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.

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

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S149-S150
Author(s):  
Samantha Huang ◽  
Katherine J Choi ◽  
Christopher H Pham ◽  
Zachary J Collier ◽  
Justin Dang ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Homeless Population ◽  
Health Crisis ◽  
Total Body ◽  
Injury Burden

Abstract Introduction Homelessness is a rising concern as insufficient housing and significant barriers to shelter has led to more individuals seeking shelter in tents. Within this demographic there has been an increased trend of burn injuries from tent fires in regions with large homeless populations. This represents a public health crisis given the long-term psychosocial and functional sequela of burn injuries and existing data that suggest worse outcomes in the homeless population. To our knowledge, homeless related tent fire burns have not previously been studied in the literature. The aim of this study is to describe the characteristics and outcomes of tent fire burn injuries in the homeless population. Methods A retrospective cohort study was conducted involving two verified regional burn centers with patients admitted for tent fire burns between January 1, 2019 to July 31, 2020. Patients were identified as either domiciled or homeless based on medical records at the time of injury. Variables recorded include demographics, injury characteristics, hospital course, and patient outcomes. Results A total of 45 patients were identified. The most common mechanisms of injury were by portable stove accident (29%), assault (27%), bonfire (22%), and tobacco or methamphetamine paraphernalia-related (16%). Median percent total body surface area (%TBSA) burned was 5.5 (IQR 5.5). Maximum depth of injury was second degree in 62% (n=28) of patients and third degree in 38% (n=17) of patients. Burns to the upper extremities were present in 84% of patients and burns to the lower extremities were present in 53% of patients. Median hospital LOS was 9.5 days (IQR=10) and median ICU LOS was 2 days (IQR=4.8), with inhalation injury present in 16% (n=7) of patients. Surgical intervention was required in 40% (n=18) of patients, which included debridement, skin grafting, and escharotomy. In-hospital mortality occurred in 5% (n=2) of patients. Conclusions Burn injuries from tent fires incur significant injury burden to an already vulnerable population, with risk factors that predispose them to poor burn outcomes. Injuries in our cohort were severe enough to require inpatient and ICU level of care. We saw a high proportion of injuries to the extremities, which pose functional and psychosocial challenges to the wellbeing of these patients. Further resources are needed to better prevent tent fires and care for this population.

scholarly journals Five Years Experience With Meek Grafting in the Management of Extensive Burns in an Adult Burn Center

2018 ◽  
Vol 27 (1) ◽  
pp. 44-48 ◽  
Author(s):  
Khosrow Siamak Houschyar ◽  
Christian Tapking ◽  
Ina Nietzschmann ◽  
Susanne Rein ◽  
Kristian Weissenberg ◽  
...  
Keyword(s):  
Total Body Surface Area ◽  
Skin Grafting ◽  
Operative Management ◽  
Burn Injuries ◽  
Burn Center ◽  
Total Body ◽  
Operative Notes ◽  
Extensive Burns ◽  
Skin Coverage ◽  
Extensive Burn

Background: In extensive burn injuries with lack of donor sites for skin grafting, the Meek technique of skin expansion can be an efficient and effective method in covering extensive wounds. The aim of this retrospective study was to present our experience with the Meek technique of grafting. Methods: We performed a retrospective analysis of patients from our burn center who underwent Meek grafting between 2012 and 2016. Demographics, burn details, clinical course, operative management, and outcomes were collected and analyzed from patient records and operative notes. Outcome measures, including graft take rate, complications and need for further surgery, were recorded. Results: Twelve patients had Meek grafting. The average age was 38 years (range: 15-66). The average percent total body surface area burned was 54.3% (range: 31%-77%). Eighty-three percent of grafted areas healed well, and no regrafting was necessary. In the remaining 17%, infection and hematoma were the leading cause of graft failure. Conclusions: Meek grafting constitutes a rapid and efficient surgical approach for the skin coverage of extensive full-thickness burn injuries with limited autograft donor sites.

scholarly journals Evaluation of EpiProtect® microbial cellulose burns dressings in young children

2020 ◽  
Vol 6 ◽  
pp. 205951312094050
Author(s):  
Lindsay A Shanks ◽  
Andrea Cronshaw ◽  
K Skaria Alexander ◽  
Jonathan A Davies ◽  
Ciaran P O’Boyle
Keyword(s):  
Young Children ◽  
Total Body Surface Area ◽  
Case Series ◽  
Skin Grafting ◽  
Healing Time ◽  
Full Thickness ◽  
Burn Wound ◽  
Partial Thickness ◽  
Split Skin Grafting ◽  
Effective Analgesia

Introduction: EpiProtect® is a biosynthetic cellulose dressing indicated for the treatment of superficial burns and the dressing of deep burns. Prior to this study the youngest reported patient treated with EpiProtect® was aged 13 years. Method: Data were collected prospectively for patients aged < 5 years, presenting to the Children’s Burns Unit with ⩾ 2% total body surface area (TBSA) burns sustained by any mechanism. Results: Thirty children were treated (median age = 17 months, age range = 1–61 months). Thirty-six burn depths were documented: superficial partial thickness (SPT) in 53% (n=19); mid-partial thickness (MPT) in 33% (n=12); deep partial thickness (DPT) in 11% (n=4); and full thickness (FT) in 3% (n=1). Median burn size was 4.5% TBSA (range = 2%–12%). EpiProtect® was applied under general anaesthesia in all cases. The median length of stay (LOS) was two days (range = 0–6 days). EpiProtect® was tolerated well and provided effective analgesia for subsequent dressing changes. Median healing time was 13 days (SPT burns), 14 days (MPT) and 24 days (DPT burns). Three patients required split skin grafting. Hypertrophic scarring arose in one patient. Discussion: This case series represents the youngest published patient group to have been treated with EpiProtect®. Authors conclude that EpiProtect® provides a safe, reliable and well-tolerated dressing option for all burn depths in young children. Importantly, EpiProtect® is culturally neutral and may be used in situations which, for cultural reasons, may preclude the use of animal-derived products. Further studies are warranted to evaluate pain scores, burn depth, size and LOS correlation, and comparative analysis between dressing types. Lay Summary Burn injuries in the paediatric population are common and often require multiple dressing changes. Dressing changes can be painful and distressing to both children and their care givers. This article describes the experience of using a synthetically derived burns dressing, called EpiProtect®, in children aged ⩽ 5 years. Thirty patients were recruited with varying depths of scald burns and all underwent application of EpiProtect® dressing. The results suggested that EpiProtect® was a user-friendly dressing that can be used to treat partial-thickness burns and to dress full-thickness (FT) burns. It was well-tolerated and provided effective analgesia at the time of dressing changes. There was no incidence of increased burn wound infection rates and all wounds healed. In addition, as EpiProtect® is a synthetic product, it has the benefit of being culturally neutral, which is advantageous in a culturally diverse population. Further studies are warranted to evaluate the effectiveness of this dressing and to compare it to similar dressings that are available.

97 Burns in the Military Setting- analyzing 12,799 Routine & Combat Cases

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S63-S64
Author(s):  
Dafna (Shilo) Yaacobi ◽  
Alex Lvovsky ◽  
Nitay Ad-El ◽  
Diana Levi ◽  
Yuval Glick ◽  
...  
Keyword(s):  
Health Education ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Medical Records ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Total Body ◽  
The Military

Abstract Introduction Burns are an important part of military trauma injuries. Studying the epidemiology, due to large morbidity related issues, is important for decision makers. The aim of the study is to review and characterize the burn injuries that occurred in the Israel Defense Forces (IDF) during the years 2008–2016 in training, routine and war. The burn area, degree, setting, unit, etc. will help us characterize the etiology, severity and consequences which is crucial in developing and directing resources to prevention and treatment programs. Methods All burn injuries in 2008–2016 were retrieved (ICD-Z 940–949). Data was collected from the IDF military medical records and included 3 months of follow-up. We retrieved 65,536 medical records, which included follow up of 12,799 soldiers. Special algorithms were specifically designed to retrieve and analyze variables included. Distribution analysis was performed, Parametric Kruskal–Wallis test was used and Chi Square test was used for comparing categorical variables. Results During the years 2008–2016, 65,536 burn related visits were retrieved and 12,799 burn injuries were identified. Gender distribution in figure 1. Gradual decrease in burn injuries was identified (figure 2). Distribution by Setting (figure 3), Commands (figure 4), Etiologies (figure 5), and etiologies within commands (figure 6). Average Total Body Surface Area (TBSA) was 7.524% (figure 7) and also declined over the years (7.7% in 2008 to 7.1% in 2016). Conclusions The decrease in burn rate could be attributed to the increased awareness of soldiers due to the emphasis given to health education and preventive medicine, as well as to improved protection. Scald and flame replaced by chemicals as the leading etiology, It is hypothesized that a small part of chemical burns is a result of self-infliction, which is more prevalent at non-combat units. Average Total Body Surface Area (TBSA) was similar but lower than other studies. The nature and operation mode of the IDF must be kept in mind- a relatively small army composed mainly with obligatory servicemen, there are no dedicated military hospitals, major trauma can be transported directly to the civilian medical system and not appear in the military medical charts. Applicability of Research to Practice This extensive report shows the trends and characteristics of burn injuries in the IDF, allowing for better understanding of these important injuries, and concluding for target health education based on common etiologies and at-risk populations and commands. IDF Commanders should preserve the current burn prevention educational programs, and protection instruments such as uniforms, special gloves and eye protection appliances, since they seem to work, and improvement was observed. Education should also focus on proper handling of various chemicals, and if self-inflicted suspected- psychological intervention should be considered.

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.

662 Single Surgeon Experience Using a Polyactide-based Copolymer Dressing to Over and Secure Split Thickness Skin Grafts in Burn Patients.

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S186-S187
Author(s):  
Eduardo Navarro ◽  
Tera Thigpin ◽  
Joshua S Carson
Keyword(s):  
Skin Graft ◽  
Outer Layer ◽  
Healing Process ◽  
Graft Loss ◽  
Total Body Surface Area ◽  
Surgeon Experience ◽  
Pain Outcomes ◽  
Total Body ◽  
Operative Notes

Abstract Introduction In both partial thickness burns and skin graft donor sites, coverage with Polylactide-based copolymer dressing (PLBC dressing) has been shown to result in expedited healing and improved pain outcomes when compared to more traditional techniques. These advantages are generally attributed to the way in which PLBC remains as an intact coating over the wound bed throughout the healing process, protecting wounds from the contamination and microtraumas associated with changes more conventional dressings. At our institution, we began selectively utilizing PLBC as a means of securing and protecting fresh skin graft, in hopes that we would find similar benefits in this application. Methods Clinical Protocol-- The PLBC dressing was used at the attending surgeon’s discretion. In these cases, meshed STSG was placed over prepared wound beds. Staples were not utilized. PLBC dressing was then placed over the entirety of the graft surface, securing graft in place by adhering to wound bed through intercises. (Staples were not used.) The graft and PLBC complex was further dressed with a layer of non-adherent cellulose based liner with petroleum based lubricant, and an outer layer of cotton gauze placed as a wrap or bolster. Post operatively, the outer layer (“wrap”) of gauze was replaced as needed for saturation. The PLBC and adherent “inner” liner were left in place until falling off naturally over the course of outpatient follow-up. Retrospective Review-- With IRB approval, patients treated PLBC over STSG between April 2018 to March 2019 were identified via surgeon’s log and pulled for review. Documentation gathered from operative notes, progress notes (inpatient and outpatient) and clinical photography was used to identify demographics, mechanism of injury, depth, total body surface area percentage (TBSA%), size of area treated with PLBC dressing, graft loss, need for re-grafting, signs of wound infection, antibiotic treatment, and length of stay. Results Twenty-two patients had STSG secured and dressed with PLBC. Median patient age was 36.5 years. Median TBSA was 5.1%, and median treated area 375 cm2. Follow up ranged from 21 to 232 days post-operatively, with two patients lost to follow up. All patients seen in outpatient follow up were noted to have “complete graft take” or “minimal” graft. None of the areas treated with PLBC dressing required re-grafting. There were no unplanned readmissions, and no wound infections were diagnosed or treated. Practitioners in in-patient setting and in follow up clinic reported satisfaction with the PLBC dressing. Conclusions The PLBC dressing was a feasible solution for securing and dressings STSGs. Future work is needed to determine whether its use is associated with an improvement in patient outcomes.

Prevalence of Psychiatric Disorders in Burn Patients in a Tertiary Care Hospital

2021 ◽  
Vol 15 (11) ◽  
pp. 3389-3391
Author(s):  
Imran Khan ◽  
Taimur Khan ◽  
Shakil Asif ◽  
Syed Azhar Ali Kazmi ◽  
Subhan Ullah ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Care Hospital ◽  
Burn Patients ◽  
Total Body

Background and Aim: Burn injuries patients generally suffer from various psychological and mental disorders especially in lower socio-economic groups. It can adversely affect their wellbeing and health. Proper consultation and clinical diagnosis need to be carried out on burns injuries patients from the early critical phase to rehabilitation phase recovery. The current study's aim was to determine the prevalence of psychiatric disorders in burn patients in a tertiary care hospital. Materials and Methods: This cross-sectional study was conducted on 82 attempted burn suicides, adult patients in Khattak Medical Center Peshawar, Khyber Teaching Hospital Peshawar and Divisional Headquarter hospital, Mirpur AJK for duration of six months from June 2020 to December 2020. All the patients admitted with suicides burns were of either gender and had ages above 15 years. The convenience technique was used for sampling. The patients’ demographic details such as psychiatric illness, self-immolation act motivation, burn injury depth, burn total body surface area, inhalation injury, hospitalization duration, and mortality was recorded on pre-designed proforma. Data analysis was carried out with SPSS version 20. Results: The mean age of all 82 patients was 28.9±5.2 with an age range of 14 to 55 years. Of the total, 66 (80.5%) were female while 16 (19.5%) were male. In this study, the most frequent suicidal attempt was made by the marital conflicted patients 50 (61%) followed by love affair failure 8 (9.7%). An overall mean of 53.6±19.6 was observed for total body surface area affected with a range of 15-100%. The hospital duration mean was 8.2±5.9 with a range of 1-38 days. Young, married, and rural area illiterate housewives were the most common self-inflicted/suicide burn injuries. The prime cause of such injuries was getting married. The mortality rate was found at 82.3%. Conclusion: Our study concluded that patient’s well-being and mental health could be severely affected by burn injuries. Prevalent depression was noted among severe burn injuries patients. Depression related to deformity could be prevented with early grafting, wound management, proper splinting, coping ability, intense physiotherapy, and long-term rehabilitation. Keywords: Burn; Depressed mood, Psychiatric morbidity, Posttraumatic stress disorder

524 Effectiveness of Burns Wound Cleansing by Comparison of Prewash and Post Wash Swab Reports

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M A Sayed ◽  
S Jabeen ◽  
A Soueid
Keyword(s):  
Bacterial Load ◽  
Total Body Surface Area ◽  
Wound Management ◽  
Burn Patients ◽  
Burn Wound ◽  
Staph Aureus ◽  
Sex Type ◽  
Total Body ◽  
Burns Unit ◽  
Type Of Injury

Abstract Aim The main aim and objective were to optimise wound healing through infection prevention. This clinical audit aimed to investigate the effectiveness of burn wound cleansing in decreasing bacterial load by comparing pre-wash and post-wash swab results against local burn wound management and aseptic non touch technique (ANTT) guidelines. Method The audit was conducted retrospectively on children admitted to Burns Unit during August 2019, excluding resuscitation burn patients. Pre- and post-wash swabs taken on admission were included and the results obtained from Chameleon database. Data were collected on excel spread sheets including demographic variables such as age, sex, type of injury, percentage total body surface area (TBSA) and mechanism of injury. Data were analysed and results compiled. Results Fifty patients were admitted over a month period; amongst those 60% were male and 40% female of ages ranging from 5 months to 14 years. Scald (50%) was found to be the most common mode of injury followed by contact burn (36%) involving 0.30 to 9% TBSA. Among 50 patients, 30 (60%) showed no growth in pre-wash and 36 (72%) in post-wash swabs. However, 6% post-wash swabs that were initially negative later showed bacillus cereus, staph aureus, Enterobacter, and Acinetobacter. Similarly, another 4% post-wash swabs developed new microorganisms as compared to pre-wash swabs. Conclusions The most common bacteria colonising both pre- and post-wash swabs was staph aureus. Overall, cleansing had reduced the bacterial load significantly around 82% very effective. It is imperative to stick to local guidelines to reduce morbidity and mortality in burn patients.

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 Multimodal Analgesia and Discharge Opioid Requirements in Burn Patients

2020 ◽  
Vol 41 (5) ◽  
pp. 963-966
Author(s):  
Michael Wright ◽  
Jin A Lee
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Multimodal Analgesia ◽  
Burn Patients ◽  
Area Burned ◽  
Total Body ◽  
The Impact

Abstract Analgesia in burn patients is challenging given the complexity of burn pain and prolonged need beyond hospital admission. Given the risks of opioids, the impact of multimodal analgesia postdischarge needs to be further elucidated in this population. This retrospective, single-center cohort study evaluated adult burn patients who were consecutively admitted to the burn service with at least 10% total body surface area burned and subsequently followed in the burn clinic between February 2015 and September 2018. Subjects were separated into two cohorts based on discharge pain regimens: multimodal and nonmultimodal. The primary outcome was the change in opioid requirements (measured in oral morphine equivalents) between discharge and first follow-up interval. Secondary outcomes included the classes of multimodal agents utilized and a comparison of opioid requirements between the last 24 hours of admission and discharge. A total of 152 patients were included for analysis, 76 in the multimodal cohort and 76 in the nonmultimodal cohort. The multimodal cohort was noted to have increased total body surface area burned and prolonged number of days spent in the intensive care unit at baseline; however, the multimodal cohort exhibited a more significant decrease in opioid requirements from discharge to first follow-up interval when compared with the nonmultimodal cohort (106.6 vs 75.4 mg, P = .039).

Sign in / Sign up

Export Citation Format

Share Document