Burn Injuries
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Sizhen Wang ◽  
Jie Li ◽  
Zhiqiang Ma ◽  
Linhong Sun ◽  
Lei Hou ◽  

As a severe clinical challenge, escharotomy and infection are always the core concerns of deep burn injuries. However, a usual dressing without multifunctionality leads to intractable treatment on deep burn wounds. Herein, we fabricated a sequential therapeutic hydrogel to solve this problem. Cross-linked by modified polyvinyl alcohol (PVA-SH/ε-PL) and benzaldehyde-terminated F127 triblock copolymers (PF127-CHO), the hydrogel demonstrated excellent mechanical properties, injectability, tissue adhesiveness, antibacterial activity, biocompatibility, and satisfactory wound cleaning through both in vitro and in vivo assays. Additionally, based on the conception of “sequential therapy,” we proposed for the first time to load bromelain and EGF into the same hydrogel in stages for wound cleaning and healing. This work provides a strategy to fabricate a promising wound dressing for the treatment of deep burn wounds with injectability and improved patients’ compliance as it simplified the process of treatment due to its “three in one” characteristic (antibacterial activity, wound cleaning, and healing effects); therefore, it has great potential in wound dressing development and clinical application.

Katherine A. Dawson ◽  
Megan A. Mickelson ◽  
April E. Blong ◽  
Rebecca A. L. Walton

Abstract CASE DESCRIPTION A 3-year-old 27-kg female spayed American Bulldog with severe burn injuries caused by a gasoline can explosion was evaluated. CLINICAL FINDINGS The dog had extensive partial- and full-thickness burns with 50% of total body surface area affected. The burns involved the dorsum extending from the tail to approximately the 10th thoracic vertebra, left pelvic limb (involving 360° burns from the hip region to the tarsus), inguinal area bilaterally, right medial aspect of the thigh, and entire perineal region. Additional burns affected the margins of the pinnae and periocular regions, with severe corneal involvement bilaterally. TREATMENT AND OUTCOME The dog was hospitalized in the hospital’s intensive care unit for 78 days. Case management involved provision of aggressive multimodal analgesia, systemic support, and a combination of novel debridement and reconstructive techniques. Debridement was facilitated by traditional surgical techniques in combination with maggot treatment. Reconstructive surgeries involved 6 staged procedures along with the use of novel treatments including applications of widespread acellular fish (cod) skin graft and autologous skin cell suspension. CLINICAL RELEVANCE The outcome for the dog of the present report highlighted the successful use of maggot treatment and applications of acellular cod skin and autologous skin cell suspension along with aggressive systemic management and long-term multimodal analgesia with debridement and wound reconstruction for management of severe burn injuries encompassing 50% of an animal’s total body surface area.

2021 ◽  
Vol 2 (4) ◽  
pp. 281-292
Constance Boissin ◽  
Lucie Laflamme

Although they are a common type of injury worldwide, burns are challenging to diagnose, not least by untrained point-of-care clinicians. Given their visual nature, developments in artificial intelligence (AI) have sparked growing interest in the automated diagnosis of burns. This review aims to appraise the state of evidence thus far, with a focus on the identification and severity classification of acute burns. Three publicly available electronic databases were searched to identify peer-reviewed studies on the automated diagnosis of acute burns, published in English since 2005. From the 20 identified, three were excluded on the grounds that they concerned animals, older burns or lacked peer review. The remaining 17 studies, from nine different countries, were classified into three AI generations, considering the type of algorithms developed and the images used. Whereas the algorithms for burn identification have not gained much in accuracy across generations, those for severity classification improved substantially (from 66.2% to 96.4%), not least in the latest generation (n = 8). Those eight studies were further assessed for methodological bias and results applicability, using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. This highlighted the feasibility nature of the studies and their detrimental dependence on online databases of poorly documented images, at the expense of a substantial risk for patient selection and limited applicability in the clinical setting. In moving past the pilot stage, future development work would benefit from greater input from clinicians, who could contribute essential point-of-care knowledge and perspectives.

Kajal Mehta ◽  
Nikhitha Thrikutam ◽  
Paa-Ekow Hoyte Williams ◽  
Henry Falk ◽  
Kiran Nakarmi ◽  

Abstract Cooking- and cookstove-related burns (CSBs) comprise a large proportion of burn injuries globally, but there are limited data on cooking behavior patterns to inform prevention and advocacy. Therefore, we aimed to describe the epidemiology, risk factors and outcomes of these injuries and highlight the potential of the World Health Organization (WHO) Global Burn Registry (GBR). Patients with cooking-related burns were identified in the WHO GBR. Patient demographics, cooking arrangement, injury characteristics and outcomes were described and compared. Bivariate regression was performed to identify risk factors associated with CSBs. Analysis demonstrated that 25% of patients in the GBR sustained cooking-related burns (n=1,723). The cooking environment and cooking fuels used varied significantly by country income level ([electricity use: LIC 1.6 vs MIC 5.9 vs HIC 49.6%; p<0.001] [kerosene use: LIC 5.7 vs MIC 10.4 vs HIC 0.0%; p<0.001]). Of cooking-related burns, 22% were cookstove-related burns (CSBs; 311 burns). Patients with CSBs were more often female (65% vs 53%; p<0.001). CSBs were significantly larger in TBSA size (30%, IQR 15-45 vs 15%, IQR 10-25; p<0.001), had higher revised Baux scores (70, IQR 46-95 vs 28, IQR 10-25; p<0.001) and more often resulted in death (41 vs 11%; p<0.001) than other cooking burns. Patients with CSBs were more likely to be burned by fires (OR 4.74; 95% CI 2.99-7.54) and explosions (OR 2.91, 95% CI 2.03-4.18) than other cooking injuries. Kerosene had the highest odds of CSB compared to other cooking fuels (OR 2.37, 95% CI 1.52-3.69). In conclusion, CSBs specifically have different epidemiology than cooking-related burns. CSBs were more likely caused by structural factors (e.g., explosion, fire) than behavioral factors (e.g., accidental movements) when compared to other cooking burns. These differences suggest prevention interventions for CSBs may require distinctive efforts than typically deployed for cooking-related injuries, and necessarily involve cookstove design and safety regulations to prevent fires and explosions.

2021 ◽  
Vol 0 ◽  
pp. 1-4
Deepti Gupta ◽  
Amrita More

Due to the recent coronavirus pandemic, there is a steep rise in the use of alcohol-based hand sanitizers (ABHSs) over the past few months. For them to be effective against microorganisms, the minimum recommended concentration of alcohol is 60%. This high alcohol content makes the sanitizers easily flammable. Although, they are extremely convenient to use, they can also prove to be a hazard if used in an improper manner. Guidelines have been published for safe manufacturing and distribution of these sanitizers. There are recommendations for storage and use, which should be adhered to in a strict manner. Their use by children should always be supervised. We report four cases of burn injuries caused by injudicious use of alcohol-based sanitizers. The flammable nature of ABHSs can also be exploited as witnessed in one of our cases. With this report, we wish to emphasize that judicious and correct use of these seemingly benign products is essential.

Vivek Gupta ◽  
Arnab Chanda

Abstract Severe burn injures lead to millions of fatalities every year due to lack of skin replacements. While skin is a very limited and expensive entity, split thickness skin grafting, which involves the projection of a parallel incision pattern on a small section of healthy excised skin, is typically employed to increase the expansion and cover a larger burn site. To date, the real expansion capacity of such grafts are low (<3 times) and insufficient for treatment of severe burn injuries. In this study, novel I-shaped auxetic incision patterns, which are known to exhibit high negative Poisson’s ratios, have been tested on the skin to investigate their expansion potential. Fourteen two-layer skin graft models with varying incision pattern parameters (i.e., length, spacing, and orientation) were developed using finite element modelling and tested under uniaxial and biaxial tensile loads. The Poisson’s ratio, meshing ratios, and induced stresses were quantified across all models. Graft models tested uniaxially along the orthogonal directions indicated opposite trends in generated Poisson’s ratios, as the length of the I-shape incisions were increased. Biaxially, with a symmetric and closely spaced I-shape pattern, graft meshing ratios up to 15.65 were achieved without overstressing the skin. Overall, the findings from the study indicated that expansion potentials much higher than that of traditional skin grafts can be achieved with novel I-shaped auxetic skin grafts, which would be indispensable for covering large wounds in severe burn injuries.

Kayhan Gurbuz ◽  
Mete Demir ◽  
Abdulkadir Basaran ◽  
Koray Das

Abstract Amputations are un-common surgical procedures in patients with severe burn injuries. However, these patients often face extreme physical and psychological challenges that result in social stigmatization and inadequate rehabilitation facilities. A retrospective cohort study was designed for the patients admitted to the Burn Center of Adana City Training and Research Hospital (ACTRH). During the study period, a total of 2007 patients aged 0.5 to 92 years were hospitalized and treated at the burn center from January 2016 to June 2020. The incidence of amputation observed among inpatient burn injuries regardless of the etiology was 1.9%, and 87.2% were male. The univariate and multivariate logistic regression analysis was performed to detect the most prominent factors contributing to burn injury-related amputations. The cause of burns appears to be one of the main factors in the past research, and in this context, the electrical burns stand out, likewise, the fire-flame-related burns, full-thickness burns, the existence of infection, male gender, patients aged within the 18 to 64 age group, and the burn extent within the total body surface area (TBSA) range of 10 to &lt;50% were found to be the most leading factors of amputations among patients having severe burns. Although they are rare, amputations related to burns commonly cause a decrease in quality of life. Therefore, besides increasing occupational health and safety methods for these risk groups, especially for adults of working age; also, it is essential to increase the importance and awareness of the precautions to be taken in daily life.

2021 ◽  
Vol 2 (4) ◽  
pp. 249-280
Catrin Griffiths ◽  
Philippa Tollow ◽  
Danielle Cox ◽  
Paul White ◽  
Timothy Pickles ◽  

The CARe Burn Scales are a portfolio of burn-specific PROMs for people affected by burns, including a Child Form (for children < 8 years (parent-proxy)), a Young Person Form (for young people aged 8–17 years), an Adult Form, and a Parent Form (for parents/carers of children aged 0–17 years). This study aimed to determine the responsiveness and minimal important difference (MID) values of the three scales developed for use in paediatric burn services and research. Participants were recruited by 15 UK Burn Services. Participants completed the appropriate CARe Burn Scale and a set of appropriate comparison validated measures, at three time points: 4 weeks (T1), 3 months (T2) and 6 months (T3) post-burn injury. Spearman’s correlation analysis and effect sizes based on Cohen’s d thresholds were reported and MID values were calculated. At baseline, 250 participants completed the Child Form, 69 completed the Young Person Form, and 320 completed the Parent Form. A total of 85–92% of participants were retained at follow up. The tested CARe Burn Scales were all responsive to change over time. MID values were created for all subscales and ranged from 2 to 11 for the Child Form, 3 to 14 for the Young Person Form and 3 to 10 for the Parent Form. The CARe Burn Scales for children, young people and parents are responsive to change over time. The scales are freely available for clinical and research use.

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