An unusual presentation to the burn’ unit – a cautionary tale

2021 ◽  
Author(s):  
Ryan Faderani ◽  
Stephen R Ali ◽  
Jeremy Yarrow
Keyword(s):  
Lupus Erythematosus ◽  
Hot Water ◽  
Water Bottle ◽  
Capillary Refill ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
Prolonged Contact ◽  
History Of ◽  
Atypical Presentations ◽  
Partial Thickness Burns

Abstract We report a case of a 34-year old female with systemic lupus erythematosus (SLE) and lupus nephritis who was referred to the regional burns service with a suspected contact burn to the left flank and hypogastrium from a hot water bottle. The patient had been applying a hot-water bottle to the area at night for pain relief and after 3-days she noticed a localised area of erythema which became larger and began to blister over a period of 5-days. The blistered areas were erythematous and wet, however the capillary refill time was sluggish. The lesion was initially diagnosed and treated as a superficial partial thickness burn that had developed secondary to prolonged contact with a hot water bottle. However, due to the history of immunosuppression as well as elements of the lesion being unusual for a burn, we consequently diagnosed this as herpes zoster infection. This case highlights the importance of always thinking of alternative diagnoses. There are several cases in the literature where shingles has been dangerously misdiagnosed, furthermore leading to patients being mistakenly treated and even operated on. In the early stages, abdominal shingles may present very similarly to superficial partial thickness burns, both with neuropathic pain, erythema and blistering. It is important for the burns surgeon to be aware of this diagnosis as a differential in atypical presentations, and to pay particular attention to the timeline of events is the key to diagnosis.

scholarly journals The use of a non-medicated dressing for superficial-partial thickness burns in children: a case series and review

2019 ◽  
Vol 5 ◽  
pp. 205951311989695
Author(s):  
Ter-Er Kusu-Orkar ◽  
Umar Islam ◽  
Benjamin Hall ◽  
Evan Araia ◽  
Nikki Allorto
Keyword(s):  
Antimicrobial Properties ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Hot Water ◽  
Secondary Outcome ◽  
Wound Complications ◽  
Burn Wounds ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
Partial Thickness Burns

Background: Cutimed® Sorbact® is a dressing marketed as having antimicrobial properties and easy application without the threat of antibiotic resistance and difficult accessibility. There is little evidence on the clinical outcomes of the use of Cutimed® Sorbact® in adults and currently no evidence of use of Cutimed® Sorbact® on superficial-partial thickness burn injuries in children. Objective: To summarise the clinical outcome of burn wounds in children with superficial-partial thickness burns in which Cutimed® Sorbact® was used. Method: An observational case series was conducted in Edendale Hospital, Pietermaritzburg, South Africa over the course of four weeks. Patients where included if they were aged < 10 years and had a ⩽ 15% superficial-partial burn. The primary outcome measure was time to 95% re-epithelialisation. Secondary outcome measures included wound complications, adverse healing and number of dressing changes. Results: Ten patients (five girls, five boys; age range = 11 months–8 years) were included in this case series. All participants had a type VI Fitzpatrick skin type and 80% of burns were hot water burns. Of all patients treated with Cutimed® Sorbact®, 50% healed within seven days, 70% within 14 days and 100% within 21 days. There was only one wound complication noted in this study and there was no adverse healing in any burn wounds. The mean number of dressing changes was 1.4 (range = 1–2) and length of hospital stay was in the range of 0–11 days (mean = 5.1 days). Conclusion: Cutimed® Sorbact® is a safe, useful and cost-effective dressing that should be used as an alternative for superficial-partial burns in children.

The Role of Autologous PRP on Deep Partial-Thickness Burn Wound Healing in Bama Pigs

2020 ◽  
Vol 41 (3) ◽  
pp. 657-662 ◽  
Author(s):  
Yanwei Sun ◽  
Yongqian Cao ◽  
Ran Zhao ◽  
Famei Xu ◽  
Dan Wu ◽  
...  
Keyword(s):  
Wound Healing ◽  
Growth Factors ◽  
Growth Factor ◽  
Healing Process ◽  
Control Group ◽  
Therapeutic Effects ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
The Mean ◽  
Partial Thickness Burns

Abstract In this study, we aimed to evaluate the therapeutic effects of autologous platelet-rich plasma (PRP) on deep partial-thickness burns in Bama pigs. Deep partial-thickness burn wounds were created on the back of Bama pigs. The reepithelialization time was compared between the PRP and control groups. The mean score of Ki67 (+) cells and α-SMA (+) vessels, the mean thickness of epidermis and dermis of the healing wounds were determined via H&E staining and immunohistochemical assay. The levels of the growth factors epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF) were examined by ELISA. Our data showed that the time to wound reepithelialization was shorter in the PRP group compared with the control group. The thickness of the epidermis was larger in the PRP group compared with the control group. On the 7th and 14th days after the treatment, the mean score of Ki67 (+) cells and α-SMA (+) vessels were higher in the PRP group compared with the control group. The PRP group showed higher levels of growth factors (EGF, bFGF, and VEGF) compared with the control group by ELISA. The results indicated that PRP could improve wound healing process of deep partial-thickness burns in Bama pigs. The PRP increased the thickness of epidermis of the healed wounds, cell proliferation, and angiogenesis. We demonstrated that applying PRP had a greater potential for the treatment of deep partial-thickness burns.

scholarly journals Keratin-Alginate Sponges Support Healing of Partial-Thickness Burns

2021 ◽  
Vol 22 (16) ◽  
pp. 8594
Author(s):  
Zi Kuang Moay ◽  
Luong T. H. Nguyen ◽  
Pietradewi Hartrianti ◽  
Declan P. Lunny ◽  
David Leavesley ◽  
...  
Keyword(s):  
Subsequent Development ◽  
Dermal Fibroblasts ◽  
Basement Membranes ◽  
Human Dermal Fibroblasts ◽  
Suitable Alternative ◽  
Dermal Substitutes ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
Partial Thickness Burns

Deep partial-thickness burns damage most of the dermis and can cause severe pain, scarring, and mortality if left untreated. This study serves to evaluate the effectiveness of crosslinked keratin–alginate composite sponges as dermal substitutes for deep partial-thickness burns. Crosslinked keratin–alginate sponges were tested for the ability to support human dermal fibroblasts in vitro and to support the closure and healing of partial-thickness burn wounds in Sus scrofa pigs. Keratin–alginate composite sponges supported the enhanced proliferation of human dermal fibroblasts compared to alginate-only sponges and exhibited decreased contraction in vitro when compared to keratin only sponges. As dermal substitutes in vivo, the sponges supported the expression of keratin 14, alpha-smooth muscle actin, and collagen IV within wound sites, comparable to collagen sponges. Keratin–alginate composite sponges supported the regeneration of basement membranes in the wounds more than in collagen-treated wounds and non-grafted controls, suggesting the subsequent development of pathological scar tissues may be minimized. Results from this study indicate that crosslinked keratin–alginate sponges are suitable alternative dermal substitutes for clinical applications in wound healing and skin regeneration.

scholarly journals Coming to Consensus: What Defines Deep Partial Thickness Burn Injuries in Porcine Models?

2020 ◽  
Author(s):  
Angela L F Gibson ◽  
Bonnie C Carney ◽  
Leila Cuttle ◽  
Christine J Andrews ◽  
Christine J Kowalczewski ◽  
...  
Keyword(s):  
Animal Models ◽  
Burn Injury ◽  
Burn Injuries ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
Consensus Statements ◽  
Partial Thickness Burns ◽  
Burn Depth ◽  
Histological Staining ◽  
Educational Component

Abstract Deep partial thickness burns are clinically prevalent and difficult to diagnose. In order to develop methods to assess burn depth and therapies to treat deep partial thickness burns, reliable, accurate animal models are needed. The variety of animal models in the literature and the lack of precise details reported for the experimental procedures make comparison of research between investigators challenging and ultimately affect translation to patients. They sought to compare deep partial thickness porcine burn models from five well-established laboratories. In doing so, they uncovered a lack of consistency in approaches to the evaluation of burn injury depth that was present within and among various models. They then used an iterative process to develop a scoring rubric with an educational component to facilitate burn injury depth evaluation that improved reliability of the scoring. Using the developed rubric to re-score the five burn models, they found that all models created a deep partial thickness injury and that agreement about specific characteristics identified on histological staining was improved. Finally, they present consensus statements on the evaluation and interpretation of the microanatomy of deep partial thickness burns in pigs.

811 Comparison of an Enzymatic Debrider with Antibiotic Ointment in the Outpatient Care of Minor Partial Thickness Burns

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S244-S245
Author(s):  
Suzanne Mitchell ◽  
Dhaval Bhavsar ◽  
Jessica Reynolds ◽  
Jessica Jones ◽  
Julia M Pena
Keyword(s):  
Wound Closure ◽  
Statistical Significance ◽  
Burn Injuries ◽  
Topical Antibiotic ◽  
Burn Wounds ◽  
Burn Care ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
Partial Thickness Burns ◽  
Antibiotic Ointment

Abstract Introduction In the U.S. about 450,000 people per year receive medical burn care through hospital emergency departments, hospital outpatient clinics, free-standing urgent care centers and private physician offices. Burns are generally classified in terms of depth and severity. Outpatient management of partial thickness burns normally involves the application of an ointment, which may contain an antibiotic and is widely used in burn care. This clinical study has been designed to prospectively evaluate potential benefits of an enzymatic debrider in partial thickness burn wounds compared to antibiotic only treatment. The primary purpose of this study is to compare an enzymatic debrider with a topical antibiotic ointment in the proportion healed at 3 weeks after initiation of treatment, and time to healing (in weeks). Methods A convenience sample of 20 subjects, aged 19–56, with an acute thermal burn injury less than 72 hours old, and less than 10% TBSA were randomly assigned to outpatient treatment with an enzymatic debrider or a topical antibiotic. The proportion of subjects healed after 3 weeks of treatment was analyzed using ANOVA. In addition, a t-test comparison between the enzymatic debrider and the topical antibiotic was performed. Results For partial thickness burns, the mean time to heal using an enzymatic debrider was 18 days compared to 28 days for the topical antibiotic. However, there was no statistical significance in burn wound closure between subjects receiving an enzymatic debrider compared to a topical antibiotic, t (13) = .677; p = .510. An analysis of variance comparing an enzymatic debrider and a topical antibiotic also showed no statistical significance in time to heal (F=.849, p=374). Conclusions Due to the small sample size, the results from this study do not support the use of an enzymatic debrider versus a topical antibiotic in treating partial thickness burn injuries to advance wound closure or shorten time to heal. The results of this study show clinical significance, with burn wounds healed in 18 days when an enzymatic debrider was used compared to 28 days when a topical antibiotic was used. The lack of statistical significance was due to an under-powered study. Furthermore, partial thickness burns should spontaneously heal within 7–14 days, regardless of the topical treatment, excluding concomitant co-morbidities. Applicability of Research to Practice Continued research is necessary, employing larger sample sizes to adequately compare the use of an enzymatic debrider compared to topical antibiotics in deep partial thickness burn wounds. In addition, outpatient management of deep thickness and full-thickness burn injuries, utilizing sharp debridement in conjunction with enzymatic debridement, in patients who decline surgical treatment of burn wounds should be explored, analyzing time to heal, scar evaluation, and cost analysis,

scholarly journals Effect of Extracorporeal Shock Wave Treatment on Deep Partial-Thickness Burn Injury in Rats: A Pilot Study

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Gabriel Djedovic ◽  
Florian Stefan Kamelger ◽  
Johannes Jeschke ◽  
Hildegunde Piza-Katzer
Keyword(s):  
Shock Wave ◽  
Burn Injury ◽  
Skin Regeneration ◽  
Partial Thickness ◽  
Extracorporeal Shock Wave ◽  
Partial Thickness Burn ◽  
Cost Effective Treatment ◽  
Group 2 ◽  
Partial Thickness Burns ◽  
Group 1

Extracorporeal shock wave therapy (ESWT) enhances tissue vascularization and neoangiogenesis. Recent animal studies showed improved soft tissue regeneration using ESWT. In most cases, deep partial-thickness burns require skin grafting; the outcome is often unsatisfactory in function and aesthetic appearance. The aim of this study was to demonstrate the effect of ESWT on skin regeneration after deep partial-thickness burns. Under general anesthesia, two standardized deep partial-thickness burns were induced on the back of 30 male Wistar rats. Immediately after the burn, ESWT was given to rats of group 1 (N=15), but not to group 2 (N=15). On days 5, 10, and 15, five rats of each group were analyzed. Reepithelialization rate was defined, perfusion units were measured, and histological analysis was performed. Digital photography was used for visual documentation. A wound score system was used. ESWT enhanced the percentage of wound closure in group 1 as compared to group 2 (P<0.05). The reepithelialization rate was improved significantly on day 15 (P<0.05). The wound score showed a significant increase in the ESWT group. ESWT improves skin regeneration of deep partial-thickness burns in rats. It may be a suitable and cost effective treatment alternative in this type of burn wounds in the future.

scholarly journals Dressing for Partial Thickness Burn Using Microbial Cellulose and Transparent Film Dressing : A Comparative Study

1970 ◽  
Vol 2 (2) ◽  
Author(s):  
Shelly M Djaprie ◽  
Aditya Wardhana
Keyword(s):  
Bacterial Contamination ◽  
Transparent Film ◽  
Microbial Cellulose ◽  
Accelerate Wound Healing ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
Strong Adhesion ◽  
Moist Environment ◽  
Total Body ◽  
Partial Thickness Burns

Background: Wound dressing aims are to create moist and warm condition to accelerate wound healing, decrease level of pain, collects of exudate, decrease the need of dressing changes, cost effectiveness and protection from bacterial contamination. Microbial cellulose creates a moist environment and strong adhesion to the wound to prevent bacterial contamination and protects from temperature changes. Meanwhile transparent film dressing has advantages such as easy to evaluate, rapid rate of epithelialization and provides high comfort for patients. This study aims to evaluate the efficacy of microbial cellulose dressing compare to transparent film dressing as control, in the treatment of partial thickness burn. Method: We perform a single blind randomized clinical trial study. All patients with partial thickness burn with total body surface less than 20% area burns at any age presenting to our burn unit will be included in the study. They were dressed using microbial cellulose and transparent film as control. Result: The epithelialization rate of patients treated by microbial cellulose was significantly faster and less pain, especially in day 3 and 10 (p=0,000) than those treated with transparent dressing. This study showed patient using microbial cellulose no need to change dressing, meanwhile in transparent dressing it need 2 to 3 times dressing changes and costs more money. Conclusion: The use of microbial cellulose dressing is a versatile and effective dressing for partial thickness burns. This innovative material will be an alternative dressing in partial-thickness burn wounds. 

scholarly journals Porcine Xenograft and Epidermal Fully Synthetic Skin Substitutes in the Treatment of Partial-Thickness Burns: A Literature Review

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 432
Author(s):  
Herbert L. Haller ◽  
Sigrid E. Blome-Eberwein ◽  
Ludwik K. Branski ◽  
Joshua S. Carson ◽  
Roselle E. Crombie ◽  
...  
Keyword(s):  
Healing Time ◽  
Subsequent Treatment ◽  
Skin Substitute ◽  
Skin Substitutes ◽  
Burn Treatment ◽  
Advantages And Disadvantages ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
Partial Thickness Burns ◽  
Porcine Xenograft

Background and Objectives: Porcine xenografts have been used successfully in partial thickness burn treatment for many years. Their disappearance from the market led to the search for effective and efficient alternatives. In this article, we examine the synthetic epidermal skin substitute Suprathel® as a substitute in the treatment of partial thickness burns. Materials and Methods: A systematic review following the PRISMA guidelines has been performed. Sixteen Suprathel® and 12 porcine xenograft studies could be included. Advantages and disadvantages between the treatments and the studies’ primary endpoints have been investigated qualitatively and quantitatively. Results: Although Suprathel had a nearly six times larger TBSA in their studies (p < 0.001), it showed a significantly lower necessity for skin grafts (p < 0.001), and we found a significantly lower infection rate (p < 0.001) than in Porcine Xenografts. Nonetheless, no significant differences in the healing time (p = 0.67) and the number of dressing changes until complete wound healing (p = 0.139) could be found. Both products reduced pain to various degrees with the impression of a better performance of Suprathel® on a qualitative level. Porcine xenograft was not recommended for donor sites or coverage of sheet-transplanted keratinocytes, while Suprathel® was used successfully in both indications. Conclusion: The investigated parameters indicate that Suprathel® to be an effective replacement for porcine xenografts with even lower subsequent treatment rates. Suprathel® appears to be usable in an extended range of indications compared to porcine xenograft. Data heterogeneity limited conclusions from the results.

scholarly journals In Vivo Assessment of Burn Depth and Wound Healing Using a Handheld Terahertz Hyperspectral Scanner

2021 ◽  
Author(s):  
Omar Osman ◽  
Zachery Harris ◽  
Juin Zhou ◽  
Mahmoud Khani ◽  
Adam Singer ◽  
...  
Keyword(s):  
Electromagnetic Scattering ◽  
Healing Process ◽  
Burn Injuries ◽  
Spectral Amplitude ◽  
Burn Care ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
Signal Contrast ◽  
Partial Thickness Burns

Abstract The accuracy of clinical assessment in partial-thickness burn injuries has remained as low as 50-75%. Depending on the depth and environmental factors in the wound, such as reactive oxygen species, inflammation, and autophagy, partial-thickness burns can heal spontaneously or require surgical intervention. In this study, we demonstrate that Terahertz Time-Domain Spectral Imaging (THz-TDSI) is a promising tool for in vivo quantitative assessment of burn injuries. We used a novel handheld THz-TDSI scanner to characterize burn injuries in a porcine scald model with histopathological control. Prior work used THz reflectivity (representation of tissue hydration) as the only source of signal contrast. However, we used the spectral amplitude and the spectral slope of the terahertz electric field to distinguish the different severities of burns, suggesting that the energy loss due to electromagnetic scattering from skin constituents serves an additional metric to quantitatively assess burn injuries. Statistical analysis (n = 40) indicates that THz-TDSI can accurately differentiate between partial-thickness and full-thickness burn injuries (1-way ANOVA, p < 0.05) and monitor the healing process of partial thickness burns. THz-TDSI has the potential to improve burn care outcomes by helping surgeons to make objective decisions for early excision.

scholarly journals Abdominal Pain Relieved By A Warm Hot Water Bottle: An Atypical Presentation Of Eosinophilic Gastroenteritis

2020 ◽  
Author(s):  
Ahmad Reza Shirazi-Nejad ◽  
John M Hebden
Keyword(s):  
Abdominal Pain ◽  
Eosinophil Count ◽  
Eosinophilic Gastroenteritis ◽  
Hot Water ◽  
Atypical Presentation ◽  
Water Bottle ◽  
History Of ◽  
Peripheral Eosinophil ◽  
Steroid Sparing

A 26-year-old woman presented with a 3-month history of worsening episodic abdominal pain, which was associated with frequent passage of watery stools, nausea and dyspepsia. Her peripheral eosinophil count was markedly elevated. This responded well to a reducing regimen of corticosteroids. Her symptoms completely resolved with a corresponding fall in eosinophil count. The patient was diagnosed with eosinophilic gastroenteritis. We have not considered steroid-sparing agents at this point, but should she have future exacerbations then this will be considered.

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