets, thereby reducing apoptosis, maintaining mitochondrial function and improving pancreatic islet function after severe burn injury. [ABSTRACT FROM AUTHOR]

Background: Among the zones of coagulation, hyperemia and stasis that occur in the burned area, the most intense metabolic process and the highest sensitivity to recovery with treatment is the zone of stasis.This metabolic process is related to how well the tissues in the zone of stasis can cope with oxidative stress. If the tissues in the zone of stasis are saved, the burn area will potentially heal faster and with less scar. In this study, we examined the effects of taurine amino acids and apocynin molecules on saving the tissues in the burn zone of stasis.Methods: The study was conducted with 48 rats. The burn zone of stasis was created according to the pattern previously described in the literature as comb burn model. In the 21-day study, biopsies were taken for histological examination on the 3rd, 7th and 21st days of the study. In addition, macroscopic photographic analysis was performed. Biopsies were taken for biochemical analysis on the 21st day. Histologically, inflammation, reepithelialization, and collagenization were evaluated, and the CD34 immunoreactivity was analysed. Biochemically, CAT, SOD, tGSH, TAS, TOS, MDA and PPC values were determined.Results: In the histological examination, on the 3rd, 7th and 21st days, inflammation was found to be reduced in the groups given taurine and apocynin on the 3rd day. On the 7th day, better reepithelialization and collagenization were observed in the group given taurine. Significant reepithelialization, collagenization and hair follicle development were observed in the groups given taurine and apocynin on the 21st day. In the biochemical analysis, the effects of apocynin on antioxidant enzymes were determined to be prominent. While we found no significant difference on the 3rd and 7th days in the photographic analysis, taurine and apocynin were observed to act synergistically on the 21st day and significantly reduced the burned areas.Conclusion: On the 3rd day, taurine and apocynin prevented inflammation, the effects of taurine in the zone of stasis in the early period (7th day) are more pronounced, the effect of apocynin on antioxidant enzymes is more pronounced. In the late period (21st day), taurine and apocynin were found to be more effective in saving the zone of stasis by creating a synergistic effect. [ABSTRACT FROM AUTHOR]

Background: This study aims to compare the use of one-per-mil tumescent solution (a mixture of epinephrine and 0.2% lidocaine in a ratio of 1:1,000,000 in normal saline solution) and tourniquet to create clear operative fields and to evaluate the functional outcomes after post burn hand contracture surgery.Methods: The subjects of this randomized controlled trial were divided into one-permil tumescent technique and tourniquet group for a similar surgical procedure. Three independent assessors evaluated the clarity of the operative fields through recorded videos for the first 15 min and the first 10-minute of each hour of the surgery. Functional outcome was evaluated at least three months postoperatively using total active and passive motion (TAM and TPM) of each digit. Malondialdehyde (MDA) and tumor necrosis factor alpha (TNF-α) were tested during baseline (5 min before the procedures), ischemia phase, and reperfusion phase (a phase when the blood flow returned to the tissue).Results: 35 subjects were included in this study: 17 in the tumescent group and 18 in the tourniquet group. We found a significant difference in the clarity of operative field between tumescent and tourniquet groups, 5 vs 35 bloodless operative fields, respectively (p < 0.05). TAM and TPM of each digit before surgery and 3 months postoperatively showed no significant difference between both groups (p > 0.05). Furthermore, we found no difference in MDA and TNF-α levels between both groups at their respective phases.Conclusions: The use of one-per-mil tumescent technique does not replace tourniquet use to create bloodless operative fields in burned hand contracture surgery. However, the postoperative functional results were similar in both groups showing that tumescent technique can be used as an alternative to tourniquet without compromising outcomes. The MDA and TNF-α examinations do not provide conclusive outcomes regarding ischemia and reperfusion injury. [ABSTRACT FROM AUTHOR]

Aims: Peripherally inserted central catheters (PICCs) are becoming common and effective in acute and critical care settings recently. Burn patients need special considerations because of restricted insertion sites, burn wounds, hyper coagulation, high infection rates and others. However, the safety of PICCs in burn patients are not well elucidated and no related protocol has been formed. This study aims to investigate the thrombosis and infections of PICCs in burn patients.Methods: This was a single center retrospective study and a systematic review. All the burn patients with PICCs between January 1, 2018 and December 31, 2020 were included. A systematic search of Medline, PubMed, EMBASE and Web of Science was performed from inception to 4 June 2021 following PRISMA guidelines. Upper extremity vein thrombosis (UEVT) and central line-associated bloodstream infection (CLABSI) were the main outcome.Results: A total of 85 successful PICCs in 78 patients were included. Most patients were male (79.5%), adults(80.8%) and injured by flame(74.4%). The mean TBSA was 50.3% and 76.9% of patients had TBSA more than 30%. Most PICCs were punctured once (60.0%) and inserted less than 30 days after injury (80.0%) through basilar vein (70.6%). The overall line days were 2195 days and the mean line days was 25.8 ± 18.3 days. Six PICCs were complicated by UEVT (7.1%) in 21.2 ± 17.3 days after insertion. Patients with UEVT had significantly higher rate of bacteremia and later insertions than those without UEVT. One patient developed CLABSI and the CLABSI rate was 1.2% and 0.5 per 1000 line days. Six PICCs had catheter colonization. No significant risk factors were identified. Five articles involving 293 patients and 319 PICCs were ultimately evaluated in systematic review. The overall incidence of UEVT was 3.2% and CLABSI was 6.9% in burn populations.Conclusion: PICCs in burn patients had acceptable incidence of UEVT and CLABSI with relative long line durations. A standardized PICC guideline for burn patients is required to further improve the feasibility and safety of PICCs. [ABSTRACT FROM AUTHOR]

Background: Surgical wound excision is a necessary procedure for burn patients that require the removal of eschar. The extent of excision is currently guided by clinical judgement, with excessinto healthy tissue potentially leading to excessive scar, or inadequate debridement increasing risk of infection. Thus, an objective real-time measure to facilitate accurate excision could support clinical judgement and improve this surgical procedure. This study was designed to investigate the potential use of Rapid evaporative ionisation mass spectrometry (REIMS) as a tool to support data-driven objective tissue excision.Methods: Data were acquired using a multi-platform approach that consisted of both Rapid Evaporative Ionisation Mass Spectrometry (REIMS) performed on intact skin, and comprehensive liquid chromatography-mass spectrometry (LC-MS/MS) lipidomics performed on homogenised skin tissue extracts. Data were analysed using principal components analysis (PCA) and multivariate orthogonal projections to latent squares discriminant analysis (OPLS-DA) and logistic regression to determine the predictability of the models.Results: PCA and OPLS-DA models of the REIMS and LC-MS/MS lipidomics data reported separation of excised and healthy tissue. Molecular fingerprints generated from REIMS analysis of healthy skin tissue revealed a high degree of heterogeneity, however, intra-individual variance was smaller than inter-individual variance. Both platforms indicated high levels of skin classification accuracy. In addition, OPLS-DA of the LC-MS/MS lipidomic data revealed significant differences in specific lipid classes between healthy control and excised skin samples; including lower free fatty acids (FFA), monoacylglycerols (MAG), lysophosphatidylglycerol (LPG) and lysophosphatidylethanolamines (LPE) in excised tissue and higher lactosylceramides (LCER) and cholesterol esters (CE) compared to healthy control tissue.Conclusions: Having established the heterogeneity in the biochemical composition of healthy skin using REIMS and LC-MS/MS, our data show that REIMS has the potential to distinguish between excied and healthy skin tissue samples. This pilot study suggests that REIMS may be an effective tool to support accurate tissue excision during burn surgery. [ABSTRACT FROM AUTHOR]

Aims: To explore the effects of self-efficacy and social support on posttraumatic growth among burn patients.Methods: This study adopted a cross-sectional design and used convenience sampling method to recruit moderate and severe burn patients. The study was conducted from January to July, 2018 in a tertiary hospital in Linyi, China. Self-administered questionnaires were used to collect data on posttraumatic growth, social support, and self-efficacy. Path analysis conducted using SPSS AMOS 21.0 software was used to explore the relationship between the above three variables.Results: The mean scores for posttraumatic growth, social support, and self-efficacy were 58.11 ± 9.60, 43.48 ± 6.81, and 24.97 ± 5.71, respectively. Self-efficacy and social support were directly and positively related to posttraumatic growth among burn patients. Social support was also indirectly and positively associated with posttraumatic growth. Self-efficacy partially mediated the relationship between social support and posttraumatic growth.Conclusions: Self-efficacy was an important mediator for burn patients' social support and posttraumatic growth. Therefore, self-efficacy and social support should be considered when designing and implementing of interventions for posttraumatic growth among burn patients. [ABSTRACT FROM AUTHOR]

Introduction: From 85348 inmates in England and Wales, over 26,000 incidents of assault and 40,000 of self-harm were reported from within prisons in 2016. This study focuses primarily on burn injuries in prison, determining the predominant aetiology as well as clinical outcomes of these injuries.Methods: Data was retrieved retrospectively and a case series performed, including all burns referred from regional prisons to our centre from 2007 to 2017 and comprising patient demographics, mechanism of injury, total body surface area affected, management, and outcome. Cost analysis of care was conducted using a previously published framework.Results: 18 cases from three regional prisons were recorded, with 67% from a single prison. Referrals rose exponentially over time, with 44% occurring in 2017. 94% were scald burns, and 56% secondary to assault, primarily through the use of kettles and mostly targeting the face and trunk. The mean TBSA of burn was 2.89% (<1-8%), and 80% received first aid. 72.2% were admitted to hospital for an average of 4 days. All burns were managed nonoperatively with dressings and underwent on average 2 outpatient reviews (1-8).Discussion: The disproportionate spread of referrals across the prisons correlates partly with the respective populations, but may also represent contrasting medical provisions. The recurring method of assault reflects the relative ease of access to hot water as a harmful agent, predominantly presenting with scalds affecting more critical areas, and with concurrent physical trauma in nearly half of cases which presents management challenges.Conclusion: Targeted education is recommended to reduce the incidence and ensure adequate management of burns in prison, referrals for which are demonstrably rising. Accordingly, the Burns Outreach team can provide training to in-house prison health staff and review referrals to specialist Burns services, aiming to ensure equitable care while alleviating costs associated with transfer to and management in hospital. [ABSTRACT FROM AUTHOR]

Pregnant women are a vulnerable subgroup of burn patients, due to altered physiological state and possible adverse effect on the fetus. The aim of this study was to develop a guideline for a tailored treatment of pregnant patients with burns to optimally treat both mother and fetus. This study consists of two parts: the first part contains a systematic review that presents a comprehensive overview of the literature on the management and outcome of pregnant women who sustain severe burn injuries and based on the results of this review, a guideline on the general, obstetric and burn management was developed and presented in the second part. A total of 35 studies including 1395 patients were included. Although the clinical outcomes seemed to be similar to non-pregnant patients, one study showed that mortality might be higher in the pregnant population. Predictive factors for maternal and fetal mortality were a total burned surface area of over 40% and inhalation injury. Early surgery may lead to a higher chance of survival of mother and fetus. A comprehensive guideline on the general management of pregnant patients with burns, obstetric management and specific burn management is provided. We encourage international burn organizations and guideline committees to use and evaluate the presented guideline. [ABSTRACT FROM AUTHOR]

Objectives: To determine the feasibility of using human cadavers to demonstrate enzymatic burn debridement, as a training aid for clinical staff.Material and Methods: A single, fresh-frozen human cadaver was used. Prior consent had been given. Burns were created by flame and scalding. Unburned control sites were also assessed. Nexobrid® enzymatic burn debridement paste was applied to all sites, in adherence to the local clinical protocol for treating burned patients. After removal of Nexobrid®, wounds were assessed to determine if the cadaveric tissue appeared similar to what would be expected in living burned patients and whether the technique could be viable for training of burn care staff.Results: Nexobrid® had a very similar effect upon burned cadaveric skin to what would have been expected in living burned skin. Burns of partial thickness burn depth and full thickness burn depth were debrided and could be clearly identified.Conclusions: Fresh-frozen human cadaveric tissue is a valid means of provision of training in the technique of enzymatic burn debridement. This finding was unexpected and shows that our understanding of the mechanism of action of Nexobrid® is incomplete. [ABSTRACT FROM AUTHOR]

Background: Globally, burn injuries are the 3rd principal cause of death due to injury among children aged 1-9 years. Yet, the management of paediatric burns is always challenging; due to limited donor sites and the cosmetic appearance that will affect the child later in life, either at the donor or the recipient site. Skin grafts may need to be expanded to minimise donor skin size or in patients with limited donor sites. Multiple techniques were described for graft expansion, mainly the mesher and the Meek technique.Patients and Methods: A prospective comparative randomised study was done from January 2019 to June 2020 on 40 paediatric burn patients with deep dermal and full-thickness burns. Patients were divided into two groups, Meek and meshed groups. The skin graft take, epithelialization time, total time of the surgery and the aesthetic outcomes (using the POSAS - Patient and observer scar assessment scale) in each group were evaluated at three months postoperatively.Results: The percentage of take in the Meek group (84.25%) was significantly better than with the meshed group (71.5%) (P = 0.006). Epithelialization time was better for the Meek group (27.11 days) compared to the meshed group (33.5 days) (P = 0.176). In addition, infection rates were lower in the Meek group (25%) than the meshed group (40%) (P = 0.311). Subjectively POSAS scar assessment scale exhibited better results for the Meek group with a mean score of 3.17 & for the meshed group was 4.2 (P = 0.048). The observer's overall score was as well better for the Meek group with a mean overall opinion score of 2.89 & for the meshed group was 4.1 (P = 0.003). The operative time was longer with the Meek technique than the traditional mesher (P < 0.001).Conclusion: The Meek technique for expanding the skin grafts is useful in covering burn wounds with greater expansion rate, more accessible application, better graft take & a better scar appearance than the traditional mesher. Still, the Meek technique has a considerable learning curve, longer procedure time & is more expensive. [ABSTRACT FROM AUTHOR]

Objective: This retrospective study compared the effectiveness of dispersed implantation of very small autologous columnar skin (SCS) grafts and full-thickness skin grafts (FTSGs) for treating upper eyelid third-degree burns.Methods: Fourteen patients and 26 eyes with granulation tissue formed by third-degree upper eyelid burns were enrolled in the study from August 2017 to June 2020. The experimental group of 6 patients with 11 eyes was treated with SCS grafts. The control group of 8 patients with 15 eyes was treated with FTSGs. The survival rate of the grafts, healing time, SCS diameter, upper eyelid movement distance (ULMD), visual analogue scale (VAS) score for patient satisfaction, and Vancouver Scar Scale (VSS) score were evaluated.Results: The difference in the survival rate between the two groups was not statistically significant (P = 0.06). The ULMD and VAS scores in the experimental group were higher than those in the control group (P < 0.05). The healing time was longer in the experimental group than in the control group (P < 0.05). The VSS scores of the donor site and the skin grafting site in the experimental group were lower than those in the control group (P < 0.05).Conclusion: Unlike classical skin grafts, SCS implantation surgery can restore the appearance of the upper eyelid, and there is no obvious scar at the donor site. This can be a viable alternative to traditional FTSGs with potential benefits. [ABSTRACT FROM AUTHOR]

Background: Severe burns can cause a hypermetabolic response and organ damage. Glutamine is a conditionally essential amino acid with various pharmacological effects. In this study, whether glutamine could alleviate the hypermetabolic response and maintain organ function after burn injury was analyzed.Methods: A multicenter, randomized, single-blind, parallel controlled trial was conducted to evaluate the efficacy of glutamine in decreasing hypermetabolism after burn injury. Physiological and biochemical indexes, such as vital signs, metabolic hormones, metabolic rate, and organ damage, were recorded on the 7th and 14th days after treatment.Results: In total, 55 adult burn patients with a total burn surface area (TBSA) of 30-70% were included in this study and randomly divided into the burn control (B, 28 patients) and burn+glutamine (B+G, 27 patients) groups. Except for the glutamine administration, the groups did not differ in the other treatments and nutrition supplements. The levels of diamine oxidase (DAO), lactulose/mannitol (L/M), β2-microglobulin, lactate dehydrogenase (LDH), hydroxybutyrate dehydrogenase (HBD) and cardiac troponin l (cTnl) in the B+G group were significantly lower than those in the B group (p < 0.05 or 0.01). The levels of resting energy expenditure (REE), serum catecholamines, glucagon, lactate and Homeostasis model assessment (HOMA) in the B+G group were significantly lower than those in the B group (p < 0.05 or 0.01). No significant difference was found in the length of hospitalization or the mortality rate between the two groups (p > 0.05).Conclusions: Glutamine moderately alleviates the hypermetabolic response and reduces organ damage after severe burns. Therefore, the early application of glutamine, which is effective and safe, should be used as an active intervention as early as possible. [ABSTRACT FROM AUTHOR]

Background: In current intensive care treatment, some patients with severe burns cannot be saved due to progressive organ failure. Further investigation of the pathogenesis of severe burns is needed to improve the mortality rate. In burns, inflammatory cytokines form a network that leads to an inflammatory response. Adipocytes secrete physiologically active substances (adipokines). The roles of adipokines have not been completely clarified in burn patients. This study aimed to determine the relation between serial changes of adipokines and clinical course in severely burned patients.Methods: This was a single-center, retrospective, observational study. Patients' blood samples were collected on the day of injury and around 1 week later. Adipokines (adiponectin, angiotensinogen, chemerin, CXCL-12/SDF-1, leptin, resistin, vaspin, visfatin), various inflammatory cytokines, syndecan-1 and C1 esterase inhibitor were measured.Results: Thirty-eight patients were included. Resistin levels were significantly higher in the non-survivors versus survivors on Day 1 after burn injury. Hierarchical clustering analysis showed common clusters on Day 1 and at 1 Week after burn injury (resistin, IL-6, IL-8, IL10 and MCP-1). The correlation coefficient of resistin to SOFA score at 1 Week was significant. Logistic regression analysis showed a significant relation of resistin levels on Day 1 with prognosis; the area under the ROC curve for resistin was 0.801.Conclusions: In the acute phase of burns, resistin was associated with other pro-inflammatory cytokines and was related to the severity and prognosis of major burns. [ABSTRACT FROM AUTHOR]

Burn injuries are an unexpected traumatic event and can be physically and emotionally devastating for a child and their families. This article presents a conceptual framework for art therapy practice with pediatric burns, founded on the three stages of burn treatment- critical, acute, and rehabilitation. The framework is based on narrative synthesis of research on the psychosocial needs of children with burn injuries, art therapy literature on pediatric burn patients, as well as in medical settings. Based on the stages of burn recovery, and the role of other relevant stakeholders, the framework provides recommendations for clinical practice of art therapy with children sustaining burn injuries, their caregivers and siblings, and healthcare providers. Robust studies including art therapy as interventions are recommended to determine their effectiveness in addressing the specific psychosocial needs in different stages of pediatric burn care. [ABSTRACT FROM AUTHOR]

Introduction: Management of donor site morbidity in the setting of split thickness skin graft (STSG) is of crucial importance with no superior wound dressing described to date and the growing need of decreasing epithelializing time. The purpose of the study was to compare the standard of care using a hydrocolloid dressing to platelet rich plasma (PRP) and plasma rich in growth factors (PRGF) in order to determine its therapeutic potential in this setting.Methods: A randomized clinical trial was conducted in which each patient served as its own control. PRGF was obtained by means of freeze-thaw out of the PRP from the subject of the study. Patients from the study had three donor sites and each donor site received either to PRP, PRGF or the standard of care, hydrocolloid. The main variable was time to epithelialization, and secondary variables subject to study were pain, quality of the scar, complications and cost.Results: 20 patients were recruited with a total number of 60 donor sites to study. On the 8th post-operative day 55% and 45% of the sites treated with PRP and PRGF, respectively, complete epithelialization was observed as compared to 20% of the sites treated with hydrocolloid, statistical significance was achieved between the latter two (p = 0.036). The areas treated with PRP and PRGF received inferior values on the visual analog scale on post-op day 5 and 8 compared to hydrocolloid. Values on wound healing metrics were lower in the PRP when compared to hydrocolloid. No adverse effects were recorded.Conclusion: Donor site of STSG treated with PRP in the setting of the burn patient decreased time to epithelialization. In our study a better pain control and in scar quality was observed in both, the PRP and PRGF group. [ABSTRACT FROM AUTHOR]

Background: The contribution of various volcanic phenomena to immediate soft tissue injury types has received limited attention challenging emergency management planning. This integrative review sought to investigate the immediate types of soft tissue-related injury sustained following volcanic eruptions.Methods: A systematic search was conducted in January 2020 across EMBASE, PubMed, and Scopus databases. 718 articles were retrieved, and 15 studies met the final inclusion criteria.Results: Injuries acquired, and health impacts were categorized by onset-direct/indirect or immediate/delayed. Health concerns following an eruption were categorised: (1) respiratory; (2) ocular; and (3) skin, including deep tissues. Respiratory concerns were attributed to ashfall, volcanic gases and pyroclastic density currents; most ocular injuries to ashfall; and skin/deep tissues to pyroclastic density currents and mudflows.Conclusions: Volcanic eruptions simultaneously present multiple hazards with immediate/short term health consequences across three major levels (i.e., respiratory, ocular, and skin, including deep tissues). Hazard(s) differ by time of onset and associated mostly with the eruptive phenomena. Understanding local volcanic phenomenon is essential to assisting health personnel provide informed and timely care. [ABSTRACT FROM AUTHOR]

Patients with burns commonly present to Emergency Departments (EDs), in addition to burn centers. Patients at burn centers typically have more severe burns than those at EDs, and previous studies have analyzed burn center databases. To update the overall burn epidemiology in the United States (US), we analyzed burn injury trends and sources across all age groups using the National Electronic Injury Surveillance System (NEISS), which collects all injuries reported to US EDs. A total of 97,986 burn injuries were recorded in NEISS, 2000-2018. We found a downward trend in the pediatric burn rate and an upward trend in the adult burn rate. Almost half of burns were in children (48.41%), especially in those under 5 (29.79%), and slightly more common in men (53.93%). Most were treatable in the ED (87.83%) and hot water was the most common source overall (20.88%), followed by hair curlers for children less than 2 years old, ranges/ovens for 2 to <5 years, microwaves for 5 to <10 years, and cookware for 10 to <18 years and adults ≥18 years. The most common injured region was the hand for all age groups (34.44%). Although most burn injuries were potentially preventable, the overall burn rate did not decrease 2000-2018. Therefore, we offer guidance on prevention strategies for high-risk sources and age groups. [ABSTRACT FROM AUTHOR]

Impaired wound healing is one of a variety of severe diabetic complications and involves many factors, including consistent oxidative stress, prolonged inflammation, impaired angiogenesis, and delayed re-epithelialization. Despite the severe negative impacts that impaired wound healing has on patients' lives, detailed mechanisms and effective therapies are still not fully developed. In this study, we aim to investigate the potential effects and mechanisms of topical administration of pterostilbene and resveratrol on burn wound healing in diabetes. Our in vitro experiments in human umbilical vein endothelial cells showed that long term exposure of hyperglycemia induces oxidative stress and suppression of hypoxia inducible factor1α (HIF1α) signaling pathway, and pterostilbene treatment completely, while resveratrol treatment partly, reversed this effect. Further in vivo experiments in diabetic rats showed that topical administration of pterostilbene exhibited stronger efficacy than resveratrol in normalizing oxidative stress, HIF1α activity, and accelerating burn wound healing in diabetes. We conclude that topical administration of pterostilbene accelerates burn wound healing in diabetes through activation of the HIF1α signaling pathway; thus, pterostilbene may be a potential candidate for clinical treatment of burn wound healing in diabetes. [ABSTRACT FROM AUTHOR]

Introduction: Autologous split thickness skin grafting is the standard-of-care for the majority of deep dermal and full thickness burns: Meshed grafting is most commonly used. Patients with extensive burn injuries have limited donor site availability. Meek micrografting is a well-known technique to enable larger expansions. A review was conducted on the outcomes of the Meek micrograft technique.Method: A database search in PubMed, Web of Science, Google Scholar and the Cochrane Library was conducted from the first Meek micrografting report in 1958 until 2021, including terms 'burns', 'micrografting' and/or 'Meek'. Original papers reporting outcomes of Meek micrografting were included.Results: 1529 papers were identified and eventually 15 articles were included, the majority classified as poor quality according to Chambers criteria. 310 patients with 56% mean TBSA were described. Weighted averages were calculated for 'graft take' 82 ± 7%, 'time to wound closure' 53 ± 20 days and 'length of hospital stay' 61 ± 31 days. Scar quality was minimally described and often poorly assessed. Limited data were available on outcomes 'donor site size', 'number of operations', 'cost effectiveness' and 'bacterial load/wound infection rate'.Conclusion: Overall poor study quality and the specific lack of data on scar quality, made it impossible to draw conclusions on the outcomes of Meek micrografting. A randomized controlled trial is required to further investigate the performance of the Meek micrograft technique. [ABSTRACT FROM AUTHOR]

Aim: As burn self-stigma has not been addressed fully, the purpose of current study is to analyze dimensions of the concept using literature and lived experiences in burn survivors.Methods: Using hybrid concept analysis method, we investigated self-stigma in three phases (i.e. theoretical, fieldwork, and final analytical phase). In the first phase we reviewed the literature using PubMed, SCOPUS, Web of Science, Cochrane Library, OVID, SID and Google Scholar. Thirteen semi-structured interviews with burn survivors were conducted during the fieldwork phase. Two extra interviews with health care providers were undertaken for the aim of data triangulation. Textual content analysis and inductive content analysis were used to analyze the data of the first and second phases of this study, respectively. The findings of both phases were combined in the final analytical phase and a comprehensive definition was emerged.Results: We assigned all our findings into three content areas (i.e. antecedents, properties and consequences), which are dimensions of self-stigma. In final analytical phase antecedent, properties and consequences of the concept were formed in one (society's misconception about burns), three (negative definition of self, emotional responses, and behavioral responses), and three (negative individual effects, negative social effects, and negative familial effects) categories, respectively. Based on these categories and their corresponding subcategories, a comprehensive definition of the concept was presented.Conclusion: Burn self-stigma is a state in which burn survivors experience unfavorable thoughts and feelings about themselves as a result of society's misconceptions about them. They give emotional and behavioral responses that define them in a negative way. In the end, the burn survivor's individual, familial, and social dimensions are significantly impacted. [ABSTRACT FROM AUTHOR]

Background& Objectives: Cyanide poisoning can occur due to exposure to smoke in closed-space fires. With no point of care cyanide test at the scene of a fire, first responders and clinicians base decisions to treat with cyanide antidote on patient history, clinical signs, and other indirect data points that have not been proven to correspond with actual systemic levels of cyanide. The aim of this exploratory study was to determine the economic implications of treating patients with known or suspected cyanide poisoning due to smoke inhalation with hydroxocobalamin.Methods: A decision analysis model was developed from the US hospital perspective. Healthcare resource utilization was estimated from a retrospective evaluation of clinical outcomes in hydroxocobalamin-treated patients and in historical controls without hydroxocobalamin use (Nguyen, et al. 2017). Epidemiologic parameters and costs were estimated from the published literature, and publicly-available hospital charges were identified. Outcomes reported in the analysis included expected healthcare resource utilization in the US population and per-patient costs with and without the use of hydroxocobalamin. A cost-to-charge ratio was applied so that all costs would reflect hospital costs rather than hospital charges. Deterministic sensitivity analysis was performed to identify the most influential model parameters. All costs were reported in 2017 US dollars.Results: Use of hydroxocobalamin reduces healthcare resource utilization and contributes to decreased per-patient hospital costs ($15,381 with hydroxocobalamin treatment versus $22,607 with no cyanide antidote). The most substantive cost-savings resulted from decreased hospital length of stay (i.e., intensive care unit [ICU] and non-ICU). Costs attributed to mechanical ventilation also decreased with use of hydroxocobalamin. A univariate sensitivity analysis demonstrated that the most impactful variables in the cost analysis were related to hospital length of stay (ICU followed by non-ICU stay), followed by the daily cost of ICU stay.Conclusions: Use of hydroxocobalamin in patients with known or suspected cyanide poisoning from closed-space fire smoke inhalation may decrease hospital costs and contribute to more efficient healthcare resource utilization. [ABSTRACT FROM AUTHOR]

Objective: The use of fat grafting is being widely used for different indications one of which is wound healing. In this study we compare the use of autologous fat grafting (AFG) as a novel indication in acute burn wounds healing and burn scarring to the conventional methods of burn wound management both clinically and histologically. Several small observational studies demonstrated the effect of the AFG in healing of chronic wounds, different vascular ulcers or effect on scars yet no randomized controlled trial is available to compare its role with conventional methods.Methods: The study was a prospective, open-label single center, randomized control clinical trial included 100 patients with superficial and deep dermal burns from March 2019 to March 2020 randomized to AFG protocol consisted of a single injection of autologous fat grafting then dressed with nano fat (Group A) or conventional methods of serial dressings with 1% silver sulphadiazine or other topical agents (Group B). Inclusion criteria included newly admitted burn patients with affected total body surface area (TBSA) (10%-25%) while exclusion criteria included burns patients with affected TBSA of< 10% or> 25%, or loss of subcutaneous fat, fascia, muscles and bones, inhalational burn, and burns in genitalia, perineum and peri-anal areas and co-morbidity(ies) that might affect wound healing or eligibility for anaesthesia and surgery. Also, results were confirmed by histological analysis for samples from both groups by light microscopic examination, and the nano-fat was subjected to flow cytometric analysis of the cluster of differentiation (CD) markers of mesenchymal stem cells markers CD 90, CD44, CD45, CD 73, and CD 34. (ClinicalTrials.gov Identifier: NCT03791710) RESULTS: We found a significant reduction in total hospital stay days (p = <0.001), less further skin grafting (p = 0.003), less contracture formation (p = <0.002) while scar texture improved (p = <0.001) in group A compared to group B. Flow cytometric analysis documented that the nano-fat was positive to CD 90, 73, 44, 45 and 34.Conclusion: In a comparison between AFG protocol to the conventional methods in the treatment of acute burn wounds, AFG protocol was associated with significant clinical improvement in the form of lower hospital stay time, lower incidence of scaring or contracture and lower skin grafting use which was confirmed by serial photographic and histological assessment. [ABSTRACT FROM AUTHOR]

Alu elements are retrotransposons related to epigenetic modifications. To date, the role of epigenetics in hypertrophic scars from burn remains unknown. Here, our aim was to examine the pathophysiology of hypertrophic scars from an epigenetic perspective. For that, we performed a cross-sectional analytical study using tissue and blood samples from burned and healthy patients (n = 23 each) to detect Alu methylation levels and patterns. The results of the combined bisulfite restriction analysis technique were categorized into four groups based on the methylation status at the CpG dinucleotides from the 5' to the 3' ends of the Alu sequence: hypermethylated (mCmC), hypomethylated (uCuC), and partially methylated (uCmC and mCuC). Alu methylation levels were significantly lower in hypertrophic scar tissues than in normal skin (29.37 ± 2.49% vs. 35.56 ± 3.18%, p = 0.0002). In contrast, the levels were significantly higher in white blood cells from blood samples of burned patients than in those of control blood samples (26.92 ± 4.04% vs. 24.58 ± 3.34%, p = 0.0278). Alu total methylation (mC) and the uCmC pattern were significantly lower, whereas uCuC was significantly higher, in hypertrophic scar tissues than in normal skin (p < 0.0001). Receiver operating characteristic analysis indicated that the uCmC and uCuC patterns are useful as hypertrophic scar DNA methylation markers after burn, with 91.30% sensitivity and 96.23% specificity and 100% sensitivity and 94.23% specificity, respectively. Our findings suggest that epigenetic modifications play a major role in hypertrophic scar pathogenesis, and may be the starting point for developing a novel technique for burn scar treatment. [ABSTRACT FROM AUTHOR]

Introduction: This study was carried out to evaluate role of intravenous tranexamic acid (TXA) in reducing blood loss during tangential excision of burns.Methods: This was a single center, prospective double-blinded parallel arm superiority randomized placebo-controlled trial. Patients (15-55 years) with deep dermal thermal burns <30% undergoing tangential excision were randomly assigned (1:1) to TXA and placebo groups. Patients in TXA and placebo groups received injection TXA 15 mg/kg and 10 ml saline respectively, 10 min preoperatively. Primary outcome was volume of blood loss per square centimeter area of burn excised. Secondary outcomes were total volume of blood loss, postoperative hemoglobin, intraoperative fluid requirement, blood transfusion, graft take and length of hospitalization (LOH).Results: Thirty patients were included. Both groups were comparable in terms of Body Mass Index (BMI) preoperative hemoglobin, area of burn excised, duration of surgery and the intraoperative temperature. The average blood loss per square centimeter burn area excised was found to be significantly lower in TXA when compared to placebo group (mean difference: 0.28 ± 0.025 ml/cm2; p = 0.000). The total volume of blood loss was lower in TXA group (258.7 ± 124.10 ml vs 388.1 ± 173.9 ml; p = 0.07). None of the patients required transfusion. The requirement of intra-operative fluids was similar between the two groups (crystalloids: p = 0.236; colloids: p = 0.238). Postoperative hemoglobin, length of hospitalization and graft-take were comparable between the two groups.Conclusion: TXA reduced blood loss per unit burn area of tangential excision in <30%TBSA burn, however, we found no significant effect on postoperative Hb and transfusion. [ABSTRACT FROM AUTHOR]

Purpose: To provide evidence of efficacy and postoperative benefit of topical anesthesia (TA) for harvesting split-thickness skin graft (STSG) in an Asian population.Materials and Methods: Patients with well-granulating wounds with skin grafting were randomized into TA or general anesthesia (GA) groups. In the TA group, an eutectic mixture of lidocaine and prilocaine (EMLA) was applied. Perioperative heart rate, postoperative donor site pain, adverse effects, patients' satisfaction, duration of surgery, and operation room (OR) stay duration were recorded.Results: Thirty-nine patients (19 males, 20 females; mean age 54.9 ± 17.8) were included. Twenty underwent TA and 19 underwent GA for STSG. The TA group patients had tolerable pain during skin graft harvesting (VAS, 0.85 ± 1.5). Average EMLA exposure duration was 180.3 ± 65.8 min, and the amount applied was 1.72 ± 0.43 g/10 cm2. The TA group had lower donor site pain score at one hour postoperatively (1.34 ± 1.49 vs 3.08 ± 1.90, p = 0.005), lower OR stay duration (36.5 ± 6.5 min vs 65.1 ± 17.2 min, p < 0.001) and less adverse effects than the GA group.Conclusion: Harvesting STSG under TA with EMLA is an effective and efficient approach for most Asian patients with less early postoperative donor site pain and fewer adverse effects. [ABSTRACT FROM AUTHOR]

Background: Safe and effective methods for sedation and analgesia in pediatric burn patients are strongly warranted. This retrospective study of electronic health care records aims to evaluate the safety and efficacy of intranasal dexmedetomidine combined with rectal ketamine as procedural sedation for young children undergoing dressing changes and debridement of burn wounds.Methods: Documentation was analyzed from 90 procedures in 58 pediatric patients aged <5 years. Safety and efficacy of the method were assessed based on documentation for complications, adverse effects, pain level, level of sedation and preoperative and recovery time.Results: All 90 sedations were completed without significant adverse events with acute airway management or medical intervention. The combination of dexmedetomidine-ketamine produced acceptable analgesia during the procedure and effectively relieved postoperative pain. However, the approach was insufficient for 7/58 patients (7.8%); these patients were converted from the dexmedetomidine-ketamine combination to intravenous anesthesia. In 23% of the cases an extra dose of either ketamine of dexmedetomidine was administered. Moreover, there were two cases of delayed awakening with recovery time >120 min.Conclusion: The drug combination intranasal dexmedetomidine and rectal ketamine is a safe and reliable approach for procedural sedation and analgesia in pediatric patients undergoing burn wound procedures, producing a clinically stable sedative condition requiring only basic monitoring. [ABSTRACT FROM AUTHOR]

Introduction: Renal failure is the most common organ failure in severely burned patients. However, defining acute kidney injury and renal failure is very challenging. This study was designed to determine the relationship between a biomarker commonly measured on admission, serum creatinine, and outcomes in burn patients.Methods: We conducted a retrospective cohort study of adult patients (≥ 18 years) with a burn ≥ 5% total body surface area (TBSA) and a serum creatinine level measured within the first 72 h after injury. Patients were admitted over an 11-year period and divided into two groups based on creatinine levels measured within the first 72 h after injury. Patients were categorized in the high creatinine group if they had a measured creatinine ≥107 μmol/L (≥1.21 mg/dL); this value was chosen as the threshold for creatinine based on our institution's reference range. Clinical outcomes included morbidities, hospital length of stay, and mortality. Multivariable logistic regression was used to model the association between high admission creatinine and each outcome, adjusting for patient and injury characteristics.Results: We studied 923 patients, mean age 47 ± 18 years and median 13% (IQR 8-24) TBSA burned. There were 718 patients categorized with low admission creatinine and 205 patients with high admission creatinine. After adjustment for patient and injury characteristics, high admission creatinine was associated with a significantly higher rate of sepsis (OR 3.44; 95% CI 2.11-5.59), pneumonia (OR 4.56; 95% CI 1.8-11.53), and mortality (OR 3.59; 95% CI 1.91-6.75).Conclusions: Elevated creatinine on admission is associated with an increased risk of morbidity and mortality. We suggest that admission creatinine can be used as a "red flag" to identify patients at a higher risk for poor outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Physical changes to appearance caused by burn injuries can have significant psychological consequences. Medical tattooing is an intervention aimed at restoring appearance but little is known about the experiences of patients or the psychological impact of medical tattooing following burns. This study aimed to explore burn patients' psychological experiences of medical tattooing.Method: In-depth interviews were conducted with eight adult women who had experienced a burn injury and subsequently undergone medical tattooing.Results: Using interpretative phenomenological analysis (IPA) to analyse the verbatim transcripts of interviews, two subordinate themes ('Management of Hope' and 'The Medical Tattooing Process') and one superordinate theme ('Impact of Medical Tattooing: 'Normal-ish is Fantastic'') emerged, which were set within a broader context of another superordinate theme: 'Inner Conflict about Acceptability of Perceived Need'. The findings suggested that medical tattooing is experienced positively, may have positive psychological consequences, and may allow women to regain a sense of normality and an improved sense of being acceptable in society following burn injuries. Findings additionally highlighted a conflicting narrative of a pressure to conform to certain expectations of appearance, alongside a sense that a desire to meet these expectations may also not be viewed as important, acceptable or legitimate.Conclusions: Medical tattooing may be a potentially valuable intervention psychologically, although support and information seem important and further research is required. [ABSTRACT FROM AUTHOR]

Burns, an endemic public health problem has had a dynamic epidemiology in India, in sync with economic and social changes. In the last decade a major shift of kitchen fuel usage from kerosene to the Liquefied Petroleum Gas has resulted in an increase in the incidence of burns from LPG mishaps. This prospective descriptive study conducted in a tertiary care burn centre in an urban area aims to determine the causes of LPG related burns, its injury profile, identify the population at risk and also to determine the level of knowledge of users regarding the safety issue with LPG usage. In the study LPG burns accounted for 52.3% of the admitted flame burns. On the whole there were 33 incidents of LPG mishaps involving multiple victims. Most common age group affected was 26-50 years. Leakage from larger cylinders was more common and malfunction of valve/regulator was the most common cause. Level of knowledge was dismally low across all socioeconomic strata. Our study highlights impact of changing socioeconomic pattern of the country on burns epidemiology and the glaring lack of public awareness regarding safe management principles. [ABSTRACT FROM AUTHOR]

Introduction: Wound infection following burn injury can be clinically challenging to manage. Its presence in a thermally compromised patient can detrimentally affect the ability of the wound to heal leading not only to wound progression but ultimately contribute to a large part of the economic health burden expenditure in the National Health Service. Despite meticulous wound care and infection control measures the colonisation of burn wounds by bacterial pathogens has and continues to be the case. There has been a growing interest in the use of antimicrobial applications when managing localised burn wound infections due to a constantly increasing number of antibiotic-resistant organisms.Aim: To survey which antimicrobial dressings are currently being used across UK burns services when managing localised pseudomonas wound infections.Methods: We conducted a nationwide telephone survey of UK burns services during October 2019 to determine which topical antimicrobial agent was used to treat local pseudomonas burn wound infections.Results: Six burns services (31.6%) used acetic acid-soaked dressings, one of which alternates acetic acid with sodium hypochlorite solution. Silver-based dressings were also used by six burns services (31.6%) - again, one department alternates silver-based dressings with sodium hypochlorite solution. Betadine-soaked, gauze-based dressings were used across five burns services (26.3%) and the remaining two burns services (10.5%) used sodium hypochlorite solution and non-medicated dressings respectively.Conclusion: We identified a significant difference in the UK burns services' approach to pseudomonas burn wound infections. Our literature review demonstrates that a daily dressing regime of 2.5-3% acetic acid is a well-tolerated treatment regime in burn patients and that it is in use in UK burns services. There are no current randomised controlled trials that evaluate the usage of acetic acid. The variation in usage suggests that there is scope for further study in order to develop evidence to generate a UK wide approach based on national standardised guidelines. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation is a well-documented complication following cardiac surgery. It is associated with increased inpatient and long-term mortality. There have been few prior studies on perioperative atrial fibrillation following burn surgery in severely burned patients. The purpose of this study was to identify the incidence, predictors, and prognosis of perioperative atrial fibrillation after burn surgery in severely burned patients.Methods: Patients aged older than 18 years with 30% burned total body surface area (TBSA) were enrolled in this study. Patients who had a previous history of atrial fibrillation or atrial fibrillation on the preoperative electrocardiogram were excluded. We reviewed medical records retrospectively, and the data of 214 patients were studied.Results: A total of 214 critically ill burned patients and 1132 operations were available for analysis during the 5-year study period; 12 (1.1%) patients were diagnosed with newly developed atrial fibrillation after a burn operation, of whom 4 patients showed paroxysmal atrial fibrillation (all related to surgical stimulation) and none changed to persistent atrial fibrillation. The incidence of perioperative atrial fibrillation was associated with TBSA%, full-thickness TBSA%, and hypertension. Multiple logistic regression analysis indicated that TBSA% (OR=13.851, P < 0.001) and full-thickness TBSA% (OR=15.223, P = 0.018) were independent predictors for developing perioperative atrial fibrillation. All of our patients had at least one risk factor, with blood volume variation or burn sepsis occurring most commonly. Perioperative atrial fibrillation developed after a median of 0 days after burn surgery. Three patients died, and the causes of death were noncardiovascular events such as sepsis and multiple organ failure.Conclusion: Atrial fibrillation was a relatively rare complication among severely burned patients admitted to surgery and was associated with TBSA% and full thickness TBSA%. All of our patients exhibited at least one of the modifiable risk factors for atrial fibrillation, confirming the importance of optimization of electrolytes and fluid status and limitation of sympathetic activation. [ABSTRACT FROM AUTHOR]

Introduction and Aim: Mesenchymal Stem Cells (MSCs) are known to contribute to wound healing by increasing tissue regeneration. This study examined the effect of MSC-Lyophilizate (MSC-L) on the recovery of the zone of stasis in thermal burns.Methods: A comb was used to induce second-degree thermal burns (1 × 2 cm) on the dorsum of the rats. Within 30 min after the burn, MSC-L derived from the umbilical cord was administered to the experimental group and 1.5 ml of 0.9% isotonic sodium chloride to the sham group. The control group did not receive any intervention. Tissue samples were collected on postoperative day 7. Histopathological assessments were made using a microscope with digital camera attachment. SPSS for IBM 25 was used for data analysis.Results: Epithelial loss and subepidermal bullae were observed in the control and sham groups on day 7. In the experimental group, the MSC-L administration was found to increase epithelial tissue formation and neovascularization in the dermis. We found no significant pathological findings in the epidermis and dermis in the experimental group.Conclusion: Administration of umbilical cord-derived MSC-L is of potential importance in wound healing. In our study, we observed that MSC-L that contained 1.5 million cells contributed significantly to the recovery of the stasis zone of burn. [ABSTRACT FROM AUTHOR]

Rationale: Skin breakdown, as in wounds, leads to an electric potential, defined as current of injury with the intent of wound closure. Burn wounds are defined by different zones of perfusion having a direct influence on further therapy (e.g. conservative management or skin grafting). We studied immediate, quantifiable effects of electric stimulation on skin perfusion in burn wounds.Method: Wireless Microcurrent Stimulation (WMCS) was utilised as an adjunct therapeutic modality in 10 patients with partial thickness burn wounds. Microcirculation in the skin was quantified with a Laser Doppler (LDI) before and after WMCS treatment. We included a control group of 10 healthy individuals.Results: A single application of WMCS significantly increased mean flow, velocity and subsequently, haemoglobin and oxygen saturation in partial thickness burn wounds. In healthy skin these parameters increased, but were far less pronounced than in thermally injured skin.Conclusion: This study revealed, for the first time that non-contact WMCS improves blood flow in critically perfused partial thickness burn wounds without disturbing the wound or systemically affecting the patient and may represent a promising adjunct tool in burn treatment, with the potential of faster healing by enhanced perfusion of burn wounds and reduction of the zone of stasis.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Background: Children and adolescents recovering from burn injury are at heightened risk of psychosocial problems. An integrative form of psychosocial intervention is burn camp. However, evidence about burn camp effectiveness is equivocal.Objectives: This study examined the role of therapeutic camp experiences in the recovery journeys of children and adolescents who had experienced burn injury and been treated in a tertiary pediatric hospital in Brisbane, Australia.Methods: Retrospective semi-structured interviews were conducted with youths and parents. Inductive reflexive thematic analysis was used with pooled interview data.Results: The participants were eight youths who attended at least one burns camp (between 2009 and 2019) and 15 parents of youth campers. An overwhelming majority (96%) reported a positive experience of camp, that they would return, and that they recommended the camp to other youth with burns. The four strengths of the camp experience were fun, adventurous activities; social relatedness (friendships, socializing); camp setting and experience; and acceptance. The four impacts of the camp on youth campers were normalizing ("I'm not the only one", shared experience); social support (making new friendships, social confidence, mentoring others); psychological recovery (happier, mentally stronger, more resilient, independence building); and confidence (increased self-confidence, increased social confidence, leadership development).Conclusions: Although this is the first known research about burn camp in Australia, the findings are similar to a handful of other qualitative studies about burn camp experiences and impacts. Recommendations include future research on aspects of camp experiences that contribute to targeted outcomes, the role of staff and previous camp participants as mentors, and comparisons with other psychosocial interventions for youth burn survivors. [ABSTRACT FROM AUTHOR]

Introduction: Mortality attributed to fire and flame for children (0-14 years) over a fifty-year period has not been previously analyzed in Australia. The literature has focused on these deaths over a shorter time period or disaggregated with other causes of burns or deaths in one burns center. However, mortality associated with fire/flames affects this age group the greatest. The aims of this study are to: (1) develop a trends analysis of fire and flames mortality between1968 to 2016, using the Australian Bureau of Statistics (ABS) mortality database and, (2) determine the association of interventions with fire and flames mortality using the Haddon's categorical intervention framework.Methods: International Classification of Disease (ICD) codes were extracted and code equivalencies between ICD 8, 9, 10 and the Australian Bureau of Statistics for fire/flames data between 1968--2016 were assessed. To determine whether population changes affected the risks of mortality, the frequency and, rates per 100,000 were used. A literature review was conducted that summarized the current knowledge of interventions associated with the major decreases in the fire and flames mortality rate.Results: In Australia, we found was a downward trend for the period although with significant variation from year to year when compared to external cause mortality. Additionally, there were multiple successful interventions associated with a sustained decrease in mortality. After 2016, child fire-related mortality remains a problem particularly in low socioeconomic groups and indigenous peoples. A combination of research, public awareness, engineering, legal enforcement, advancements in burns care and, evidence-based policy development all have a role to play in future injury prevention initiatives. Although direct causation to an individual is not possible, associations can be drawn from interventions on a population level to decreases in mortality.Conclusion: We found was a steady decline in both rates and frequency of childhood fire and flames mortality from 1968 to 2016 associated with multiple interventions. [ABSTRACT FROM AUTHOR]

Background: Postoperative pain at skin graft donor sites is frequently undertreated in burn patients, which can impair reconstructive outcomes and result in harmful psychological consequences. We find a critical need to explore and promote non-opioid, multimodal analgesics. Donor site infiltration of the local anesthetic liposomal bupivacaine in adolescent and young adult burn patients has not been previously investigated. Therefore, the goal of this study was to evaluate intraoperative liposomal bupivacaine infiltration for postoperative donor site pain control in adolescent and young adult burn patients undergoing reconstructive skin graft procedures.Methods: This retrospective analysis included patients aged 14-25 years, who underwent at least two reconstructive skin graft procedures, one that received donor site infiltration of the standard treatment (bupivacaine hydrochloride) and one that received donor site infiltration of liposomal bupivacaine. The final sample included 30 patients with a total of 44 liposomal bupivacaine cases and 53 standard treatment cases analyzed.Results: In the authors' five-year experience, the use of liposomal bupivacaine compared to standard treatment was associated with statistically significant decreases in 0-4 h postoperative pain scores (mean 1.4/10 versus 2.3/10, p = 0.04) and 0-24 h postoperative pain scores (mean 1.7/10 versus 2.4/10, p = 0.02). Neither analgesic was associated with adverse events. Differences in length of stay and inpatient postoperative opioid usage were not regarded as significant.Conclusion: In this retrospective analysis, the authors report the first results that suggest intraoperative liposomal bupivacaine donor site infiltration may be associated with statistically improved patient outcomes in adolescent and young adult burn patients. However, the reported differences are most likely not clinically significant, establishing the necessity for further evaluation of using liposomal bupivacaine in this unique patient population. [ABSTRACT FROM AUTHOR]

Objective: Enzymatic debridement of burn eschar became an accepted and widely used technique for burn wound treatment over the last years. However, this practice is not exempt from failure and recent experimental studies indicate that it may not be as efficient in scalds as in flame burns.Methods: Patients that were admitted to the burn intensive care unit between June 2017 and February 2021 and received enzymatic debridement within the first 72 h after scald and flame burn were included. Patients with scald burns were matched regarding age, sex and per cent total body surface area (%TBSA) burned in a 1:2 ratio with patients presenting with flame burns.Results: Eighteen patients with scald burns were matched with 36 with flame burns. After matching, both groups were similar in terms of age (flame burns 44.5 ± 21.1 years vs. scald 41.8 ± 22.6 years, p = 0.666), and %TBSA burned (11.0 ± 8.2% vs. 10.6 ± 9.6%, p = 0.851). Patients with scald burns significantly more often underwent further surgical eschar excision compared to controls (scald 16 (88.9%) vs. flame 19 (52.8%), p = 0.016). Length of stay per %TBSA was significantly longer in scald burns (scald 7.8 ± 9.2 days vs. flame 3.7 ± 3.8, p = 0.013).Conclusion: This study indicates that enzymatic debridement may not be as effective in scalds as in flame burns. It was shown that patients with scalds and subsequent enzymatic debridement more frequently underwent additional surgical intervention and that the size of the transplanted area was larger compared to control. Moreover, those patients had a longer length of stay at the hospital per %TBSA burned. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to describe the prevalence, characteristics and outcome of critically burn patients with pulmonary HSV reactivation.Methods: Retrospective, single-center cohort study in a burn critical care unit in a tertiary center, including all consecutive severely burn patients with bronchoalveolar lavage performed for pneumoniae suspicion and screened for HSV from January 2013 and April 2017. We used logistic regression to identify factors associated with HSV reactivation and outcomes.Results: 94 patients were included, mean age was 51 (39-64) years; median total body surface area burned was 36 (25-54)% and ICU mortality 38%. Fifty-five patients (59%) had pulmonary HSV reactivation and 30 (55%) were treated with acyclovir. Patients with HSV reactivation were more severely ill with higher SOFA score at admission compared to patient without HSV reactivation (6 [3-8] vs. 2 [1-4], p < 0.0001 respectively). In multivariate analysis, sex, SOFA score at admission and smoke inhalation were significantly associated with HSV reactivation. Only septic shock was associated with 90-day mortality when HSV reactivation was not.Conclusions: Pulmonary HSV reactivation is frequent among severely ill burn patients. Initial severity and smoke inhalation are risk factors. Antiviral treatment was not associated with outcome. [ABSTRACT FROM AUTHOR]

Skin substitutes are designed dressings intended to promote wound closure. In previous in vitro and in vivo studies on small animal, an acellular skin patch made of collagen hydrogel with dermal fibroblast conditioned medium (Col-DFCM), a collagen sponge scaffold with freshly harvested skin cells (OTC), and a platelet-rich-plasma gel with freshly harvested skin cells (PRP) have been developed and tested for immediate treatment of full-thickness wound. However, to determine the safety and efficacy of these skin patches for clinical applications, further study in a large animal model is needed. The aim of this study is to evaluate the potential of Col-DFCM, OTC and PRP in treating full-thickness wound in an ovine model via histological analysis and immunohistochemistry staining were performed, with the untreated (NT) group serving as the control. Gross examination was conducted on day 7, 14 and 21 to determine the wound closure rate. The findings of percentage of wound size reduction showed that the wound healed fastest in the presence of Col-DFCM (91.34 ± 23.35%) followed by OTC (84.49 ± 23.13%), PRP (77.73 ± 20.9%) and NT group (73.94 ± 23.71%). Histological evaluation with Hematoxylin & Eosin (H & E) and Masson's trichrome staining was used to study the structure of the wound area. The results showed that OTC treated wound was more mature as indicated by the presence of a thinner epidermis followed by the Col-DFCM, PRP and NT group. Immunohistochemistry analysis also confirmed the integrity and maturity of the regenerated skin, with positive expression of cytokeratin 10 (CK10) and involucrin in the epidermal layer. In conclusion, Col-DFCM, OTC and PRP treatments promote healing of full-thickness wound and have the potential to be used clinically for rapid treatment of full-thickness wound. [ABSTRACT FROM AUTHOR]

Background: Microneedles composed of arrays of micro-sized needles assembled on a patch, has attracted increasing interest in transdermal drug delivery due to its ease of use and lack of painful responses. Here, a bibliometric analysis was conducted to determine a hotspot and trend of microneedles in the biomedical field.Methods: All relevant articles about microneedles between 2011 and 2020 were obtained from the databases of Web of Science (WOS) and PubMed of the National Center for Biotechnology Information (NCBI). A series of software such as VOSviwewer, the online bibliometric analysis website, CiteSpace, BICOMB and gCLUTO were used to process the data and get visual images. Processed data and visualized images were conducted to predict the trend of this research field.Results: The number of articles published over the last decade had increased rapidly (37 in 2011, 165 in 2020), the Journal of Controlled Release was the most productive journal in microneedle studies. The United States was the most productive country, while the Queens Univ Belfast topped the other institutions. Ryan F Donnelly was the most productive author in the field, while the two most cited articles were published by Gu Zhen group. More importantly, the research trend of microneedles had ranged from physicochemical properties and pharmacokinetics to insulin transdermal injection and vaccine development over the past decade. The four hot spots in microneedle studies, including skin rejuvenation, vaccines, fabrication technology and insulin delivery, were identified. Microneedle vaccination shows promising application prospects, and polymers are considered as the most promising materials for microneedles manufacturing.Conclusions: This study will help researchers understand the hot spots and trends of microneedles in the biomedical field accurately and quickly. Moreover, the exploitation of novel polymeric microneedles will be a solid direction for subsequent research and development of transdermal drug delivery. [ABSTRACT FROM AUTHOR]