scholarly journals Burn Hand, Outcome Analyzis and Therapeutic Aspects of Burn Treated in Albania

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Gentian Zikaj ◽  
Gjergji Belba ◽  
Gezim Xhepa
Keyword(s):  
Life Support ◽  
Wound Care ◽  
Skin Grafting ◽  
The Body ◽  
University Hospital ◽  
Wound Management ◽  
Advanced Trauma Life Support ◽  
Split Thickness Skin Grafting ◽  
Hand Burns ◽  
Burn Hand

Background: Even that the entire hand represents 4 percent of the TBSA, The American Burn Association, the Advanced Trauma Life Support, and the Advanced Burn Life Support curricula all recognize the severity of hand burns by classifying these as injuries requiring treatment at a burn qualified center. Hand burns occur commonly both as part of larger burn injuries as well as isolated injuries. Due to damage to the skin and other parts of the hand, burns can lead to open wounds, disability, severe emotional and psychological complications, and economic burden. To further improve the effects of preventive measures, studies are needed to investigate the epidemiology, etiology, and outcomes of burn hand patient population. Aim: To give an overview of epidemiologic features and outcome of burn hand patients who admitted in our Service. This current study was performed in University Hospital Center “Mother Teresa” Tirana which is the only tertiary hospital in Albania.   Material and methods: In this retrospective study were included all patients who had combustion of the hands solely or hands accompanied with burns to other areas of the body, treated and followed up at our Service during the years 2011-2016. Results: Of the 333 included burn patients, 64% were males.The median age of women is 21.8 years, of men is 27.5 years and the median age total patients’ population is 25.9 years. About half of patients belong to the age group 20-60 years (49.5%) and only 10.2% belong to the age above 60 years.  In most of the cases (73.6%), the burn of hands is associated with burn of the other anatomical region, mostly forearm. Conclusion: The goal of wound management is to have the skin healed by post-burn in two weeks’ time. In many cases, this will occur nonoperatively with good wound care. The surgical treatment is used for less 30% than of patients.Surgical excision of the burn with split-thickness skin grafting should be undertaken as soon as it becomes obvious that wound healing will not be complete by post-burn day 14.The undesirable results of theburn of hands are presented in the 33% of the patients. The contractures were the main unfavorable outcome of the burned hand.

scholarly journals Epidemiology of Hand Burn in Albania 2011-2016

2018 ◽  
Vol 6 (5) ◽  
pp. 931-933 ◽  
Author(s):  
Gentian Zikaj ◽  
Gjergji Belba ◽  
Gezim Xhepa
Keyword(s):  
Tertiary Hospital ◽  
The Body ◽  
Burn Injuries ◽  
University Hospital ◽  
Burn Patients ◽  
Unfavourable Outcome ◽  
Hand Burns ◽  
Burn Hand ◽  
Epidemiologic Features ◽  
Hospital Center

INTRODUCTION: Hand burns occur commonly both as part of larger burn injuries as well as isolated injuries.AIM: To give an overview of epidemiologic features and outcome of burn hand patients who admitted to our Service. This study was performed at University Hospital Center “Mother Teresa” Tirana which is the only tertiary hospital in Albania.MATERIAL AND METHODS: This prospective study included all patients who had combustion of the hands solely or hands accompanied with burns to other areas of the body, treated and followed up at our service during the years 2011-2016.RESULTS: Of the 333 included burn patients, 64% were males. The median age of patients is 25.9 years. About half of patients belong to the age group 20-60 years (49.5%) and only 10.2% belong to the age of 60 years. In most of the cases (73.6%), the burn of hands is associated with the burn of the other anatomical region, mostly forearm.CONCLUSION: The surgical treatment is used for less 30% that of patients. The undesirable results of the burn of hands are presented in the 33% of the patients. The contractures were the main unfavourable outcome of the burned hand.

scholarly journals Impact of Implementation of Sequential Trauma Education Programs (STEPs) Course on Missed Injuries in Emergency Polytrauma Patients, Ismailia, Egypt

2021 ◽  
Author(s):  
Adel Hamed Elbaih ◽  
Maged El-Setouhy ◽  
Jon Mark Hirshon ◽  
Hazem Mohamed El-Hariri ◽  
Mohamed El-Shinawi
Keyword(s):  
Low Income ◽  
Life Support ◽  
University Hospital ◽  
Low Income Countries ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Education Programs ◽  
Missed Injuries ◽  
Polytrauma Patients ◽  
Trauma Education

Abstract IntroductionTrauma deaths account for 8% of all deaths in Egypt. Patients with multiple injuries are at high risk but may be saved with a good triage system and a well-trained trauma team in dedicated institutions. The incidence of missed injuries in the Emergency Department (ED) of Suez Canal University Hospital (SCUH) was found to be 9.0% after applying Advanced Trauma Life Support (ATLS) guidelines. However, this rate is still high compared with many trauma centers.AimImprove the quality of management of polytrauma patients by decreasing the incidence of missed injuries by implementing the Sequential Trauma Education Programs (STEPs) course in the ED at SCUH.MethodsThis interventional training study was conducted in the SCUH ED that adheres to CONSORT guidelines. The study was conducted during the 1-month precourse and for 6 months after the implementation of the STEPs course for ED physicians. Overall, 458 polytrauma patients were randomly selected, of which 45 were found to have missed injuries after applying the inclusion and exclusion criteria. We assessed the clinical relevance of these cases for missed injuries before and after the STEPs course.ResultsOverall, 45 patients were found to have missed injuries, of which 15 (12%) were pre-STEPs and 30 (9%) were post-STEPs course. The STEPs course significantly increased adherence to vital data recording, but the reduction of missed injuries (3.0%) was not statistically significant in relation to demographic and trauma findings. However, the decrease in missed injuries in the post-STEPs course group was an essential clinically significant finding.ConclusionSTEPs course implementation decreased the incidence of missed injuries in polytrauma patients. Thus, the STEPs course can be considered at the same level of other advanced trauma courses as a training skills program or possibly better in dealing with trauma patients. Repetition of this course by physicians should be mandatory to prevent more missed injuries. Therefore, the validation of STEPs course certification should be completed at least every 2 years to help decrease the number of missed injuries, especially in low-income countries and low-resource settings.Trial RegistrationProject manager for the Pan African Clinical Trial Registry (www.pactr.org) database has been accepted with the date of approval:18/11/2020. Current Controlled Trials number for the registry is PACTR202011853914203. Please note that the article state Retrospectively registered that my study adheres to CONSORT guidelines.

Functional outcome of immediate split thickness skin grafting of deep hand burns

2006 ◽  
Vol 130 (2) ◽  
pp. 297-298
Author(s):  
D. Juang ◽  
H. Slater ◽  
I.W. Goldfarb ◽  
P.K. Papasavas ◽  
P.F. Caushaj
Keyword(s):  
Functional Outcome ◽  
Skin Grafting ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Hand Burns

scholarly journals Impact of Implementation of Sequential Trauma Education Programs (STEPs) Course on Missed Injuries in Emergency Polytrauma Patients, Ismailia, Egypt

2020 ◽  
Author(s):  
Adel Hamed Elbaih ◽  
Maged El-Setouhy ◽  
Jon Mark Hirshon ◽  
Hazem Mohamed El-Hariri ◽  
Mohamed El-Shinawi
Keyword(s):  
Low Income ◽  
Life Support ◽  
University Hospital ◽  
Low Income Countries ◽  
Advanced Trauma Life Support ◽  
Significant Finding ◽  
Education Programs ◽  
Missed Injuries ◽  
Polytrauma Patients ◽  
Trauma Education

Abstract Introduction: Trauma deaths account for 8% of all deaths in Egypt. Patients with multiple injuries are at high risk but may be saved with a good triage system and a well-trained trauma team in dedicated institutions. The incidence of missed injuries in the Emergency Department (ED) of Suez Canal University Hospital (SCUH) was found to be 9.0% after applying Advanced Trauma Life Support (ATLS) guidelines. However, this rate is still high compared with many trauma centers.Aim: Improve the quality of management of polytrauma patients by decreasing the incidence of missed injuries by implementing the Sequential Trauma Education Programs (STEPs) course in the ED at SCUH.Methods: This interventional training study was conducted in the SCUH ED. The study was conducted during the 1-month precourse and for 6 months after the implementation of the STEPs course for ED physicians. Overall, 458 polytrauma patients were randomly selected, of which 45 were found to have missed injuries after applying the inclusion and exclusion criteria. We assessed the clinical relevance of these cases for missed injuries before and after the STEPs course.Results: Overall, 45 patients were found to have missed injuries, of which 15 (12%) were pre-STEPs and 30 (9%) were post-STEPs course. The STEPs course significantly increased adherence to vital data recording, but the reduction of missed injuries (3.0%) was not statistically significant in relation to demographic and trauma findings. However, the decrease in missed injuries in the post-STEPs course group was an essential clinically significant finding.Conclusion: STEPs course implementation decreased the incidence of missed injuries in polytrauma patients. Thus, the STEPs course can be considered at the same level of other advanced trauma courses as a training skills program or possibly better in dealing with trauma patients. Repetition of this course by physicians should be mandatory to prevent more missed injuries. Therefore, the validation of STEPs course certification should be completed at least every 2 years to help decrease the number of missed injuries, especially in low-income countries and low-resource settings.

Management of the Burn Wound

2019 ◽  
Author(s):  
Nicole S. Gibran ◽  
Jose P. Sterling ◽  
David M. Heimbach
Keyword(s):  
Wound Care ◽  
Donor Site ◽  
Skin Grafting ◽  
Wound Management ◽  
Skin Substitutes ◽  
Burn Wound ◽  
Burn Wounds ◽  
Initial Care ◽  
Wound Excision ◽  
Burn Depth

Current approaches to burn management are based on an understanding of the biology and physiology of human skin and the pathophysiology of the burn wound. The clinical evaluation and initial care of a burn wound is described and includes an assessment of burn depth, determining the need for escharatomy and daily burn wound care. Burns can be topical or surgical. Topical burn wounds require choice in the use of antibiotics. Considerations and techniques for surgical burn wound management are described and include early excision and grafting, wound excision, skin grafting, graft and donor-site dressings, postoperative wound care, biologic dressings and skin substitutes, allograft and xenograft skin, cultured epidermal autografts, and skin substitutes. Figures show the two distinct layers of the skin, various types of burns, and both fascial and tangential excision of burn wounds.  This review contains 12 figures, 11 tables, and 61 references. Keywords: Burn wound, graft, partial-thickness, full-thickness, dermis, epidermis,  sloughing, dressing

Management of the Burn Wound

2019 ◽  
Author(s):  
Nicole S. Gibran ◽  
Jose P. Sterling ◽  
David M. Heimbach
Keyword(s):  
Wound Care ◽  
Donor Site ◽  
Skin Grafting ◽  
Wound Management ◽  
Skin Substitutes ◽  
Burn Wound ◽  
Burn Wounds ◽  
Initial Care ◽  
Wound Excision ◽  
Burn Depth

Current approaches to burn management are based on an understanding of the biology and physiology of human skin and the pathophysiology of the burn wound. The clinical evaluation and initial care of a burn wound is described and includes an assessment of burn depth, determining the need for escharatomy and daily burn wound care. Burns can be topical or surgical. Topical burn wounds require choice in the use of antibiotics. Considerations and techniques for surgical burn wound management are described and include early excision and grafting, wound excision, skin grafting, graft and donor-site dressings, postoperative wound care, biologic dressings and skin substitutes, allograft and xenograft skin, cultured epidermal autografts, and skin substitutes. Figures show the two distinct layers of the skin, various types of burns, and both fascial and tangential excision of burn wounds.  This review contains 12 figures, 11 tables, and 61 references. Keywords: Burn wound, graft, partial-thickness, full-thickness, dermis, epidermis,  sloughing, dressing

scholarly journals Safety of Early Postoperative Range of Motion in Burn Patients With Newly Placed Hand Autografts: A Pilot Study

2020 ◽  
Vol 41 (4) ◽  
pp. 809-813
Author(s):  
William Scott Dewey ◽  
Kyle B Cunningham ◽  
Sarah K Shingleton ◽  
Kaitlin A Pruskowski ◽  
Ashley Welsh ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Graft Loss ◽  
Skin Grafting ◽  
Thickness Skin ◽  
Additional Surgery ◽  
Split Thickness Skin Grafting ◽  
Risk Areas ◽  
Matched Case ◽  
Hand Burns

Abstract Patients who suffer hand burns are at a high contracture risk, partly due to numerous cutaneous functional units, or contracture risk areas, located within the hand. Patients who undergo split-thickness skin grafting are often immobilized postoperatively for graft protection. Recent practice at our burn center includes an early range of motion (EROM) following hand grafting to limit unnecessary immobilization. The purpose of this study was to determine whether EROM is safe to perform after hand grafting and if there is any clinical benefit. This retrospective, matched case–control study of adults compared patients who received EROM to subjects who received the standard 3 to 5 days of postoperative immobilization. Patients were evaluated for graft loss and range of motion. Seventy-one patients were included in this study: 37 EROM patients and 34 matched controls. Six patients experienced minor graft loss, three of these were not attributable to EROM. All graft loss was less than 1 cm and none required additional surgery. Significantly more patients who received EROM achieved full-digital flexion by the first outpatient visit (25/27 = 92.6% vs 15/22 = 68.2%; P = .028). Performing EROM does not cause an increase in graft loss. All areas of graft loss from the EROM group healed without intervention. There appears to be a benefit to EROM since there was a significant improvement in the patients’ ability to make a full fist at initial outpatient follow-up. Additional prospective analysis is needed to examine the true clinical utility of EROM in the hand and other contracture-prone areas.

scholarly journals Assessment of management of polytrauma patients in the emergency department in Suez Canal University hospital

2019 ◽  
Vol 6 (6) ◽  
pp. 1844
Author(s):  
Nashwa M. Abdelgeleel ◽  
Khaled Morsy Salama ◽  
Mohamed A. Ali ◽  
Aasha N. Elsagher
Keyword(s):  
Emergency Department ◽  
Life Support ◽  
Suez Canal ◽  
University Hospital ◽  
Advanced Trauma Life Support ◽  
Cross Sectional ◽  
Car Crash ◽  
Common Framework ◽  
Significant Disability ◽  
Mechanism Of Trauma

Background: Trauma is a serious global health problem, it is the fifth leading cause of significant disability and is still the most frequent cause of death in the first four decades of life, accounting for approximately one in 10 deaths worldwide.Methods: This study is cross sectional prospective study was conducted to evaluate assessment of management of patients according to the advanced trauma life support guideline in Emergency Department at Suez Canal University Hospital. All patients (n=103) were subjected to baseline assessment by history, clinical examination and investigations. The patients were followed up and recorded till the full assessment was done and the decision was made and the fate of the patient was recorded.Results: The majority of the studied patient had motor car crash (55.30%), while motor cycle crash was the second mechanism of trauma (21.40%), run over was the third mechanism (14.60%). Airway management was done (95.1%), cervical spine kept immobilized only in (71.8%). Blood pressure was measured in (97.1%) and 2ry survey assessment, head to toe examination (78.6%), while AMPLE history was taken in minority of cases percentage (33%). Finally majority of patients was admitted in ICU (44.70%), followed by 18.40% of the studied patient died and less than (2%) discharged from the ER.Conclusions: ATLS protocols provide a common framework and organized approach during polytrauma patient’s management. Also, it has been shown to improve outcomes so we should enhance its application in our hospital.

Emergency medicine

2016 ◽  
pp. 762-795
Author(s):  
Andrew Baldwin ◽  
Nina Hjelde ◽  
Charlotte Goumalatsou ◽  
Gil Myers
Keyword(s):  
Emergency Medicine ◽  
Traffic Accidents ◽  
Life Support ◽  
Road Traffic ◽  
Wound Management ◽  
Pelvic Injury ◽  
Advanced Trauma Life Support ◽  
Inappropriate Use ◽  
Trauma Networks ◽  
Trauma In Pregnancy

This chapter explores emergency medicine, including appropriate and inappropriate use of emergency departments (EDs), as well as burns, drowning, electric shock injuries, high altitude medicine, wound management, bites, stings, and foreign bodies, major trauma, the Glasgow Coma Score, trauma networks, choking, advanced trauma life support, shock in the trauma patient, road traffic accidents, chest injury, blast injuries, head injury, abdominal injury, radiology in trauma, pelvic injury, and trauma in pregnancy.

T2 Safety of Early Post-operative Range of Motion in Burn Patients with Newly Placed Hand Autografts

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S1-S2 ◽  
Author(s):  
William S Dewey ◽  
Kyle B Cunningham ◽  
Sarah K Shingleton ◽  
Kaitlin A Pruskowski ◽  
Ashley M Welsh ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Graft Loss ◽  
Skin Grafting ◽  
Operative Management ◽  
Adult Patients ◽  
Thickness Skin ◽  
Additional Surgery ◽  
Split Thickness Skin Grafting ◽  
Hand Burns

Abstract Introduction Patients who suffer hand burns are at a high risk for developing contractures, partly due to the presence of numerous cutaneous functional units, or contracture risk areas, located within the hand. Patients who undergo split-thickness skin grafting (STSG) are often immobilized post-operatively for graft protection. Restricting mobility following a STSG is thought to protect against subdermal edema and shear forces, despite limited evidence. Early range of motion (EROM) has been described previously. Recent practice at our burn center includes EROM following hand STSG to limit unnecessary immobilization. The purpose of this retrospective study was to determine if EROM is safe to perform after hand STSG and if there is any clinical benefit. Methods In an approved, retrospective, matched case-control study of adult patients who sustained hand burns, patients who received EROM were defined as cases; patients who did not receive EROM were considered controls and received the standard 3–5 days of post-operative immobilization in a resting hand splint. Adult patients admitted over a 3-year period were eligible for inclusion. Patients were evaluated for graft loss and range of motion. Results Seventy-two patients were included in this study; 37 EROM patients and 35 matched controls. EROM patients tended to have a larger area excised (170.4 ± 69.8cm2 vs. 132.9 ± 76.2cm2; p=0.034) and grafted (171 ± 70.8 cm2 vs. 132.9 ± 76.2 cm2; p=0.033). Most patients were male, with an average age of 39 years. Patients had an average of approximately 5% TBSA burns with 1.5% to the hands. On post-op day (POD) 1 and 2, patients received EROM for an average of 30 minutes (29.25 ± 14.9 vs. 31 ± 16.4 minutes). Six patients experienced minor graft loss. Three patients (8%) experienced graft loss not attributable to EROM. One patient (2.7%) experienced graft loss pre-EROM on POD2 and 3 patients (8%) experienced graft loss post-EROM on either POD1 or POD2. All graft loss was less than 1 cm in greatest dimension and no patient who experienced graft loss required additional surgery as they all closed by their first outpatient follow-up. Significantly more patients who received EROM achieved full digital flexion by the first outpatient visit (25/27=92.6% vs. 15/22=68.2%; p=0.028). Conclusions Performing EROM does not cause an increase in graft loss. All areas of graft loss from the EROM group healed without intervention. There appears to be a benefit to EROM since there was a significant improvement in the patients’ ability to make a full fist at initial outpatient follow up. Further prospective analysis is needed to examine the true clinical utility of EROM in the hand and other contracture-prone areas. Applicability of Research to Practice Clinical change in post-operative management after hand grafting.

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