Burn lessons learned from the Whakaari White Island volcanic eruption

2021 ◽  
Author(s):  
Paul Baker ◽  
Michelle Locke ◽  
Amber Moazzam ◽  
Matthew Taylor ◽  
Francois Stapelberg ◽  
...  
Keyword(s):  
Volcanic Ash ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Active Volcano ◽  
Lessons Learned ◽  
Protective Equipment ◽  
Total Body ◽  
Burn Depth ◽  
White Island ◽  
Ballistic Trauma

Abstract New Zealand's most active volcano, Whakaari White Island was a common tourist attraction prior to its eruption on 9 th December 2019. At the time of the eruption, there were 47 people on the island from three tour groups. 39 people survived the initial eruption and were extracted. 31 entered into the New Zealand National Burn Service across four hospitals. The median age of the patients treated at the National Burn Centre was 45.5 years (range: 14 − 67 years) and median total body surface area burn was 49.5% (range: 9% - 90%). The three month survival of this eruptive event was 55%, which subsequently fell to an overall rate of 53% following one late death of an early survivor after repatriation home. Of the patients who survived the initial eruption for long enough to be admitted to the National Burn Service, the overall survival rate was 71% at three months. We describe 12 lessons we have learnt from our management of the survivors. The key surgical lessons among these are: The injuring mechanism combined ballistic trauma, thermal and acidic burn components, with the acid component being the most problematic and urgent for management. Volcanic ash burns result in on-going burn depth progression, deep underlying tissue damage and significant metabolic instability. Early skin grafting was not successful in many cases. Reconstructive strategy needed adjusting to cope with the high operative demand and limited donor sites in all patients. Protect yourself from potential dangers with additional personal protective equipment (PPE) in an unfamiliar setting.

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 A paradigm shift in practice—the benefits of early active wound temporisation rather than early skin grafting after burn eschar excision

2020 ◽  
Vol 48 (2) ◽  
pp. 93-100
Author(s):  
John E Greenwood
Keyword(s):  
Skin Graft ◽  
Paradigm Shift ◽  
Burn Injury ◽  
Donor Site ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Graft Harvest ◽  
Major Burn ◽  
Early Closure ◽  
Total Body

After major burn injury, once survival is achieved by the immediate excision of all deep burn eschar, we are faced with a patient who is often physiologically well but with very extensive wounds. While very early grafting yields excellent results after the excision of small burns, it is not possible to achieve the same results once the wound size exceeds the available donor site. In patients where 50%–100% of the total body surface area is wound, we rely on serial skin graft harvest, from finite donor site resources, and the massive expansion of those harvested grafts to effect healing. The result is frequently disabling and dysaesthetic. Temporisation of the wounds both passively, with cadaver allograft, and actively, with dermal scaffolds, has been successfully employed to ameliorate some of the problems caused by our inability to definitively close wounds early. Recent advances in technology have demonstrated that superior functional and cosmetic outcomes can be achieved in actively temporised areas even when compared with definitive early closure with skin graft. This has several beneficial implications for both patient and surgeon, affecting the timing of definitive wound closure and creating a paradigm shift in the care of the burned patient.

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.

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.

scholarly journals Massive burns: retrospective analysis of changes in outcomes indicators across 18 years

2021 ◽  
Author(s):  
Joachim N Meuli ◽  
Olivier Pantet ◽  
Mette M Berger ◽  
Laurent Waselle ◽  
Wassim Raffoul
Keyword(s):  
Fluid Resuscitation ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
University Hospital ◽  
Skin Grafts ◽  
Early Care ◽  
Icu Stay ◽  
Total Body ◽  
Length Of Icu Stay ◽  
Over Time

Abstract Background The treatment and management of massive burns, defined as burns affecting≥ 50% of total body surface area (TBSA) has considerably changed since the 90s. This study aimed at analyzing if the length of intensive care unit (ICU) stay, the success of skin grafting operations and the mortality changed in the last 18 years. Methods Between 2000 and 2018, 77 patients were admitted for massive burns to the ICU of a university hospital. Transfers and early care withdrawal precluded inclusion for 38 patients, leaving 39 for analysis. Study variables were year of admission, demographics, burn characteristics, critical care treatment (fluid resuscitation, ventilation and nutrition) and surgical therapy. Association between outcomes and year of admission were assessed through correlation and logistic regression analysis. Potential confounders were assessed through stepwise linear regression. Results Patients’ characteristics were stable over time with a median age of 36[25.0, 48.0] years, burns 65% [55.0, 83.0] TBSA and deep burns 55% [50.0, 68.0] TBSA . Length of ICU stay remained stable at 0.97 [0.6, 1.5] days/%TBSA. Mortality was stable as well. Energy and carbohydrate delivery decreased in parallel with the number of infectious episodes per patient. Number of operations was stable but the take rate of skin grafts increased significantly. The multivariate analysis retained year of admission, weight, total number of infections, daily lipid intakes and fluid resuscitation as independent predicting variables, Conclusion Length of ICU stay and mortality did not change over time but skin grafts take rates improved significantly.

654 Successful Wound Closure in Patients with Large Total Body Surface Area Calciphylaxis with Aggressive Multi-modal Therapy Including Excision and Skin Grafting

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S184-S185
Author(s):  
Eric Curfman ◽  
Anjay Khandelwal
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Wound Closure ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Surgical Debridement ◽  
Treatment Modalities ◽  
Total Body ◽  
Tract Infections

Abstract Introduction Calcific Uremic Arteriolopathy (CUA), commonly known as Calciphylaxis, is a rare disorder characterized by ischemic necrosis of the skin and histologically by arteriolar calcification. CUA is most commonly seen in patients with end-stage renal disease (ESRD) but can be seen in other patients as well. CUA carries an extremely high mortality rate, with up to 80% in some studies, even in patients with limited disease. In light of this, many surgeons have adopted a “do-not-touch” practice with these patients. Over the past several years, our institution has seen an increase in referrals for the management of large total-body-surface-area (TBSA) CUA. Methods Retrospective review of all patients with biopsy-proven (by dermatopathology) large TBSA (>=5% TBSA) CUA admitted to a Verified Adult and Pediatric Burn Center from 2015 to present. Demographics, laboratory data, treatment modalities and outcomes including mortality and wound closure were recorded. Results A total of 8 patients with large TBSA CUA were admitted after being transferred from outside hospitals. Average TBSA affected was 13.76% (SD 7.27). 6 of these patients (75%) were noted to have non-uremic calciphylaxis. All patients had positive wound cultures on admission, and 1 patient (12.5%) developed a bacteremia in hospital. There were no central line associated bloodstream infections, catheter associated urinary tract infections or ventilator associated infections. All patients underwent surgical debridement (average 4.125, range 2–5), and 5 patients (62.5%) underwent grafting, (average 1.6, range 2–5) and subsequently proceeded to wound closure. In-hospital mortality was 25% and another patient was referred to a hospice facility after being readmitted with medical complications of her calciphylaxis. Secondary findings included 50% of the patients recently experienced significant weight loss (>100 lbs). On admission, 2 patients (25%) had abnormal serum calcium, 3 patients (37.5%) had abnormal serum PO4, and 4 (50%) patients had abnormal PTH levels. 2 patients (25%) had a recent exposure to warfarin (within 6 months). Conclusions Utilizing a multi-modal management strategy that includes surgical debridement and skin grafting, patients with calciphylaxis can progress to wound closure.

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.

Homeless Tent Fires: A Descriptive Analysis of Tent Fires in the Homeless Population

2021 ◽  
Author(s):  
Samantha Huang ◽  
Katherine J Choi ◽  
Christopher H Pham ◽  
Zachary J Collier ◽  
Justin M Dang ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Hospital Length ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Homeless Population ◽  
The Us ◽  
Upper And Lower Extremities ◽  
Total Body

Abstract Tent fires are a growing issue in regions with large homeless populations given the rise in homelessness within the US and existing data that suggest worse outcomes in this population. The aim of this study is to describe the characteristics and outcomes of tent fire burn injuries in the homeless population. A retrospective review was conducted involving two verified regional burn centers with patients admitted for tent fire burns between January 2015 and December 2020. Variables recorded include demographics, injury characteristics, hospital course, and patient outcomes. Sixty-nine patients met the study inclusion criteria. The most common mechanisms of injury were by portable stove accident, assault, and tobacco or methamphetamine-related. Median percent total body surface area (%TBSA) burned was 6% (IQR 9%). Maximum depth of injury was partial thickness in 65% (n=45) and full thickness in 35% (n=24) of patients. Burns to the upper and lower extremities were present in 87% and 54% of patients, respectively. Median hospital Length-of-Stay (LOS) was 10 days (IQR=10.5) and median ICU LOS was 1 day (IQR=5). Inhalation injury was present in 14% (n=10) of patients. Surgical intervention was required in 43% (n=30) of patients, which included excision, debridement, skin grafting, and escharotomy. In-hospital mortality occurred in 4% (n=3) of patients. Tent fire burns are severe enough to require inpatient and ICU level of care. A high proportion of injuries involved the extremities and pose significant barriers to functional recovery in this vulnerable population. Strategies to prevent these injuries are paramount.

Bromelain-based enzymatic debridement of e-cigarette burns: a single unit experience

2019 ◽  
Vol 28 (11) ◽  
pp. 758-761
Author(s):  
Weiguang Ho ◽  
Christopher D. Jones ◽  
Daniel Widdowson ◽  
Hilal Bahia
Keyword(s):  
Total Body Surface Area ◽  
Case Series ◽  
Skin Grafting ◽  
Burn Injuries ◽  
Chemical Burns ◽  
Burn Wound ◽  
Total Body ◽  
Partial Thickness Burns ◽  
Enzymatic Debridement

Objective: It is widely accepted that the early debridement of burns improves outcome. There is increasing evidence that enzymatic debridement is an effective technique for removal of full-thickness and deep-dermal burns, reducing blood loss and often the need for autologous skin grafting by avoiding over excision of the burn. We aim to highlight the potential use of this form of debridement as an alternative to surgical management in patients with electronic cigarette (e-cigarette)-associated flame burn injuries. Methods: This case series presents the use of Nexobrid (MediWound Ltd, Israel), a non-surgical, bromelain-based enzymatic debridement technique, in patients with deep partial-thickness burns (range: 1–3% total body surface area), avoiding the need for autologous skin grafting. Results: Burn wounds in two patients healed within 14 days without complications or the need for further surgical intervention. Another patient required further dressings after discharge but failed to attend follow-up appointments. These results are comparable with those reported by others using conservative management of e-cigarette burns. Conclusion: The authors wish to raise awareness of the potential for a combination of thermal and chemical burns related to e-cigarette explosions. Chemical burns should be excluded by pH testing of the burn wound. From our experience, small e-cigarette-associated flame burns can be considered for management with enzymatic debridement.

scholarly journals Amniotic membrane graft in a recurrent re-fusing temporal tarsorrhaphy: a case report

2020 ◽  
Vol 12 ◽  
pp. 251584142097192
Author(s):  
G. Bryant Giles ◽  
Donovan S. Reed ◽  
Timothy A. Soeken ◽  
Brett W. Davies
Keyword(s):  
Skin Graft ◽  
Amniotic Membrane ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Vehicle Accident ◽  
Graft Donor ◽  
Total Body ◽  
Amniotic Graft

Amniotic membrane grafts (AMGs) are commonly used to treat a variety of ophthalmologic conditions. Complications exist with permanent tarsorrhaphies, including the risk of re-fusion following tarsorrhaphy separation. We report a novel application of amniotic graft in lieu of skin grafts to protect the exposed marginal surface during the initial re-epithelialization period following release of a permanent tarsorrhaphy. We present a 24-year-old man who sustained an 80% total body surface area burn from a motor vehicle accident 16 months prior to presentation at our Oculoplastic service for evaluation of residual lagophthalmos. His original permanent tarsorrhaphies were removed; however, re-fusion occurred temporally in both sides. During a second attempt, AMGs were secured over the eyelid margins, leading to a successful tarsorrhaphy takedown without re-fusion. Periocular burn injuries present particular challenges, as cicatricial changes continue to evolve and viable skin graft areas diminish with each successive graft. In the setting of recurrent auto-tarsorrhaphy, the AMG has shown to be a viable alternative to standard skin grafting. This case demonstrates excellent results in a skin graft sparing procedure that is effective and efficient. Amniotic membrane grafting reduces morbidity by foregoing skin graft donor sites and can achieve similar functional and cosmetic results to standard skin grafting with reduced overall surgical time. As such, AMGs have the potential to supplant standard skin grafting in cases of recurrent auto-tarsorrhaphy, particularly in the setting of diminished available healthy skin tissue.

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