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.

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

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S120-S120
Author(s):  
Greg S Lifferth ◽  
Bryan J Roth ◽  
Marisse Lardizabal ◽  
Areta Kowal-Vern ◽  
Kevin N Foster ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Compartment Syndrome ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Burn Injuries ◽  
Metatarsal Bones ◽  
Fat Level ◽  
Total Body ◽  
Extremity Amputation ◽  
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.

Sun heated surfaces are an environmental hazard for young children

2019 ◽  
Vol 139 (5) ◽  
pp. 264-270
Author(s):  
YM Choi ◽  
T Chopra ◽  
D Smith ◽  
S Moulton
Keyword(s):  
Burn Injury ◽  
Healthcare Providers ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Burn Injuries ◽  
Contact Type ◽  
Common Causes ◽  
The Mean ◽  
Total Body ◽  
Mean Time

Aims: Children commonly sustain heat contact type burn injuries from sun heated surfaces during the summer months in hot, sunny climates. The aim of this study was to review the causes and outcomes in a series of heat contact type burns sustained by children who touched hot sun heated surfaces. Methods: A retrospective chart review was performed to identify all children who sustained burn injuries due to naturally heated surfaces and were treated between January 2012 and December 2017 at Children’s Hospital Colorado. Demographics of the subjects and clinical data regarding their burn injuries were collected. Results: A total of 58 children were identified over the study period, involving 118 burn wounds. The median age was 17 months (interquartile range = 14–23), and 33 were male (57%). Mean total body surface area (TBSA) was 1.4% (standard deviation = 1). A foot was the most commonly involved area, affecting 36 subjects (62%). The most common causes of these burn injuries were metal thresholds ( n = 7, 12%) and metal covers or lids ( n = 5, 9%) outside the home. The depth of the burn injury was partial thickness in 57 children (98%). The mean time to heal was 12 ± 6 days, and the majority of injuries occurred in June ( n = 28, 48%). Conclusion: Heat contact type burn injuries from sun heated surfaces commonly affect children ⩽2 years of age during the summer months, and the majority of these injuries occur around the home environment. They are preventable injuries, and this information should be used for prevention and education materials for parents and healthcare providers, who reside in hot, sunny climates.

Burns and Electrical Injuries

2019 ◽  
pp. 409-414
Author(s):  
Brandon T. Nokes ◽  
Ayan Sen
Keyword(s):  
Critical Care ◽  
Surface Area ◽  
Body Surface ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Burn Severity ◽  
Thermal Burn ◽  
Total Body ◽  
Electrical Injuries

Burn injuries may cause morbidity and death, and patients may have widely variable presentations and outcomes. This chapter focuses on the critical care aspects of burn injury and management issues of burn and electrical injuries. Burns are classified according to the amount of total body surface area (TBSA) affected, the depth of burn, and the type of exposure associated with the burn. More specifically, burns can be chemical, electrical, or thermal. Burn severity is determined by the depth of involvement.

scholarly journals The epidemiology of burn injury among children during COVID-19 19 pandemic and WFH policy in Malang, East Java, Indonesia

2021 ◽  
Vol 10 (4) ◽  
pp. 744
Author(s):  
Herman Yosef Limpat Wihastyoko ◽  
Arviansyah Arviansyah ◽  
Erdo Puncak Sidarta
Keyword(s):  
Comparative Analysis ◽  
Body Surface ◽  
Clinical Characteristics ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Work From Home ◽  
Injury Group ◽  
Significant Difference ◽  
Total Body

Work from home (WFH) mandate is one of the major changes known during this pandemic, aimed as a preventive way to mitigate the spread of the COVID-19 virus. This study aimed to observe the characteristics of pediatric burn injury during COVID-19 pandemic and WFH mandate's impact on pediatric burn injury admission at some Hospital burn centers in Malang. Every patient’s age, gender, clinical characteristics, parent's background, and other variables such as the possession of siblings, response time using our burn registry form, and comparative analysis of the incident in WFH housewife mother were assessed. The majority were in the group age of under five years old group age (70%) with a mean of 5.5 years. The most frequent part of the burn injured is extremity 36.7%, and hot liquid dominates as the cause of the injury 73.3% with the total body surface area of burn injury group >10% is the most common 56.7%. The burn injury incident happened more frequently in mothers with children less than two in both groups. This study showed that the increase in increasement of the pediatric burn injury during COVID-19 pandemic between housewife mother and WFH mother has no significant difference also showed that parent especially mother unable to supervise the children during WFH. Strategies to mitigate pediatric burn injuries during WFH should be thoughtfully implemented.

scholarly journals Soluble CD163: A novel biomarker for the susceptibility to sepsis in severe burn injuries

2011 ◽  
Vol 44 (01) ◽  
pp. 118-124
Author(s):  
Andrzej Piatkowski ◽  
Gerrit Grieb ◽  
Rittuparna Das ◽  
Ahmet Bozkurt ◽  
Dietmar Ulrich ◽  
...  
Keyword(s):  
Time Course ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Serum Levels ◽  
Burn Injuries ◽  
Burn Patients ◽  
Serum Samples ◽  
Soluble Cd163 ◽  
Bivariate Correlation ◽  
Total Body

ABSTRACT Objective: Soluble CD163 (sCD163) has been previously shown to play a role in inflammatory and infectious diseases. This study, for the first time, investigates the characteristics and potential values of sCD163 in burn patients. A first look is taken on the changes of sCD163 levels in burn patients by comparing predefined subgroups at single time points. Materials and Methods: Serum samples of 18 patients with burn injuries were collected for biochemical analysis at the time of admission and in a chronological sequence of 12, 24, 48 and 120 h after the injury and were matched to clinical parameters. Statistical analysis was performed using the Mann-Whitney test, Wilcoxon signed rank and Pearson bivariate correlation. Results: Patients with sepsis showed a significant increase of sCD163 levels. sCD163 was correlated with leukocytes (P=0.035) over the time course of 120 h. Patients characterized by a burn size exceeding 25% of the total body surface area (TBSA) showed a significant increase of sCD163 between 12 and 48 h after burn injury (P=0.038). Conclusions: The first view on the characteristics of sCD163 in the serum of burn patients points out that sCD163 seems to be an early indicator for the susceptibility to sepsis. Furthermore, the changes in sCD163 serum levels within the first hours after burn trauma have great potential for early prediction of organ failure after burn injury.

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.

scholarly journals The Association between the Extend of Burn Injuries with Albumin Level on Burn Injury patients

2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Adetya Indah Sari Matondang ◽  
Desiree Anggia Paramita
Keyword(s):  
General Hospital ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Secondary Data ◽  
Albumin Level ◽  
Burn Injuries ◽  
Observational Research ◽  
Percentage Increase ◽  
Cross Sectional ◽  
Total Body

Abstract. Burn injuries is a damaged or loss of skin caused by a contact with either high temperature sources or very low temperature sources. Burn injuries is classified according to its etiology, depth and extend of the wound.  The extend of the burn can be determined by calculating TBSA (Total Body Surface Area). Wider TBSA will cause lower serum albumin levels due to a higher percentage increase. The purpose of this study was to determine the association between the extend of burn injuries with albumin levels on burn injury patients at Haji Adam Malik General Hospital Medan in 2017-2018. This research uses observational research with cross-sectional research design, using secondary data obtained from medical records at Haji Adam Malik General Hospital Medan in 2017-2018. The research sample was selected by using the total sampling method from all medical record data that met the research criteria. In this study, significant results were obtained with a value of p = 0.006 (p < 0.05) between the extend of ​​burn injuries and albumin levels in burn injury patients at  Haji Adam Malik General Hospital Medan in 2017-2018.     Keyword: Burn injury, Albumin, TBSA, RSUP Haji Adam Malik, Medan  

scholarly journals Effect of celecoxib in treatment of burn-induced hypermetabolism

2020 ◽  
Vol 40 (4) ◽  
Author(s):  
Shubo Zhuang ◽  
Jiake Chai ◽  
Lingying Liu ◽  
Huinan Yin ◽  
Yonghui Yu
Keyword(s):  
Adipose Tissue ◽  
Burn Injury ◽  
Morphological Changes ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Rate Limiting Step ◽  
Brown Adipose ◽  
Cox 2 ◽  
Total Body ◽  
Rate Limiting

Abstract Background: Cyclooxygenase-2 (COX-2) catalyzes the rate-limiting step of prostanoid biosynthesis. Under pathologic conditions, COX-2 activity can produce reactive oxygen species and toxic prostaglandin metabolites that exacerbate injury and metabolic disturbance. The present study was performed to investigate the effect of Celecoxib (the inhibitor of COX-2) treatment on lipolysis in burn mice. Methods: One hundred male BALB/c mice were randomly divided into sham group, burn group, celecoxib group, and burn with celecoxib group (25 mice in each group). Thirty percent total body surface area (TBSA) full-thickness injury was made for mice to mimic burn injuries. Volume of oxygen uptake (VO2), volume of carbon dioxide output (VCO2), respiratory exchange ratio (RER), energy expenditure (EE), COX-2 and uncoupled protein-1 (UCP-1) expression in brown adipose tissue (BAT) were measured for different groups. Results: Adipose tissue (AT) activation was associated with the augmentation of mitochondria biogenesis, and UCP-1 expression in isolated iBAT mitochondria. In addition, VO2, VCO2, EE, COX-2, and UCP-1 expression were significantly higher in burn group than in burn with celecoxib group (P&lt;0.05). Conclusion: BAT plays important roles in burn injury-induced hypermetabolism through its morphological changes and elevating the expression of UCP-1. Celecoxib could improve lipolysis after burn injury.

scholarly journals Influence of early childhood burns on school performance: an Australian population study

2017 ◽  
Vol 103 (5) ◽  
pp. 444-451 ◽  
Author(s):  
Nadin Azzam ◽  
Ju-Lee Oei ◽  
Susan Adams ◽  
Barbara Bajuk ◽  
Lisa Hilder ◽  
...  
Keyword(s):  
School Performance ◽  
Parental Education ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Formal Schooling ◽  
Indigenous Status ◽  
South Wales ◽  
Education Levels ◽  
Total Body

ObjectivesTo determine the influence of burn injuries on childhood performance in national standardised curriculum-based school tests.DesignBirth and health records of 977 children who were hospitalised with a burn injury between 2000 and 2006 in the state of New South Wales, Australia, were linked to performance scores in the National Assessment Program: Literacy and Numeracy test, a compulsory nationwide curriculum-based test (CBT) and compared with children who were not hospitalised for burns and who were matched for birth year, gender, gestation and socioeconomic status.Main outcome measuresTest scores in years 3 (ages 8–9), 5 (ages 10–11) and 7 (ages 13–14) in numeracy, writing, reading, spelling, grammar and punctuation.ResultsMean age at first burn injury was 28 months (median: 20, range: 0–140). Children with burns were significantly more likely to have younger mothers (28.5 vs 29.6 years) (P<0.001), be indigenous (OR 2.5 (95% CI 2.1 to 3.1)) (P<0.001) and have siblings (OR 1.2 (95% CI 1.1 to 1.4)) (P<0.001). They were also less likely to meet national minimum standards in most domains of testing until year 5, even after adjustment for parental education levels, parental smoking, maternal age and indigenous status. Each 10% increase in total body surface area burnt was associated with a decrease in year 5 scores by 37.0% in numeracy and 71.9% in writing.ConclusionsMost childhood burn injuries occur before the start of formal schooling. Children who are hospitalised for burns perform more poorly in CBT even after accounting for family and socioeconomic disadvantage. Rehabilitation of children with burn injuries must address school performance to decrease any long-term negative societal impact of burns.

scholarly journals Epidemiology and Characteristics of Burn Patients in Dr. Soedarso General Hospital during 2017 – 2020: Retrospective Study

2021 ◽  
Vol 9 (B) ◽  
pp. 711-714
Author(s):  
Doni Setiawan ◽  
Winsen Haryono
Keyword(s):  
Retrospective Study ◽  
Medical Records ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Well Being ◽  
Epidemiological Studies ◽  
Burn Injuries ◽  
Burn Patients ◽  
Total Body

Background: Burns are devastating injuries, often resulting in significant morbidity, impairment of emotional well-being, and experienced quality of life. The etiological factors of burn injuries is vary considerably in different communities and regions, hence the need for detailed epidemiological studies to understand the problem status in different regions. Methods: A retrospective study of non-random consecutive sampling of medical records of Dr. Soedarso Regional Hospital in the period August 2017 – December 2020 Results: A total 108 samples were included in this study. There were 88 (81,5%)  male and 20 (18,5%) female; mostly adult (>18 years) 57 (52,8%). The etiology of burn injury was flame (35,2%), electrical (34,3%) and scald (30,6%). The most total body surface area (TBSA) of burns from 1-10%. The mortality rate was obtained by 8 (7.4%) respondents. Conclusion: : Based on the results of this study, that the major proportion of burn patients were male  and in the age group of > 18 years old. Flame was the most leading cause of burn. Considering the size of the burn, it was revealed that the most TBSA of  burns was 1-10%.

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