720 Scalds and Contact Burns: Are They Really Different?

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S191-S191
Author(s):  
Adam Singer ◽  
Evyatar Baer ◽  
Henry Thode
Keyword(s):  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Stepwise Logistic Regression ◽  
Full Thickness ◽  
Chi Square ◽  
Included Patient ◽  
Body Location ◽  
Total Body ◽  
Fire Flame ◽  
Burn Depth

Abstract Introduction Prior studies comparing scalds and contact burns rarely address the affect of burn etiology on burn depth. However, it is commonly believed that scalds tend to heal faster than similarly sized contact and flame burns. As a result, expectant therapy is often preferred after scald injuries. We compared the percentages of full-thickness burns based on burn etiology controlling for burn size, location and patient age. We hypothesized that the percentage of full thickness burns would be lower after scalds compared with contact and flame burns. Methods We performed a retrospective chart review of a prospectively collected burn registry of all patients admitted to a regional burn center between 2000–2010. Data collection included patient and burn characteristics including age, gender, body location, and burn etiology. We compared the percentages of full thickness burns among scald, contact and flame burns using Chi-square tests. Stepwise logistic regression was used to adjust for age, location, and burn size. Results There were 1038 patients in the study with either scald (n=537, 52%), fire/flame (n=434, 42%) or contact (n=67, 6%) burn. Mean (SD) age was 29 (25); 75% were male. Mean (SD) total body surface area (TBSA) was 11 (13)%. Mean (SD) length of stay was 10 (18) days. The percentages of full thickness burns by etiology were scalds 13.1%, fire/flame 34%, and contact burns 45% (P< 0.001). Patients with scalds were younger (22+/-24) than patients with contacts (32+/-28) and fire/flame (38+/-22) burns. Multivariate analysis for predicting full thickness burns found that compared with contact burns, scalds were less likely full thickness (OR 0.23, 95%CI 0.11–0.48) while fire/flame burns were as likely to be full thickness (OR 0.54, 95%CI 0.26–1.15). TBSA and age were also associated with full thickness burns (OR 1.06, 95%CI 1.04–1.09 and OR 1.015, 95%CI 1.007–1.024, respectively). Burns on the head and neck were less likely to be full thickness (OR 0.30, 95%CI, 0.11–0.82). Conclusions Scald burns are significantly less likely to be full thickness than contact or fire/flame burns. Applicability of Research to Practice Based on these results, expectant therapy may be more appropriate for scalds than contact or fire/flame burns.

549 Lessons Learned from Two Survivors of Greater Than 90% Total Body Surface Area Full Thickness Burn Injuries Using a Dermal Biodegradable Substitute and Autologous Skin Cell Suspension: A Case Series

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S123-S123
Author(s):  
Aldin Malkoc ◽  
David Wong
Keyword(s):  
Cell Suspension ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Fluid Loss ◽  
Dermal Substitute ◽  
Full Thickness ◽  
Skin Cell ◽  
Thickness Skin ◽  
Total Body ◽  
Skin Coverage

Abstract Introduction Advances in burn injury knowledge, critical care, and pharmacological developments have increased survival rates among extensive burn patients. Survival now dependents not just on skin coverage, but effective control of SIRS response, metabolic derangement, fluid loss and sepsis. Novel synthetic dermal substitutes create robustness, thickness, and pliability of the skin in addition to an improved aesthetic appearance while; point-of-care autologous skin cell harvesting enhances treatment by amplifying small split-thickness skin samples to produce an autologous skin cell suspension (ASCS) to cover a larger burn area. This study reports on two survivors with greater than 90% total body surface area full-thickness burns utilizing a combined treatment of a dermal substitute along with ASCS and traditional burn management strategies. Methods Chart review of two patients with >90% burns and inhalation injury after being trapped in a burning vehicle following a traffic collision occurred. Most of the burns in both patients were “leathery” and consistent with full thickness, sparing only the plantar and dorsal aspect of the feet and bilateral small areas of the hip in Patient 1. Patient 2 had fourth-degree burns in some areas of the chest and flank with only the bilateral groin regions and feet spared. The patients were treated with a multi-step process which included using allograft, dermal substitute, and ASCS with split-thickness skin grafts (STSG) in place of cultured epidermal autograft to achieve coverage of >90% burns with high meshed ratio. Results The dermal substitute was limited to deep burns that penetrated down to fat, muscle, and/or joints. Fluid loss was well controlled by the dermal substitute during initial resuscitation. Post reconstruction, areas covered with the dermal substitute and grafted with autogenous STSG with ASCS exhibited less hypertrophy and contracture bands. The elbow and knee joints showed minimal restriction with passive motion and good skin compliance, but contractures persisted in areas where 4th degree tendon and fascia thermal injury occurred. Areas that showed signs of infection were trimmed or unroofed and allowed to drain while maintaining the remainder of the dermal substitute. Conclusions The use of dermal substitutes and ASCS allowed the care team to achieve SIRS control, improved fluid management, enhanced skin coverage, and reduced hospitalization stay. The process experienced in these cases shows promise for future patients with extensive burns. Both patients were able to survive and show improvement during rehabilitation.

scholarly journals A Framework for Automatic Burn Image Segmentation and Burn Depth Diagnosis Using Deep Learning

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Hao Liu ◽  
Keqiang Yue ◽  
Siyi Cheng ◽  
Wenjun Li ◽  
Zhihui Fu
Keyword(s):  
Deep Learning ◽  
Total Body Surface Area ◽  
High Morbidity ◽  
Learning Technology ◽  
Human Errors ◽  
Burn Wounds ◽  
Output Structure ◽  
Network Output ◽  
Total Body ◽  
Burn Depth

Burn is a common traumatic disease with high morbidity and mortality. The treatment of burns requires accurate and reliable diagnosis of burn wounds and burn depth, which can save lives in some cases. However, due to the complexity of burn wounds, the early diagnosis of burns lacks accuracy and difference. Therefore, we use deep learning technology to automate and standardize burn diagnosis to reduce human errors and improve burn diagnosis. First, the burn dataset with detailed burn area segmentation and burn depth labelling is created. Then, an end-to-end framework based on deep learning method for advanced burn area segmentation and burn depth diagnosis is proposed. The framework is firstly used to segment the burn area in the burn images. On this basis, the calculation of the percentage of the burn area in the total body surface area (TBSA) can be realized by extending the network output structure and the labels of the burn dataset. Then, the framework is used to segment multiple burn depth areas. Finally, the network achieves the best result with IOU of 0.8467 for the segmentation of burn and no burn area. And for multiple burn depth areas segmentation, the best average IOU is 0.5144.

scholarly journals Acanthus ebracteatusVahl. Ethanol Extract Enhancement of the Efficacy of the Collagen Scaffold in Wound Closure: A Study in a Full-Thickness-Wound Mouse Model

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Jutamas Somchaichana ◽  
Tanom Bunaprasert ◽  
Suthiluk Patumraj
Keyword(s):  
Wound Closure ◽  
Total Body Surface Area ◽  
Collagen Scaffold ◽  
Ethanol Extract ◽  
Neutrophil Infiltration ◽  
Skin Incision ◽  
Full Thickness ◽  
Combined Application ◽  
Acanthus Ebracteatus ◽  
Total Body

Acanthus ebracteatusVahl. is a Thai herb that is effective in wound healing. We sought to quantitatively determine whether or not the combined application ofAcanthus ebracteatusVahl. and a collagen scaffold will increase wound closure and angiogenesis. Balb/c mice (body weight: 22–25 g) were anesthetized with sodium thiopental. The dorsal skin incision measuring 1.5 × 1.5 cm was made and then deepened using scissors to produce a full-thickness incision down to the level of the panniculus carnosus. The size of the wound was approximately 10% of the total body surface area. The collagen sheet was implanted onto the wound. Animals were divided into 4 major groups as follows: wound with normal saline (W-NSS), wound treated with 0.3 g/kg BW ofAcanthus ebracteatusVahl. extract (W-AE (0.3 g/kg.bw)), wound implanted with collagen scaffold (W-Coll), and wound implanted with collagen scaffold and treated with 0.3 g/kg BW ofAcanthus ebracteatusVahl. (W-Coll-AE combination). On day 14, the W-Coll-AE group showed decreased wound areas and increased capillary vascularity (CV) when compared to the other 3 groups, W-NSS, W-AE0.3, and W-Coll. In the present study, the combination of AE0.3 with collagen showed the best effect on skin angiogenesis and promoted wound closure with less neutrophil infiltration.

scholarly journals Face burns: A four-year experience

2021 ◽  
Author(s):  
Stephanie A Rasmussen ◽  
Kathleen S Romanowski ◽  
Soman Sen ◽  
Tina L Palmieri ◽  
David G Greenhalgh
Keyword(s):  
Total Body Surface Area ◽  
Adult Patients ◽  
P Value ◽  
Chi Square ◽  
Lengths Of Stay ◽  
Degree Burn ◽  
The Face ◽  
The Mean ◽  
Total Body ◽  
Student’S T

Abstract Introduction Burns on the face pose unique management challenges because they are in a place that is constantly visible, so scars are hard to hide. The goal of this study was to review our experience of adult patients who had face burns. Methods We performed a retrospective review of adult patients (≥ 18 years old) who were admitted to a regional burn center from July 2015 – June 2019 with face burns. Sex, age, ethnicity, burn etiology, burn size, and discharge status were collected from electronic medical records of the patients who met study criteria. Descriptive statistics, student’s t-tests, and chi-square tests were performed in Stata/SE 16.1. Significance was defined as a p-value <0.05. Results In four years, 595/1705 patients (~35% of admissions) were admitted with face burns. The mean age was 44.9 ± 17.0 (mean ± SD) years, with the majority being men (475, 80%). The mean burn size was 19.8 ± 20.9% total body surface area (TBSA) with 10.1 ± 19.8% TBSA being third degree. The mean head burn size for any face burn was 2.8 ± 1.8% TBSA. The majority of burns were due to flames (478, 80%) and of those 122 (21%) were from accelerant use and 43 (7%) resulted from propane or butane use. Scalds caused 53 (9%), electric 25 (4%), hot tar 5 (1%), and chemical 5 (1%). Overall, 208 (35%) patients had grafting of some portion of their body, but only 31 patients (5.2%) had face grafting. The mean age of those with face grafting compared to patients who did not need grafting was 45.9 ± 13.8 and 44.9 ± 17.2 years, respectively. Patients who needed grafting had a mean third degree burn size of 31.7 ± 25.4% TBSA and a mean head (including face) burn size of 4.7 ± 2.0% TBSA, whereas patients who did not need grafting had a mean third degree burn size of 8.9 ± 18.7% TBSA and a mean head burn size of 2.7 ± 1.8% head TBSA. Patients requiring face grafts had longer lengths of stay, intensive unit stays, ventilator days, and mortality than those whose face burns healed spontaneously. Discussion Overall, head burns in adults were common within the four-year time span we studied, but only a small fraction (5%) had face grafts. The patients who needed grafting for their head burns had significantly larger total body and face burns, and had a 2.4-fold higher mortality rate compared to patients who did not need grafting. Most face burns were caused by flame, especially the use of accelerants or flammable gases. Prevention efforts should focus on avoiding the use of accelerants and being careful with flammable gases.

Rehabilitation of the Burn Patient

2019 ◽  
Author(s):  
Barclay T Stewart ◽  
Samuel P Mandell ◽  
Nicole Gibran
Keyword(s):  
Injury Severity ◽  
Community Integration ◽  
Total Body Surface Area ◽  
Rehabilitation Medicine ◽  
Rehabilitation Program ◽  
Loved One ◽  
Total Body ◽  
The Moment ◽  
Burn Depth ◽  
Need For Rehabilitation

Burn rehabilitation begins the moment the patient contacts the healthcare system and, for many patients, it never truly ends. Returning severely burned patients to their pre-injury level of function has become more challenging, as more severely burned patients survive their injury. The need for rehabilitation does not simply correspond with burn depth, total body surface area involved, or injury severity. Other factors also impact need for rehabilitation, such as anatomic location of injury (eg, across finger joints, face), additional psychosocial strain from a house fire or having an injured loved one, or body image concerns related to visible scarring. To meet these and other challenges posed by burn injuries, rehabilitation requires a multidisciplinary team including, but not limited to, nursing, surgery, burn therapy, rehabilitation medicine, vocational counseling, rehabilitation psychology, psychiatry, and nutrition. Accord­ingly, verification as a burn center by the American Burn Association requires a goal-oriented, multidisciplinary rehabilitation program. This chapter broadly discusses the spectrum and integral components of burn rehabilitation. This review contains 13 figures, 8 tables, and 71 references.  Key Words: burn, community integration, function, mental health, multidisciplinary, outcome, pain, quality of life, reconstruction, rehabilitation, therapy.

725 Escharotomy Incisions in the Burn Foot and Toe with Compartment Syndrome

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S194-S194
Author(s):  
Gregory Lifferth ◽  
Bryan Roth ◽  
Marisse Lardizabal ◽  
Areta Kowal-Vern ◽  
Kevin N Foster ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Compartment Syndrome ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Burn Injuries ◽  
Metatarsal Bones ◽  
Fat Level ◽  
Total Body ◽  
Effective Site

Abstract Introduction Patients with burn injuries are at risk for lower extremity compartment syndrome, especially if the injury is circumferential. The hypothesis was that two dorsal escharotomy incisions to release foot and toe compartment syndrome would be most efficacious in the prevention of lower extremity amputations. Methods This was a retrospective chart review of foot compartment syndrome in burn patients between January 2001 and May 2019. Results The study consisted of 59 feet from 32 patients who had been admitted to the Burn Center for thermal injury. The patient age was a mean±sd of 29±30 years, and 41±29 as the % total body surface area (%TBSA); there were 19 males and 13 females. All patients had received fluid resuscitation on admission. Twenty-one (66%) of the patients did not require amputations after undergoing a median of two incisions (range 1–5); 6 of 59 (11%) required fasciotomies. Compared to medial or dorsal or multiple echarotomies, the majority of patients who underwent two dorsal foot escharotomies did not require amputations, p = .0001. Significantly more patients were alive with no amputation 15 (50%) compared to 4 (13%) (dead with amputations), p = .02. Survivors were significantly younger than the non-survivors (median 20 and range1-69) compared to the non-survivors (48, 12–59), p =.04. The survivors also had significantly less severe %TBSA median 22 (range 2–75) versus 83 (35–95) %TBSA, p < .0002. Dorsal/Lateral incisions had the highest number of amputations. Conclusions Foot dorsal compartment release is the most effective site for escharotomies in the treatment of burn-induced compartment syndrome. It does not require more than two incisions at the skin/fat level and over the second and fourth metatarsal bones on the dorsal part of the foot to decrease the lower extremity amputation rate in the majority of cases. Applicability of Research to Practice This research was a critical appraisal of the safest escharotomy foot incisions for compartment syndrome to avoid possible amputations in burn injury.

Complex approach to skin repair in an extensively burned child: a case study

2020 ◽  
Vol 29 (8) ◽  
pp. 458-463
Author(s):  
Robert Zajicek ◽  
Richard Kubok ◽  
Nikola Petrova ◽  
Monika Tokarik ◽  
Eva Matouskova ◽  
...  
Keyword(s):  
Donor Site ◽  
Total Body Surface Area ◽  
Wound Management ◽  
Dermal Substitute ◽  
Full Thickness ◽  
Skin Cells ◽  
Skin Repair ◽  
Thickness Skin ◽  
Complex Approach ◽  
Total Body

The limited amount of donor sites and loss of dermis are major challenges in the therapy of extensively burned patients. Here, we present a complex treatment approach of an eight-year-old boy with full-thickness burns on 90% of the total body surface area, using simple and efficient techniques of tissue engineering. To obtain sufficient skin for grafting we repeatedly harvested the same anatomical areas. Acceleration of donor site healing was achieved by treatment with a suspension of noncultured autologous skin cells (NASC) and acellular porcine dermis (Xe-Derma (XD), Czech Republic). Moreover, such wound management allowed up to six reharvestings, compared with one-to-three procedures following routine treatment. Bilayer Integra template (Integra LifeSciences Corp., US) was used as the dermal substitute in over 60% of full-thickness burns. Following successful vascularisation of the neodermis in 3–4 weeks, the templates were covered with meshed split-thickness skin grafts (STSG), or Meek autografts, and facilitated by NASC/XD. We may conclude that such a ‘sandwich’ technique approach, combining four biological covers (Integra, STSG, NASC and XD), significantly contributed to the successful skin repair of the patient.

scholarly journals Epidemiology of Scars and Their Consequences: Burn Scars

2020 ◽  
pp. 37-43
Author(s):  
Margriet E. van Baar
Keyword(s):  
Risk Factors ◽  
Burn Injury ◽  
Healing Process ◽  
Total Body Surface Area ◽  
Female Gender ◽  
Burn Injuries ◽  
Post Injury ◽  
The People ◽  
Total Body ◽  
Burn Depth

AbstractPathological scarring in burn wounds can result in hypertrophic scars and/or contractures. Prevalences of hypertrophic scarring after burn injuries between 8% and 67% are reported. A recent prospective study revealed a prevalence of 8%. Data on prevalence of burn scar contractures are limited; reported prevalence at discharge varied between 38 and 54% and decreased with an increasing time post burn. About 5–20% of the people who suffered from burn injuries received reconstructive surgery after burns, up to 10 years post injury.Factors predicting pathological scar formation after burn injuries include patient, injury and treatment characteristics. Injury- and treatment-related characteristics are the main predictors of scar outcomes after burn injury. These characteristics are related to burn size (total body surface area burned) and burn depth (number or type of surgery) or the overall healing process in general (length of stay, wound healing complications). Intrinsic patient-related risk factors seem to play a role as well but are less consistent predictors of scar outcome. This includes the risk factors like the female gender and also a younger age and darker skin.Knowledge on risk factors for poor scar outcome can be used to tailor treatment, aftercare and scar prevention to these patients with a high-risk profile.

27 Utilization of an Ethics Service in a Large Urban Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S20-S21
Author(s):  
Andrew Greenway ◽  
Jamie Heffernan ◽  
Nicole Markow ◽  
Jennifer Yang ◽  
Linda Gibbons ◽  
...  
Keyword(s):  
Palliative Care ◽  
Ethical Dilemmas ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Ethics Consultation ◽  
Pregnant Patient ◽  
Ethical Principles ◽  
Clinical Utilization ◽  
Surrogate Decision ◽  
Total Body

Abstract Introduction Ethical dilemmas arise related to tension between one or more values held by stake-holders. Identifying which ethical principles (i.e., autonomy, beneficence, non-maleficence, and justice) are in tension represents one way to categorize ethical dilemmas that arise in clinical cases. The purpose of this review is to describe the population of patients for whom Medical Ethicists (ME) were consulted and identify the primary ethical principles in tension for these cases. Methods A retrospective chart review of patients admitted from 2/2014–8/2019 (n=3701) capturing ME notes. Each note was independently rated by burn team RNs and medical ethicists to identify which two of the four common ethical principles were perceived to be in tension. Reviewers also noted if surrogate decision-making and/or goals of care were prominent themes in the case. Additional data points include circumstances of injury, total body surface area (TBSA) involved, age, mortality, length of stay (LOS), Hospital Day (HD) of ethics consult (EC), +/- psychology/psychiatry note, +/-chaplaincy, +/-palliative care, initiator of and stated reason for the EC. Results Of the 3701 patients admitted, 26 had formal EC’s (0.7%). Twelve died. Average age was 55.6 (7–85). Two patients had Calciphylaxis and four self-immolated. One EC concerned interests of fetus vs the pregnant patient. TBSA for the burned group averaged 39.7% (2–100). Average LOS was 55.6 days. Average HD of ethics consults was 20.5. For mortalities, EC was 10.8 HDs prior to death. LOS for survivors was 55.6 vs 42.33 days for non-survivors. TBSA for survivors was less than those who died (29% vs 50%). Chaplaincy was involved in 19/26 (73%), palliative care 3/26 (12%), Psychology/ psychiatry 15/26 (58%) of EC’s. The burn RNs most often characterized the ethical dilemmas as tension between beneficence and nonmaleficence while the ethicist found autonomy vs. nonmaleficence. All raters found only 1 or 2 cases involved justice. The team identified GOC tension in 20/26 cases, the ethicist, fewer than half. The burn team requested ethics consultation in all cases of self-immolation. Initiators of ethics consults were 14 burn team, 7 burn MD, 1 burn nursing, 2 chaplaincy and 2 not stated. Conclusions Circumstances of injury, the nature of wound and intensive care management and the association of significant injury with end of life care present challenges to the burn team. Many may be framed and addressed as ethical dilemmas. This pilot exploration of clinical utilization of medical ethics suggests patterns and questions that warrant further discussion and study. Value-driven tensions between the professional duties to do good, the duty to do no harm, and the duty to respect autonomous decisions by patients and by extension, surrogate decision makers, account for most triggers for ECs initiated by the burn team. Applicability of Research to Practice Directly Applicable.

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