Electronic cigarette burns: A case series

Trauma ◽  
2018 ◽  
Vol 21 (2) ◽  
pp. 103-106 ◽  
Author(s):  
Cameron JS Gibson ◽  
Niknam Eshraghi ◽  
Nathan A Kemalyan ◽  
Charles Mueller
Keyword(s):  
Lithium Ion Battery ◽  
Medical Literature ◽  
Electronic Cigarettes ◽  
Total Body Surface Area ◽  
Case Series ◽  
Lithium Ion ◽  
Electronic Cigarette ◽  
Full Thickness ◽  
Total Body ◽  
Partial Thickness Burns

Background There have been many reports of electronic cigarette burns and lithium ion battery explosions leading to property and/or bodily damage, but there is a paucity of data about these injuries in the medical literature. We present a series of patients treated for electronic cigarette burns and lithium ion explosions and review the literature. Methods Patients treated for electronic cigarette burns between January 2012 and December 2016 were identified. Patients were included if they suffered injuries from either an electronic cigarette device or from batteries used in the devices. Data were collected on the mode of injury, depth, size, and location of the burn, whether or not they had any surgeries and length to recovery. Results Fourteen patients were treated for electronic cigarette burns between 2012 and 2016. Burn size ranged from <1% to 6% total body surface area. Most patients suffered burns to their thighs because the battery or device exploded in their pocket. The majority suffered partial thickness burns while four patients had full thickness burns. Three patients required excision and autografting, all of which were full thickness burns. The average time to recovery was 24.5 days. Conclusions Electronic cigarettes pose a new and unique risk to consumers. Lithium ion battery explosions can cause severe injury and significant burns requiring surgery. The incidence of e-cigarette burns are expected to increase as the number of users grow.

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.

79 Electronic Cigarette-Related Injuries Presenting to Five Large Burn Centers, 2015–2019

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S54-S55
Author(s):  
Carmen E Flores ◽  
Paul J Chestovich ◽  
Syed F Saquib ◽  
Joseph T Carroll ◽  
Mariam Al-Hamad Daubs ◽  
...  
Keyword(s):  
Thermal Injury ◽  
Spontaneous Combustion ◽  
Electronic Cigarettes ◽  
Total Body Surface Area ◽  
Public Health Problem ◽  
Electronic Cigarette ◽  
Outpatient Basis ◽  
Burn Centers ◽  
Split Thickness Skin Grafting ◽  
Inpatient Basis

Abstract Introduction Electronic cigarettes are advertised as safer alternatives to smoking cigarettes yet can cause serious injury. As consumer use of electronic cigarettes has increased, burn centers have witnessed a rise in both inpatient and outpatient visits to treat thermal and blast injuries related to their use. Methods A multicenter retrospective chart review of ABA burn registry data from 5 large burn centers was performed from January 2015 to July 2019 to identify patients who sustained Electronic Nicotine Delivery Systems (ENDS)-related injuries. Results A total of 127 patients with electronic cigarette-related injuries were identified, of which 113 were male (89%) and 14 were female (11%). Mean age was 34.0 years (SD 13.5%, range 1–75 years). The majority of patients (n=92, 72%) were treated on an inpatient basis, and average length of stay was 6.7 days. Most patients sustained less than 10% total body surface area burns (mean 3.8%, SD 2.6%, range 0.1% to 16.5%). 66% (n=85) sustained 2nd degree burns, and 36% (n=46) sustained 3rd degree burns. Most patients were injured while using the ENDS (n=100, 78%), while 18% (n=24) of patients reported spontaneous combustion. 2 patients (1.5%) were injured while changing their device battery, and 2 patients (1.5%) were injured while modifying the device. 3% (n=4) were injured by second-hand mechanism. Burn injury was the most common injury pattern (100%), followed by blast injury (n=81, 63%). Flame burns were the most common (n=89, 70%) type of thermal injury, followed by contact burns (n= 70, 55%), flash burns (n=47, 37%), chemical burns (n=2, 1.5%), and electrical burns (n=1, 0.7%). The most commonly injured body region was the extremities. There were no ENDS-related deaths. Silvadene was the most common topical agent used in the initial management of thermal injuries, followed by Bacitracin and Xeroform. 63% (n=80) of patients did not require surgery, while 36% (n=46) required surgical excision, and 15% (n=20) required split-thickness skin grafting. Multiple surgeries were uncommon. 22% of patients required one operation, 12% required two operations, and 2% required 3 operations. Conclusions Our data recognizes use of ENDS as a growing public health problem with potential to cause thermal injury and secondary trauma. Most injuries occur during use, however many result from spontaneous combustion while the device is not being used. Treatment of ENDS-related injuries is institution-dependent. Most patients are treated on an inpatient basis however the majority of patients treated on outpatient basis have good outcomes.

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 &gt;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 &gt;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 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.

Electronic Cigarette-Related Injuries Presenting to Five Large Burn Centers, 2015-2019

2021 ◽  
Author(s):  
Carmen E Flores ◽  
Paul J Chestovich ◽  
Syed Saquib ◽  
Joseph Carroll ◽  
Mariam Al-Hamad ◽  
...  
Keyword(s):  
Thermal Injury ◽  
Burn Injury ◽  
Electronic Cigarettes ◽  
Total Body Surface Area ◽  
Public Health Problem ◽  
Electronic Cigarette ◽  
Body Region ◽  
Outpatient Basis ◽  
Burn Centers ◽  
Thermal Injuries

Abstract Electronic cigarettes are advertised as safer alternatives to traditional cigarettes yet cause serious injury. US burn centers have witnessed a rise in both inpatient and outpatient visits to treat thermal injuries related to their use. A multicenter retrospective chart review of American Burn Association burn registry data from 5 large burn centers was performed from January 2015 to July 2019 to identify patients with electronic cigarette-related injuries. A total of 127 patients were identified. Most sustained less than 10% total body surface area burns (mean 3.8%). Sixty-six percent sustained 2nd degree burns. Most patients (78%) were injured while using their device. Eighteen percent of patients reported spontaneous device combustion. Two patients were injured while changing their device battery, and two were injured modifying their device. Three percent were injured by second-hand mechanism. Burn injury was the most common injury pattern (100%), followed by blast injury (3.93%). Flame burns were the most common (70%) type of thermal injury; however, most patients sustained a combination-type injury secondary to multiple burn mechanisms. The most injured body region was the extremities. Silver sulfadiazine was the most common agent used in initial management of thermal injuries. Sixty-three percent of patients did not require surgery. Of the 36% requiring surgery, 43.4% required skin grafting. Multiple surgeries were uncommon. Our data recognizes electronic cigarette use as a public health problem with potential to cause thermal injury and secondary trauma. Most patients are treated on an inpatient basis although most patients treated on outpatient basis have good outcomes.

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&lt; 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.

534 Persistent Copper and Zinc Deficiency in Excess of 30 Days Post Burn Injury

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S115-S115
Author(s):  
Louisa Sullivan ◽  
Asia N Quan ◽  
Karen J Richey ◽  
Kevin N Foster
Keyword(s):  
Wound Healing ◽  
Zinc Deficiency ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Case Series ◽  
Nutritional Guidelines ◽  
Copper And Zinc ◽  
Daily Allowance ◽  
Total Body ◽  
Zinc Levels

Abstract Introduction Copper and zinc deficiencies are common after burn injury, with the lowest levels usually occurring within seven days. Both trace elements are important for wound healing, but due to competition for absorption in the small intestine, oral replacement of zinc and copper may not be sufficient. Nutritional guidelines recommend copper and zinc replacement for up to 30 days, but little data is available to guide long-term trace element replacement. Methods This case series includes four patients with 15% or larger total body surface area burns who had hypocupremia at least 30 days after admission despite receiving at least the recommended daily allowance of copper via tube feeds. Results In two patients, copper levels increased following discontinuation of oral zinc tablets. However, one patient had continued hypocupremia and increasing zinc levels while receiving zinc only from tube feeds, suggesting this amount of zinc may decrease dietary copper absorption. For one patient with 95% TBSA burns, hypocupremia was associated with polyneuropathy and osteopenia. Another patient experienced an acute drop in zinc levels associated with bacteremia and sepsis. Conclusions In this case series, hypocupremia was associated with anemia and zinc deficiency with poor wound healing. Additional multicenter practice reviews of copper and zinc supplementation in burn centers would be beneficial.

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 Mucormycosis in Burn Patients

2019 ◽  
Vol 5 (1) ◽  
pp. 25 ◽  
Author(s):  
Pauline Devauchelle ◽  
Mathieu Jeanne ◽  
Emilie Fréalle
Keyword(s):  
Amphotericin B ◽  
Total Body Surface Area ◽  
Case Series ◽  
Skin Lesions ◽  
Burn Patients ◽  
Medline Search ◽  
Cutaneous Mucormycosis ◽  
Total Body ◽  
Dna 2 ◽  
Extensive Burns

Patients with extensive burns are an important group at risk for cutaneous mucormycosis. This study aimed to perform a systematic review of all reported mucormycosis cases in burn patients from 1990 onward. A Medline search yielded identification of 7 case series, 3 outbreaks, and 25 individual cases reports. The prevalence reached 0.04%–0.6%. The median age was 42–48 in the case series and outbreaks, except for the studies from military centers (23.5–32.5) and in individual reports (29.5). The median total body surface area reached 42.5%–65%. Various skin lesions were described, none being pathognomonic: the diagnosis was mainly reached because of extensive necrotic lesions sometimes associated with sepsis. Most patients were treated with systemic amphotericin B or liposomal amphotericin B, and all underwent debridement and/or amputation. Mortality reached 33%–100% in the case series, 29%–62% during outbreaks, and 40% in individual cases. Most patients were diagnosed using histopathology and/or culture. Mucorales qPCR showed detection of circulating DNA 2–24 days before the standard diagnosis. Species included the main clinically relevant mucorales (i.e., Mucor, Rhizopus, Absidia/Lichtheimia, Rhizomucor) but also more uncommon mucorales such as Saksenaea or Apophysomyces. Contact with soil was reported in most individual cases. Bandages were identified as the source of contamination in two nosocomial outbreaks.

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