Emergent Management of Thermal Burns in Emergency Rooms Saudi Arabia - A Review

According to WHO statistics, over 300,000 people die each year by burns, and more dying from electric burns, scalds or other causes of burns. Burn injuries and wounds are typically fatal. And they can cause serious long-term implications for victims. The most important aspect in reducing the morbidity and mortality associated with burns is to prevent them. Exposure of tissue to an external high temperature source causes thermal burns. Burns that occur at greater temperatures or over longer periods of time cause deeper and more serious injuries. Because burn patients are the most common trauma patients, the initial step in treating them should be to assess and stabilize their airway, breathing, and circulation according to ATLS standards. Supportive care should include crystalloid resuscitation, blood composition, and potentially endotracheal intubation. In this review we will be looking at thermal burns epidemiology, etiology, pathophysiology and most importantly management.

Limb Salvage Procedure in a Patient of High-tension Electric Burns Utilising Delay Phenomenon in Perforator-based Flap- A Case Report

Electric burn is a devastating injury causing tissue and organ loss. We present here a case of an electric burn injury over a bilateral lower limb and bilateral upper limb. The patient had undergone left above-knee amputation, thus cross-leg flap from the left side was not possible and due to electric burns, the vascularity of the right leg was also doubtful therefore a delayed flap was planned to cover the exposed defect over the right knee and defect over the right tibia. The Flaps underwent a delay procedure before the final inset so that the flap undergo ischemic preconditioning and the neovascularization that increases the size of the flap and chances of survival of the flap by manifold.

Application of vascularized perforant flaps in the hand restoration in electro-thermic affections

Objective. To improve the results of surgical treatment in patients with deep electric burns of the hand, using local vascularized flaps, based on perforant vessels. Materials and methods. Analysis of the treatment results in 17 patients, suffering electric trauma of the hand was conducted, the defects plasty was performed, using local vascularized flaps, based on perforant vessels of the hand. Results. In 17 patients 20 flaps were formed. Application of revascularization procedures have permitted to obtain good results in immediate period in 76.5% patients, and satisfactory - in 13.5% patients, in late follow-up period good results - in 88.2% patients, and satisfactory - in 11.8% patients. Conclusion. The transplant, owing own blood circulation and locally vascularized flaps, based on perforant vessels, which are formed on non-injured parts of the hand, guarantee the blood supply restoration in the zone of electric thermic affection as well as the wound defect closing.

A GHASTLY RISING RATE OF PREVENTABLE PEDIATRIC BURNS: WE NEED TO ACT

ABSTRACT Objective: To ascertain the increase in paediatric burn admissions in our tertiary care facility. Find various causes of this trend and assess the morbidity and mortality in paediatric population, and suggest remedies. Study Design: This is a “descriptive case series study” Place of Study: This Study was conducted during September 2017 to August 2019 at Department of Burns & Plastic surgery. Materials and Methods: Total number of acute burn admissions under 12 years were recorded. Subdivided this group into 0 to 2 years and 2 to 12 years. We assessed epidemiology, sex, cause of burn, mode of admission, location of incident, type of first aid given, mortality, and compared results during two equal halves of this period. We used SPSS 20 for data analysis. Results: 504 (49.85%) were pediatric acute burn admissions. Their age ranged from 25 days to 12 years (mean 5 ±1.2 years). 152 were infants/toddlers aged 0-2 years. 270 male and 234 females. 316 were direct admissions. There were 72.43% more pediatric burn admissions. 381 were scalds, 91 flame burns, 21 electric burns and 11 chemical burns. There was 11.94% improved survival among burn patients. Two temporal peaks, largest in summer from May to Jul and second in Dec to Feb. Conclusion: There is an increasing trend in acute pediatric burn admissions. Majority of victims did not receive proper first aid. We need to start a very aggressive campaign on print and electronic media for public education.

Utility of Shoelace Technique in Closure of Fasciotomy Wounds in Electric Burns

Fasciotomy is indicated to relieve compartment syndrome caused by electric burns. Many techniques are available to close the fasciotomy wounds including vacuum-assisted closure, skin grafting, and healing by secondary intention. This study assessed the shoelace technique in fasciotomy wound closure in patients with electric burns. The study included 19 fasciotomy wounds that were treated by shoelace technique (Group ST, n = 10 fasciotomy wounds) or by skin grafting/healing by secondary intention (Group C, n = 9 fasciotomy wounds). Data were collected for wound surface area, time to intervention, time to wound closure, rate of decrease in wound surface area after application of shoelace technique and associated complications. The mean time to intervention after fasciotomy was significantly lower in Group ST—7.6 ± 3.8 days as compared to 15.8 ± 5.3 days in Group C (P = .004). The median time to closure was also significantly lower in Group ST—7 days (range 6–10) as compared to Group C—20 days (range 12–48) (P < .001). Primary closure was achieved in 80% cases in the group ST and no complications were recorded. The shoelace technique is an economical, fast, and effective method of fasciotomy wound closure in electric burns, especially in high volume centers and resource-limited areas.

Soft tissue reconstruction of low voltage electric burn injuries of the thumb and first web space by the first dorsal metacarpal artery island flap: a three-year study from Eastern India

Background: Complex soft tissue defects of thumb and first web space are a reconstructive challenge. Low voltage electric burns of the hand commonly result in localised and deep soft tissue destruction. The first dorsal metacarpal artery flap (FDMA) is an attractive local flap option to reconstruct these. This study illustrates our experience with the same.Methods: Between March 2014 and February 2017, 16 patients with complex soft tissue defects of thumb and first web space resulting from low voltage electric burns underwent reconstruction with the FDMA flap and subsequent structured hand therapy. In the follow up visits objective assessment of hand function included tests of mobility using Kapandji Score, sensory evaluation with static 2 point discrimination and cortical reorientation. The Subjective Satisfaction Score was used to ascertain the patient’s overall perception of aesthetic and functional outcome.Results: Majority (43.75%) of the patients had defects involving the thumb IP joint. No case of complete flap failure was noted. In a mean follow-up of 11.5 months the reconstructed thumb showed return of good protective sensation as well as mobility. Though cortical reorientation was complete in only 18.75 %, it did not substantially impede hand functioning. All patients were satisfied with the functional and aesthetic result.Conclusions: In cases of low voltage electric burn injuries the FDMA flap is a reliable reconstructive option for small to moderate sized complex defects of thumb and first web space. It has minimal donor site morbidity and can be accomplished in a relatively simple single stage procedure.

CLINICAL DYNAMICS OF TISSUE CHANGES IN THE FORMATION OF COMPARTMENT SYNDROME IN BURNS

Summary. Compartment syndrome — local hypertensive-ischemic syndrome - a formidable complication of traumatic tissue damage, the basis of which is the increase in intrafascial pressure of muscle masses above 20 mm. The treatment of this dangerous condition is carried out by emergency surgery to decompress tissues. The aim of the study was to study in an experiment the clinical and morphological development of the compartment syndrome for burns and to evaluate the effectiveness of necrotomy operations and impregnation of affected tissues with ozonized physiological saline. Materials and methods. The experiment was carried out on 18 rats of the WAG line, weighing 190-210 g. The study material was skin with adjacent soft tissues of the thigh area. To simulate experimental deep burns, we used a device developed by us for the formation of burns, standard in depth and area of the lesion. After the burn was formed, interstitial pressure was measured. Research results and discussion. The dynamics of macroscopic observations of the wound process and x-ray studies reflect their correspondence to the severity of thermal injury and the positive impact of the proposed therapeutic measures. Сonclusions. The development of the compartment syndrome with circular and subcircular limb burns and electric burns is a formidable complication, leading to a sharp deterioration in thermal injury and requires immediate surgical intervention. The critical point of the level of interstitial pressure should be considered 20 mm, the increase is an absolute indicator for the operation. The effectiveness of necrotomy can be improved by the use of a number of medications, in particular local infiltration with ozonized saline.

Microbiology and Infection Profile of Electric Burned Patients in a Referral Burn Hospital in Mexico City

Electrical burn injuries are one of the most severe forms of trauma. This study aims to investigate the infection complications in electrical burn patients in a referral hospital in Mexico City. A longitudinal retrospective study was conducted, involving electrical burn patients admitted from April 2011 to December 2016. Demographic and clinical data including type of electric burns, infection complications, and mortality was sought. Data were collected at admission and daily until discharge. Number and type of infections and microorganism isolations were sought. Risk factors for death were analyzed. A total of 111 patients were included, of which 96.4% were males, mean age of 31.6±16.22, most injuries were high voltage associated. The total body surface area average was 27.8% ± 19.63. The overall infection rate was 72.9 cases per 100 patients. Mortality was observed in 4 (3.6%) patients. About 59.1% (443/749) had growth for Gram-negative bacteria. Multidrug-resistant Pseudomonas aeruginosa was the most frequent microorganism isolated. Fungi were present in 4.9% of cases. Electrical burn injuries occurred in young males in our study. Infection was frequent, most of them caused by Gram-negative rods with an important rate of antimicrobial resistance; however, an important microbial diversity was present.

Magnitude of electric burns at a burn center in tertiary level hospital

Background: Burns are a public health problem throughout the world. Electrical injury is a major cause of burn injury which causes significant functional disability, disfigurement and mortality. In Bangladesh, the number of electrical injuries are increasing but they are typically underreported. Aims: This study was conducted to analyze the epidemiological variables of electrical burn injuries and identify preventable measures through them in Khulna region of Bangladesh. Methods: This descriptive study is a prospective analysis of patients suffering from electrical burns admitted at Burn and plastic surgery department from July 2017 to June 2018. The study population consists of 68 patients who sustained electrical injuries irrespective of age and time with cutaneous burns, admitted at this Center. Patients with electrocution but no electrical cutaneous burn injuries were excluded from this study. Results: Majority were males (77.94%) of working age and injuries were work related (52.94%) of which 32.36% were construction workers. The primary cause in majority of the cases (57.35%) was accidental direct contact with electric wire followed by secondary contact with electrical power lines by metal rods and electrification of different metallic equipments (42.64%). Most of the patients admitted were high voltage electrical injuries (54.42%). Among them 16.17% had severe electrical burns and 2.94% had associated traumatic injuries. There was a delay in time of injury to hospital admission, 35.29% arrived at the emergency room 8 or more hours after the injury. Most (63.24%) of the patients underwent surgery, majority of which had moderate to severe burns. Length of hospital stay was 3-102 days. Two patients (2.94%) died during this study period due to renal failure and septicaemia. Conclusion: Most of the electric burn patients acquired injury at working place and primary cause was direct or secondary contact with powerline. Immediate preventive measures should be taken to reduce the incidence of electric burns. Bang Med J (Khulna) 2018; 51 : 29-34