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Burn Injury

Tarsila Pagnan Silva Dos Santos, Marcelo Tavares de Oliveira, Luiz Carlos Angelini
Objective: To assess the homodigital flap surgical procedure, as well as the function of the finger, pain, sensation, esthetics, and patient satisfaction. Method: Retrospective analysis of records and questionnaires of patients who underwent this surgical technique between the months of May 2013 and October 2016. Eight were included in the study, with an average follow-up period of 23 months. Patients with digital pulp lesions of the thumbs and those who did not perform rehabilitation were excluded...
March 2018: Revista Brasileira de Ortopedia
Ioannis Malagaris, David N Herndon, Efstathia Polychronopoulou, Victoria G Rontoyanni, Clark R Andersen, Oscar E Suman, Craig Porter, Labros S Sidossis
BACKGROUND & AIMS: Burns remain the fifth cause of non-fatal pediatric injuries globally, with muscle cachexia being a hallmark of the stress response to burns. Burn-induced muscle wasting is associated with morbidity, yet the determinants of muscle protein catabolism in response to burn trauma remains unclear. Our objective was to determine the effect of patient and injury characteristics on muscle protein kinetics in burn patients. METHODS: This retrospective, observational study was performed using protein kinetic data from pediatric patients who had severe burns (>30% of the total body surface area burned) and underwent cross-limb stable isotope infusions between 1999 and 2008 as part of prospective clinical trials...
June 4, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Rajan K Thakkar, Zachary Diltz, Joseph D Drews, Krista K Wheeler, Junxin Shi, Racheal Devine, Renata Fabia, Mark Hall
BACKGROUND: Burns are a leading cause of morbidity in children, with infections representing the most common group of complications. Severe thermal injuries are associated with a profound inflammatory response, but the utility of laboratory values to predict infections in pediatric burn patients is poorly understood. MATERIALS AND METHODS: Our institutional burn database was queried for patients aged 18 y and younger with at least 10% total body surface area burns...
August 2018: Journal of Surgical Research
Anita C Randolph, Satoshi Fukuda, Koji Ihara, Perenlei Enkhbaatar, Maria-Adelaide Micci
Only a handful of published reports exist today that describe neurological complications following smoke inhalation injury. In this study, we characterize acute pathophysiological changes in the brain of sheep exposed to smoke inhalation, with- and without third-degree skin burn that models the injuries sustained by human victims of fire accidents. Blood-brain barrier integrity and hemorrhage were analyzed throughout the brain using specific histological stains: Hematoxylin & Eosin, Luxol fast blue, Periodic acid-Schiff (PAS), and Martius, Scarlet and Blue (MSB)...
June 13, 2018: Shock
Chad M Teven, Lawrence J Gottlieb
Burn injuries raise questions about decision-making capacity, informed consent, medical decision making, patient autonomy, the patient-physician relationship, and medical futility that must be acutely addressed. A commonly used approach to managing ethical challenges focuses on moral principles including respect for patient autonomy, beneficence, nonmaleficence, and justice. Another paradigm for ethical analysis is the "four-quadrant" approach, which poses questions for a given case regarding medical indications, patient preferences, quality of life, and contextual features...
June 1, 2018: AMA Journal of Ethics
Monica L Gerrek
Much has been written about Dax Cowart's tragic burn injury, treatment, and recovery. While Dax's case is certainly important to conversations regarding decision making in burn care, his is not the only story there is. In this article, the case of Andrea Rubin, also a severe burn survivor, is introduced as another voice in this conversation. Her experience during treatment and recovery is very different from Dax's and should cause us to at least pause and reconsider how we think about treatment and decision making in burn care...
June 1, 2018: AMA Journal of Ethics
Laura S Johnson, Jeffrey W Shupp
While current evidence-based practices might be applicable to caring for patients with routine diseases and common injury patterns, their application to burn care is less clear. Quality metrics created for large patient populations have failed to account for diseases that are not included in landmark research. Tasked to provide not only medically appropriate but also high-quality and cost-effective care for patients, burn clinicians must find a balance between patient-specific quality metrics and external quality metrics...
June 1, 2018: AMA Journal of Ethics
Lauren C Nigro, Michael J Feldman, Robin L Foster, Andrea L Pozez
Context: Pediatric burn patients warrant thorough evaluation because a sizeable proportion of pediatric burns are nonaccidental. Design: A multidisciplinary method involving an internal child protection team (CPT) was developed and used to identify suspected nonaccidental pediatric burns in all pediatric burn patients 5 years of age or younger who were evaluated by the CPT and social workers at our institution over a 55-month period. Results: We identified 343 cases for review that fit our age criteria, 6 of which we identified as cases of suspected abuse or neglect...
June 1, 2018: AMA Journal of Ethics
Yuk Ming Liu, Kathleen Skipton Romanowski
We focus on surrogate decision making and, specifically, the topic of cosmetic outcomes following burn injury in a case in which potential surrogates dispute what the patient would have wanted. In particular, we examine the choice and role of surrogate decision makers in light of ethical principles that guide surrogate decision making. We also examine whether and when cosmesis should enter into goals of care discussions and consider potential roles cosmetic outcomes could play in such discussions. Finally, we discuss how caregivers should respond when surrogate decision makers suggest cosmetic results as a reason for withdrawing care...
June 1, 2018: AMA Journal of Ethics
Linda Hollén, Rosemary Greenwood, Rebecca Kandiyali, Jenny Ingram, Chris Foy, Susan George, Sandra Mulligan, Francesca Spickett-Jones, Simon Booth, Anthony Sack, Alan Emond, Ken Dunn, Amber Young
OBJECTIVES: To evaluate the impact of low-friction (LF) bedding on graft loss in an acute burn care setting, and to examine the feasibility and costs of using LF bedding compared with standard care. DESIGN: Proof of concept before and after study with feasibility of delivering the intervention. SETTING: Three burns services within two UK hospital trusts. PARTICIPANTS: Inclusion criteria were patients older than 4 weeks, who received a skin graft after burn injury and were admitted overnight...
June 14, 2018: BMJ Open
Malcolm Maden
The spiny mouse, Acomys cahirinus, shows remarkable regenerative abilities after excisional skin wounding by regrowing hair, sebaceous glands, smooth muscle, skeletal muscle and dermis without scarring. We have asked here whether this same regeneration can be seen after full thickness thermal burn injuries. Using a brass rod thermal injury model we show that in contrast to the lab mouse, Mus musculus, which forms a thick scar covered by a hairless epidermis, the spiny mouse regenerates all the tissues injured - skeletal muscle, dermis, hairs, sebaceous glands such that the skin is externally indistinguishable from its original appearance...
June 11, 2018: Burns: Journal of the International Society for Burn Injuries
Craig R Ainsworth, Jeffrey Dellavolpe, Kevin K Chung, Leopoldo C Cancio, Phillip Mason
INTRODUCTION: Recent reports on the use of extracorporeal membrane oxygenation (ECMO) in critically ill burn patients with Acute Respiratory Distress Syndrome (ARDS) recommended against the use of ECMO. The authors cited the high mortality rates associated with the use of ECMO in these patients with no appreciable benefit. Accumulating evidence from referral centers suggests improved survival in patients with ARDS receiving ECMO. We report our recent experience treating patients with severe ARDS with ECMO in a burn intensive care unit...
June 11, 2018: Burns: Journal of the International Society for Burn Injuries
Matthew Godleski, Austin F Lee, Jeremy Goverman, David N Herndon, Oscar E Suman, Karen J Kowalske, Radha K Holavanahalli, Nicole S Gibran, Peter C Esselman, Laura C Simko, Colleen M Ryan, Jeffrey C Schneider
Contracture is a common complication of burn injury and can cause significant barriers to functional recovery and rehabilitation. There are limited studies of quantitative range of motion after burn injury. The purpose of this study is to examine quantitative contracture outcomes by anatomical location, burn size, and length of stay in adults. Data were obtained from the Burn Model System National Database from 1994 to 2003. All adult patients with a joint contracture at acute discharge were included and 16 joint motions were examined...
June 13, 2018: Journal of Burn Care & Research: Official Publication of the American Burn Association
Johan Zötterman, Ingrid Steinvall, Moustafa Elmasry
The impression among the attending physicians at their Burn Centre is that the number of contact burns caused by glass-fronted stoves is increasing, particularly in the youngest group of patients. It is an interesting subgroup, as these injuries are preventable. The authors' aim of this study was to find out whether the incidence of burns after contact with glass-fronted stoves has increased.The authors included all patients aged between 0 and 3.9 years who presented to the National Burn Centre during the period 2008-2015 with contact burn injuries caused by glass-fronted stoves...
June 13, 2018: Journal of Burn Care & Research: Official Publication of the American Burn Association
Amit Aurora, Alexander Beasy, Julie A Rizzo, Kevin K Chung
The military has used silver-nylon dressings as a topical antimicrobial on combat-related burns for the past 15 years. However, their clinical efficacy and associated risks have not been evaluated. Herein, the authors document our experience with the use of a specific silver-nylon dressing (Silverlon®) during global evacuation of casualties from combat zones to the United States sArmy Institute of Surgical Research Burn Center. A 10-year retrospective analysis was performed. Variables included patient demographics, total body surface area, length of stay, Injury Severity Score, incidence of urinary tract and burn infections, pneumonia, patient status at the time of discharge, and a composite endpoint...
June 13, 2018: Journal of Burn Care & Research: Official Publication of the American Burn Association
Juliet J Ray, Richard J Straker, Valerie J Hart, Jonathan P Meizoso, Carl I Schulman, Matthias Loebe, Ali Ghodsizad
Burn injury results in a severe systemic inflammatory response which is associated with the development of acute respiratory distress syndrome (ARDS), even without associated inhalation injury. Venous-venous extracorporeal membrane oxygenation (VV-ECMO) has been implemented in various cases of ARDS to provide support and allow for protective lung ventilation strategies. We report the case of a 27-year-old man presenting with a 60% total body surface area partial thickness burn who developed refractory ARDS with Murray Score of 3...
June 13, 2018: Journal of Burn Care & Research: Official Publication of the American Burn Association
Colleen M Ryan, Austin Lee, Frederick J Stoddard, Nien Chen Li, Jeffrey C Schneider, Gabriel D Shapiro, Cornelia L Griggs, Chao Wang, Tina Palmieri, Walter J Meyer, Frank S Pidcock, Debra Reilly, Robert L Sheridan, Lewis E Kazis, Ronald G Tompkins
Long-term functional outcomes in young adults with facial burns remain poorly studied. This 5-year (2003-2008) prospective multicenter study includes burn survivors (age 19-30 years) who completed the Young Adult Burn Outcome Questionnaire (YABOQ) from 0 to 36 months after baseline survey administration. A composite canonical score was developed from 15 YABOQ domains using discriminant analysis, maximizing the difference at the baseline between burn-injured patients with face involved and not involved. A generalized linear model with the generalized estimation equation technique was used to track the changing pattern of the composite score over time...
June 13, 2018: Journal of Burn Care & Research: Official Publication of the American Burn Association
Christopher McCulloh, Andrew Nordin, Lindsay J Talbot, Junxin Shi, Renata Fabia, Rajan K Thakkar
Accurate measurement of total body surface area (TBSA) burned is a key factor in the care of pediatric patients with burn, especially those with large thermal injuries. There is a paucity of data on the accuracy of these measurements by prehospital, nonburn center, and emergency department (ED) providers, which can have drastic implications for patient management and outcomes. We sought to determine the accuracy of these estimates for large pediatric burns. A retrospective chart review was conducted of patients with TBSA ≥10% admitted to an American Burn Association (ABA)-verified pediatric burn center from 2007 to 2015...
June 13, 2018: Journal of Burn Care & Research: Official Publication of the American Burn Association
Jafar Kazemzadeh, Reza Vaghardoost, Mostafa Dahmardehei, Soheila Rabiepoor, Ramyar Farzan, Ali Asghar Kheiri, Rahman Khosravy
Background: Burn injuries are considered an important preventable cause of injuries in children, and it still produces significant death in Iran. This study investigated the causes and severity of burns in patients. Methods: This study was retrospective descriptive study of children-burn injury in a referral Burn Care Center in Tehran, Iran during a ten-year period since 2005 to 2014. Data collection have been facilitated by using a specially designed checklist...
April 2018: Iranian Journal of Public Health
Yi-Sin Wong, Cheung-Ter Ong, Yi-Ying Hsieh, Tuey-Wen Hung, How-Ran Guo
INTRODUCTION: Carpal tunnel syndrome (CTS) is prevalent in workers who utilize hand-held vibration tools, engage in tasks involving repetitive wrist movements, and suffer from wrist overuse. Although electrical injuries involving the median nerve are a relatively rare but plausible cause of CTS, the related literature is limited. Here, we report a case of CTS in which the symptoms developed after an electrical injury, and review the related literature. CASE SUMMARY: The patient was a right-handed male electrician who often used hand tools but had no symptoms of CTS before the injury, with the left hand as the point of entry...
June 14, 2018: Journal of Occupational Health
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