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Lumsden E, Kimble R, McMillan C, Storey K, Ware RS, Griffin B. The feasibility of negative pressure wound therapy versus standard dressings in paediatric hand and foot burns protocol: a pilot, single-centre, randomised control trial. Pilot Feasibility Stud 2023; 9:90. [PMID: 37237316 DOI: 10.1186/s40814-023-01308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION The goal of paediatric hand and foot burn management is hypertrophic scar and/or contracture prevention. The risk of scar formation may be minimised by integrating negative pressure wound therapy (NPWT) as an acute care adjunct as it decreases the time to re-epithelialisation. NPWT has known associated therapeutic burden; however, this burden is hypothesised to be outweighed by an increased likelihood of hypertrophic scar prevention. This study will assess the feasibility, acceptability and safety of NPWT in paediatric hand and foot burns with secondary outcomes of time to re-epithelialisation, pain, itch, cost and scar formation. METHODS AND ANALYSIS This is a single-site, pilot randomised control trial. Participants must be aged ≤ 16 years, otherwise well and managed within 24 h of sustaining either a hand or foot burn. Thirty participants will be randomised to either standard care (Mepitel®-a silicone wound interface contact dressing-and ACTICOAT™-a nanocrystalline silver-impregnated dressing) or standard care plus NPWT. Patients will be reviewed until 3 months post-burn wound re-epithelialisation, with measurements taken at dressing changes to assess primary and secondary outcomes. Surveys, randomisation and data storage will be done via online platforms and physical data storage collated at the Centre for Children's Health Research, Brisbane, Australia. Analysis will be performed using the Stata statistical software. ETHICS AND DISSEMINATION Queensland Health and Griffith University Human Research ethics approval including a site-specific assessment was obtained. The findings of this study will be disseminated through clinical meetings, conference presentations and peer reviewed journals. TRIAL REGISTRATION Registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12622000044729, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381890&isReview=true , registered 17/01/2022).
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Affiliation(s)
- Emma Lumsden
- Faculty of Health, Griffith University, Gold Coast Campus, Parklands Dr, Southport, QLD, 4222, Australia.
- Queensland Children's Hospital, Stanley St., South Brisbane, QLD, 4101, Australia.
- Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD, 4101, Australia.
| | - Roy Kimble
- Faculty of Health, Griffith University, Gold Coast Campus, Parklands Dr, Southport, QLD, 4222, Australia
- Queensland Children's Hospital, Stanley St., South Brisbane, QLD, 4101, Australia
- Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD, 4101, Australia
| | - Catherine McMillan
- Queensland Children's Hospital, Stanley St., South Brisbane, QLD, 4101, Australia
| | - Kristen Storey
- Queensland Children's Hospital, Stanley St., South Brisbane, QLD, 4101, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Dr, Southport, QLD, 4222, Australia
| | - Bronwyn Griffin
- Faculty of Health, Griffith University, Gold Coast Campus, Parklands Dr, Southport, QLD, 4222, Australia
- Centre for Children's Health Research, 62 Graham Street, South Brisbane, QLD, 4101, Australia
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Abstract
Thermal injuries are one of the most common injuries in both civilian and combat scenarios. The importance of clinical determination of burn and frostbite injuries and treatment involves understanding the pathophysiology and mechanisms of these injuries while continually reviewing literature and studying new treatment modalities. This present review examines the (1) epidemiology, (2) etiology, (3) pathophysiology and classification, and (4) treatment of thermal injuries occurring to the foot. In addition to the paucity of new literature and studies on thermal injury, this is the first review, to the best of our knowledge, to examine the management of thermal injuries occurring to the foot.
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Affiliation(s)
- John M Tarazi
- Donald and Barbara Zucker, School of Medicine at Hofstra/Northwell, 500 Hofstra boulevard, Hempstead, NY 11549, USA; Department of Orthopaedic Surgery, Northwell Health-Huntington Hospital, 270 Park Avenue, Huntington, NY 11743, USA.
| | - Adam D Bitterman
- Donald and Barbara Zucker, School of Medicine at Hofstra/Northwell, 500 Hofstra boulevard, Hempstead, NY 11549, USA; Department of Orthopaedic Surgery, Northwell Health-Huntington Hospital, 270 Park Avenue, Huntington, NY 11743, USA
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3
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Antrum JHG, Galloway JE, Anwar MU, Hodson SL. Managing a small burn. BMJ 2022; 379:e068812. [PMID: 36270643 DOI: 10.1136/bmj-2021-068812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shakirov BM. Methods of Investigation of Functional Disturbances After Burn Injury of the Foot. J Am Podiatr Med Assoc 2022; 112:18-204. [PMID: 36074538 DOI: 10.7547/18-204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Foot burns involve a specialized area of function, and although they involve a small total body surface area (3.5%), they can cause a significant degree of morbidity. METHODS This study included 104 patients with burn trauma of the foot treated at the burn department of Republican Scientific Centre of Urgent Medical Aid and Inter-Regional Burn Center, Samarkand, Uzbekistan. A study of support-motor function of the foot after a burn by means of simultaneous registration of mechanograms of ankle join mobility in various terms made it possible to reveal considerable walking disturbances manifested in short-term support ability of various foot parts compared with normal. RESULTS Deviations in podagrams were clearly marked during the first weeks after elimination of burn wounds, especially the duration of support ability of the plantar surface in those who experienced burns. CONCLUSIONS The study in separate terms after elimination of burn injury showed that the function of feet begins to regenerate in 3 to 4 months in deep foot burns.
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Affiliation(s)
- Babur M Shakirov
- *Burn Department of the Centre of Emergency Medical Care, Samarkand State Medical Institute, 2/3 Nor Yakubov, Samarkand, 140129, Uzbekistan. (E-mail:)
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Perrault D, Cobert J, Gadiraju V, Sharma A, Gurtner G, Pham T, Sheckter C. Foot Burns in Persons with Diabetes—Outcomes from the National Trauma Data Bank. J Burn Care Res 2022; 43:541-547. [DOI: 10.1093/jbcr/irac021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Diabetes Mellitus (DM) complicates the treatment of burn injuries. Foot burns in diabetic patients are challenging problems with unfavorable outcomes. National-scale evaluations are needed, especially with regard to limb salvage. We aim to characterize lower extremity burns in persons with DM and evaluate the likelihood of amputation. The National Trauma Data Bank (NTDB) was queried from 2007-2015 extracting encounters with primary burn injuries of the feet using International Classification of Diseases (ICD) 9 th Edition codes. Logistic regression modeled predictors of lower extremity amputation. Covariables included age, sex, race/ethnicity, comorbidities including DM, % burn total body surface area (TBSA), mechanism, and region of burn center. Poisson regression evaluated temporal incidence rate changes in DM foot burns. Of 116,796 adult burn encounters, 7,963 (7%) had foot burns. Of this group, 1,308 (16%) had DM. 5.6% of encounters with DM foot burns underwent amputation compared to 1.5% of non-DM encounters (p<0.001). Independent predictors of lower extremity amputation included DM (OR 3.70, 95% CI 2.98 – 4.59), alcohol use, smoking, chronic kidney disease, burn size >20%, African American/Black race, male sex, and age>40 years (all p<0.01). The incidence of DM foot burns increased over the study period with an incidence rate ratio (IRR) of 1.07 (95% CI 1.05 – 1.10, p<0.001). In conclusion, DM was associated with nearly a 4-fold increase in amputation after adjusting for covariables. Furthermore, the incidence of DM foot burns is increasing. Strategies for optimizing care in persons with DM foot burns are need to improve limb salvage.
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Affiliation(s)
| | | | | | | | | | - Tam Pham
- Department of Surgery. University of Washington
- Harborview Injury Prevention and Research Center (HIPRC). University of Washington
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Potential efficacy of sensorimotor exercise program on pain, proprioception, mobility, and quality of life in diabetic patients with foot burns: A 12-week randomized control study. Burns 2020; 47:587-593. [PMID: 32888746 DOI: 10.1016/j.burns.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/26/2020] [Accepted: 08/05/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Both diabetes mellitus (DM) and burn injuries lead to physical and psychological impairments. Foot burns are still a challenging health condition because of its important sensory role. No previous studies have assessed the physical therapy intervention on diabetic patients with foot burns. Therefore, this study aimed to assess the potential efficacy of sensorimotor exercise on pain, proprioception, mobility, balance, and quality of life in diabetic patients with foot burns. METHODS Between July 2019 and February 2020, thirty-three diabetic patients with foot burns, aged 32 to 46yrs, were enrolled in this randomized control study, and randomized consecutively into two groups, study group (n=16) and control group (n=17). The study group underwent a sensorimotor exercise program thrice a week for 12 consecutive weeks, however the control group did not undergo the exercise intervention. Both groups were instructed to conduct home exercises. Visual analogue scale (VAS), proprioceptive responses, time-up and go (TUG) values, and short form-36 (SF-36) have been assessed prior and subsequent to the study intervention. RESULTS No significant differences were observed between groups regarding baseline data (p˃0.05). Subsequent to 12wk intervention, the study group showed significant improvements in outcome measures (proprioceptive responses, p˂0.05, VAS, p˂0.001, TUG, p=0.003, and SF-36, p˂0.001) and the control group exhibited significant changes in VAS and SF-36 (p=0.004, p=0.043 respectively) however, no significant changes were found in proprioceptive responses and TUG values (p˃0.05). Between groups, the post-intervention comparison demonstrated statistical differences with tending toward the study group (proprioceptive responses, p˂0.05, VAS, p˂0.001, TUG, p=0.013, and SF-36, p=0.046). CONCLUSIONS Sensorimotor exercise training may improve, pain, proprioceptive responses, mobility, balance, and quality of life in diabetic patients with foot burns. Physiotherapists and rehabilitation providers should include the sensorimotor exercise in their protocols in the treatment of diabetic patients with foot burns.
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Diab J, O'Hara J, Pye M, Parker C, Maitz PKM, Issler-Fisher A. Foot burns: A comparative analysis of diabetic and non-diabetic patients. Burns 2020; 47:705-713. [PMID: 32863067 DOI: 10.1016/j.burns.2020.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Foot burns represent a small part of the body with many challenges. The impact of diabetes on clinical outcomes adds further issues in management that clinicians must consider in their management. These factors have serious implications on morbidity and long term sequelae. Our aim is to analyse epidemiological trends of foot burns and examine the differences between diabetic and non-diabetics at Concord hospital from 2014 to 2019. METHODS A retrospective audit from 2014-19 at Concord General Repatriation Hospital Burns Unit summarised patient demographics, burn injury, diabetic status, operations and length of stay. All foot burn injuries from 2014-19 of all ages and gender that attended Concord burns hospital were included in this study. RESULTS We treated 797 patients who presented with foot burns, of which 16.2% were diabetic. The average age was higher in diabetics (60.72 years) than non-diabetics (39.72 years) and more males suffered burns compared to females in both groups (p < 0.001). There was a larger portion of elderly patients (greater than 65 years old, 15.1% of total) who sustained foot burns in the diabetic group compared to the non-diabetic group (p < 0.001). The most affected season was summer (27.0%), but diabetic patients were 1.7 times more likely to sustain injury in winter than non-diabetics. Diabetics were 3.8 times more likely to have contact burns compared to non-diabetic patients (p < 0.001). In a multivariable linear regression analysis, factors that contributed to increased length of stay included elderly status, place of event, diabetic status, number of operations, ICU admission, wound infection, amputation, and admission [F (16, 757 = 41.149, p < 0.001, R2 = 0.465]. CONCLUSIONS With the increase of diabetes, our multidisciplinary approach to diabetic foot care should include nursing, medical and surgical disciplines to identify patients at risk. The data highlights that a focus on prevention and education for diabetes is central to optimize glycaemic control and burn management, whilst providing a multidisciplinary network on discharge.
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Affiliation(s)
- Jason Diab
- Concord Repatriation General Hospital, Burns Unit, Australia; Concord Clinical School, University of Sydney, Sydney, Australia; School of Medicine, University of Notre Dame, Sydney, Australia.
| | - Justine O'Hara
- Concord Repatriation General Hospital, Burns Unit, Australia; Concord Clinical School, University of Sydney, Sydney, Australia
| | - Miranda Pye
- Concord Repatriation General Hospital, Burns Unit, Australia
| | | | - Peter K M Maitz
- Concord Repatriation General Hospital, Burns Unit, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; Concord Clinical School, University of Sydney, Sydney, Australia
| | - Andrea Issler-Fisher
- Concord Repatriation General Hospital, Burns Unit, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; Concord Clinical School, University of Sydney, Sydney, Australia
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Sharaf A, Bautista M, Taylor L, Jivan S. Epidemiology of isolated adult lower limb burns over 15 years with a focus on preventable work-related injuries. Burns 2020; 46:1432-1435. [PMID: 31901405 DOI: 10.1016/j.burns.2019.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/11/2019] [Accepted: 12/22/2019] [Indexed: 10/25/2022]
Abstract
Our aim was to describe the epidemiology of isolated adult lower limb burns presenting to the Pinderfields Regional Burns Centre, Wakefield, United Kingdom between 2003 and 2018. Data was obtained using our local records of the international Burn Injury Database (iBID). 6059 patients were treated in our department during this period. 18.7% presented with isolated lower limb burns (n = 1133). 65.4% of patients were male (n = 741). Scald was the most common mechanism of injury. Work-related burns accounted for 23.4% of the injuries (n = 265). 36% of patients were admitted (n = 408), and 11.7% underwent surgical intervention (n = 133). Isolated lower limb burns are common in patients in the working age group. Work-related injuries are preventable. Targeted education to highlight the risks, reduce the incidence, and improve awareness of first aid measures are recommended.
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Affiliation(s)
- Amal Sharaf
- Department of Plastic Surgery and Burns, Pinderfields Hospital, Mid Yorkshire NHS Trust, United Kingdom.
| | - Melissa Bautista
- Department of Plastic Surgery and Burns, Pinderfields Hospital, Mid Yorkshire NHS Trust, United Kingdom
| | - Lauren Taylor
- Department of Plastic Surgery and Burns, Pinderfields Hospital, Mid Yorkshire NHS Trust, United Kingdom
| | - Sharmila Jivan
- Department of Plastic Surgery and Burns, Pinderfields Hospital, Mid Yorkshire NHS Trust, United Kingdom
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Momeni M, Sediegh-Marufi S, Safari-Faramani R, Akhoondinasab MR, Karimi H, Karimi AM. Lower Extremity Burns, Complications, and Outcome. J Burn Care Res 2019; 41:409-415. [DOI: 10.1093/jbcr/irz182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
We have encountered many burn cases with lower extremity burn with adverse outcome. The study was a retrospective cohort study in 2 years, mean (SD) of follow up was 12(7) months. All demographic data, cause burn, time, total burn surface area (TBSA), presence lower extremity burn and its burn surface area (BSA), foot burn, delay in treatment, smoking, infection, morbidity, co-morbid diseases, length of stay (LOS), amputation, mortality, and outcome were gathered from patients’ files. Statistical analysis was done with SPSS 21software. We had 14,215 burn patients, of them 995 were admitted according to criteria of ABA. Six hundred and ten (61.3%) were male and 358 (37%) female. Male to female ratio was 1.58:1. The mean age ± SD was 33.64 ±23.45. Mean (SD) of lower extremity BSA was 12.09 ± 9.18%. The patients who had 10 to 19% burn, had 3 times more risk of mortality than patients with 0 to 9% burn (P < .018). And those with 20 to 29% burn had 35 times more risk of mortality comparing to patients with 0 to 9% burn. The difference was significant too. (P < .000). Delay in treatment, presence of co-morbid diseases and diabetes would not do any increase in mortality. The sex, weight, cause of burn, diabetes, and delay in treatment have not any influence on the death risk. But age and lower extremity BSA have influence on the risk of death. According to statistical study: with every 1-year increase in age, death rate increased by 4% (P < .0001). With every 1% increase in lower extremity BSA, death rate increase by 9% (P < .0005) and with every 1 day increase in LOS, the death rate increase by 4%. Statistical study shows lower extremity burn, TBSA, age, and LOS have great influence on the outcome of these patients. Sex, weight, cause of burn, and delay in treatment have not affected the risk of mortality.
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Affiliation(s)
- Mahnoush Momeni
- General Surgery, Motahary Hospital, School of Medicine, Burn Research Center
| | | | - Roya Safari-Faramani
- Department of Epidemiology, Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Hamid Karimi
- Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, School of Medicine, Burn Research Center
| | - Ali-Mohammad Karimi
- Surgery Department, Medical School, Iran University of Medical Sciences, Tehran, Iran
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Asif M, Ebrahim S, Major M, Caffrey J. The use of Integra TM as a novel technique in deep burn foot management. JPRAS Open 2018; 17:15-20. [PMID: 32158826 PMCID: PMC7061667 DOI: 10.1016/j.jpra.2018.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 04/22/2018] [Accepted: 04/29/2018] [Indexed: 01/10/2023] Open
Abstract
Deep burns in patients with co-morbidities carry a significant challenge for surgeons. The use of synthetic skin substitutes has played an increasingly important role in tissue reconstruction. IntegraTM is an artificial dermal substitute that allows temporary coverage after burn excision. The main advantages of this bi-layered template are its immediate availability, optimal scarring and decreased requirement for donor tissue. However, the downsides are the requirement for complex wound care, risk of infection and two stage procedure that can be both costly and prolong the stay in hospital. Here, we present the case of a patient with deep burns to the plantar aspect of both feet. Given the patient's medical history of diabetes, hypertension and peripheral neuropathy, we elected to use IntegraTM in combination with negative pressure wound therapy. Three weeks after the application of the IntegraTM matrix, the surface layer was replaced with autograft. At discharge, the patient was fully ambulatory and six months post-operatively this status was maintained without significant graft breakdown. To the best of our knowledge, the use of IntegraTM and split thickness skin graft in the management of full thickness burns to the plantar aspect of the feet has not been reported previously. Overall, our experience with IntegraTM in this setting was found to be satisfactory and can be considered as a promising treatment option in acute burn resurfacing.
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Our experience with an unusual age distribution of patients with isolated burns of the foot. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-017-1320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ngu F, Patel B, McBride C. Epidemiology of isolated foot burns in children presenting to a Queensland paediatric burns centre- a two-year study in warmer climate. BURNS & TRAUMA 2017; 5:6. [PMID: 28261623 PMCID: PMC5330149 DOI: 10.1186/s41038-017-0070-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/07/2017] [Indexed: 11/30/2022]
Abstract
Background European studies of paediatric foot burns report scalds as the leading cause. Mechanisms of injury are different in warmer climates. We sought to characterize the mechanisms and outcomes of isolated foot burns in our population. Methods Retrospective review of a prospectively collected database of all children aged 0–15 years presenting to a Queensland paediatric burns centre over a 26-month period. Non-parametric analyses such as the Mann-Whitney U and Pearson Chi-square were used. Results There were 218 children with foot burns treated over a period of 2 years and 2 months of which 214 had complete records. There were significantly more boys than girls (n = 134, 62.6% cf. n = 80, 37.4%, p < 0.0001). The leading mechanism of injury was a contact burn accounting for 63.1% (n = 135) followed by scalds (23.8%, n = 51). Friction, flame and chemical burns were a minority but were significantly deeper (p = 0.03) and significantly more likely to require grafting (p = 0.04) and scar management (p < 0.0001) compared to contact and scald burns. Conclusions In our population, contact burns are the most common mechanism of injury causing burns to the feet. The leading aetiology is campfire burns, which account for one-third of all burns to the feet. Prevention campaigns targeted at this population could significantly reduce the burden of morbidity from these burns. Friction, flame and chemical burns constitute a minority of patients but are deeper and more likely to require skin grafting and scar management.
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Affiliation(s)
- Florence Ngu
- Pegg Leditschke Children's Burns Centre, Department of Paediatric Surgery, Lady Cilento Children's Hospital, 501 Stanley Street, South Brisbane, QLD 4101 Australia.,Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Queensland, Australia
| | - Bhaveshkumar Patel
- Pegg Leditschke Children's Burns Centre, Department of Paediatric Surgery, Lady Cilento Children's Hospital, 501 Stanley Street, South Brisbane, QLD 4101 Australia.,Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Queensland, Australia
| | - Craig McBride
- Pegg Leditschke Children's Burns Centre, Department of Paediatric Surgery, Lady Cilento Children's Hospital, 501 Stanley Street, South Brisbane, QLD 4101 Australia.,Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Queensland, Australia
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Ngu F, Patel B, McBride C. Epidemiology of isolated foot burns in children presenting to a Queensland paediatric burns centre- a two-year study in warmer climate. BURNS & TRAUMA 2017. [PMID: 28261623 DOI: 10.1186/s41038-017-0070-3.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND European studies of paediatric foot burns report scalds as the leading cause. Mechanisms of injury are different in warmer climates. We sought to characterize the mechanisms and outcomes of isolated foot burns in our population. METHODS Retrospective review of a prospectively collected database of all children aged 0-15 years presenting to a Queensland paediatric burns centre over a 26-month period. Non-parametric analyses such as the Mann-Whitney U and Pearson Chi-square were used. RESULTS There were 218 children with foot burns treated over a period of 2 years and 2 months of which 214 had complete records. There were significantly more boys than girls (n = 134, 62.6% cf. n = 80, 37.4%, p < 0.0001). The leading mechanism of injury was a contact burn accounting for 63.1% (n = 135) followed by scalds (23.8%, n = 51). Friction, flame and chemical burns were a minority but were significantly deeper (p = 0.03) and significantly more likely to require grafting (p = 0.04) and scar management (p < 0.0001) compared to contact and scald burns. CONCLUSIONS In our population, contact burns are the most common mechanism of injury causing burns to the feet. The leading aetiology is campfire burns, which account for one-third of all burns to the feet. Prevention campaigns targeted at this population could significantly reduce the burden of morbidity from these burns. Friction, flame and chemical burns constitute a minority of patients but are deeper and more likely to require skin grafting and scar management.
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Affiliation(s)
- Florence Ngu
- Pegg Leditschke Children's Burns Centre, Department of Paediatric Surgery, Lady Cilento Children's Hospital, 501 Stanley Street, South Brisbane, QLD 4101 Australia.,Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Queensland, Australia
| | - Bhaveshkumar Patel
- Pegg Leditschke Children's Burns Centre, Department of Paediatric Surgery, Lady Cilento Children's Hospital, 501 Stanley Street, South Brisbane, QLD 4101 Australia.,Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Queensland, Australia
| | - Craig McBride
- Pegg Leditschke Children's Burns Centre, Department of Paediatric Surgery, Lady Cilento Children's Hospital, 501 Stanley Street, South Brisbane, QLD 4101 Australia.,Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Queensland, Australia
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Lawrence E, Li F. Foot burns and diabetes: a retrospective study. BURNS & TRAUMA 2015; 3:24. [PMID: 27574670 PMCID: PMC4963922 DOI: 10.1186/s41038-015-0024-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 12/08/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Diabetes in conjunction with a foot burn can compound the challenges in wound healing; however, the impact of diabetes on outcomes of patients with foot burns has not been examined. METHODS A retrospective notes audit was conducted at the Concord Hospital Burns Unit for patients with foot burns who were admitted from 1(st) January 2012 to 31(st) December 2013. Data were collected for 15 subjects with foot burns and diabetes and 18 subjects with foot burns and no diabetes as a control group. Subjects were matched for percentage total body surface area of burns. RESULTS The mean inpatient and total lengths of stay for the diabetic group were 21.27 days and 64.80 days, which were significantly longer (P = 0.090 and P = 0.054) than the 9.61 days and 30.56 days in the control, based on a significance level of 0.10. The diabetic group was significantly older (P = 0.001), at 56.60 years versus 39.44 years in the control. Significantly (P = 0.033) more patients with diabetes were not working (n = 12/15 or 80.00 % versus n = 7/18 or 38.89 %) compared to the control. The diabetic group had higher rates of regrafting (n = 3/15 or 20.00 % versus n = 1/18 or 5.55 %) than the control and significantly (P = 0.013) more amputations (n = 5/15 or 33.33 % versus n = 0 or 0.00 %) compared to the control. Fewer patients with diabetes were prescribed pressure garments (n = 2/15 or 13.33 % versus n = 9/18 or 50.00 %), which was significant (P = 0.034). The increased age of patients in the diabetic group correlates with results from other studies. Healing time may be reflected by total length of stay, which was more than double for patients with diabetes, increasing demand and cost of inpatient and outpatient services. CONCLUSION This study highlights the importance of recognizing the potential for poorer outcomes for patients with diabetes and indicates the need for more burn prevention education and promotion in this 'at risk' patient group.
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Affiliation(s)
- E Lawrence
- Concord Hospital Burns Unit, Rhodes, Australia
| | - F Li
- Concord Hospital Burns Unit, Rhodes, Australia
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Kılıç T, Krijnen P, Tuinebreijer WE, Breederveld RS. Epidemiology of foot burns in a Dutch burn centre. BURNS & TRAUMA 2015; 3:5. [PMID: 27574651 PMCID: PMC4964016 DOI: 10.1186/s41038-015-0003-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 04/20/2015] [Indexed: 11/16/2022]
Abstract
Background Although the feet involve a small percentage of the total body surface area, they can have major effects in daily life, caused by prolonged bed rest, hospitalization and high risk of both early and late complications. The aim of this study was to define the aetiology, treatment and outcomes of foot burns, with special interest in paediatric patients, patients with diabetic disease and burns acquired at the workplace. Methods This is a retrospective cohort study of 82 patients who were admitted to one of the three burn centres in the Netherlands during the period 2004 to 2013. The patients had a median age of 43.5 years (range 0.01–85.9), and included 14 children and 8 diabetics. Data were collected from the hospital records. Results Scalding was the most common cause of the injury. Almost all patients required surgical management. It is notable that most of hospitalized patients (82 %) were not admitted on the day of injury. Children had a significantly shorter length of stay compared to adults (p = 0.01). The eight patients with diabetes had a significantly longer length of hospital stay, more complications and more often residual defects compared to the non-diabetic patients. In 13 patients, the injury took place at work. Half of these burns were caused by scalding, and foot burns caused by chemicals at work were rare (two patients). Conclusions Although the incidence of foot burns is low, there is a significant morbidity due to complications and long hospital stay. The following three points are suggested. Immediate referral to a burn centre is essential. It is important to educate diabetic patients on the risk of complications and adverse outcomes after burn injury. Preventative measures at the workplace are worth considering.
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Affiliation(s)
- Tülay Kılıç
- Department of Surgery, Leiden University Medical Center University Leiden, 2300 RC Leiden, The Netherlands
| | - Pieta Krijnen
- Department of Surgery, Leiden University Medical Center University Leiden, 2300 RC Leiden, The Netherlands
| | - Wim E Tuinebreijer
- Acute Burn Care & Trauma Surgery, Department Surgery/Burn Centre, Rode Kruis Ziekenhuis, Vondellaan 13, 1942 LE Beverwijk, The Netherlands
| | - Roelf S Breederveld
- Acute Burn Care & Trauma Surgery, Department Surgery/Burn Centre, Rode Kruis Ziekenhuis, Vondellaan 13, 1942 LE Beverwijk, The Netherlands
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Hardwicke J, Bechar J, Bella H, Moiemen N. Cutaneous chemical burns in children – A comparative study. Burns 2013; 39:1626-30. [DOI: 10.1016/j.burns.2013.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 04/10/2013] [Accepted: 04/11/2013] [Indexed: 11/25/2022]
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Shakirov BM. Treatment of sandal burns of the feet in children in a moist environment. Burns 2013; 40:520-4. [PMID: 24094987 DOI: 10.1016/j.burns.2013.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 07/04/2013] [Accepted: 07/05/2013] [Indexed: 12/01/2022]
Abstract
Burns to children's feet are often due to scalds, from hot tap water, as an infant's skin is thinner and hence more susceptible to a full-thickness injury. In Central Asia, and particularly in Uzbekistan, many episodes of burns take place at homes because of using sandal heaters. In the case of sandal burns of the foot, it usually is not only skin that is injured but also underlying tissues: subcutaneous fat, fasciae, muscles and even bones. Many controlled studies have confirmed that wounds heal more readily in a moist, physiological environment. After performing the toilet of burn wounds of the foot, we applied Dermazin cream on the affected areas and then the foot was placed onto a polyethylene packet of large size and fixed by a bandage. Measurement of wound water evaporation was performed every day post-burn. Surgery was usually performed 15-17 days after burn by applying a perforated skin graft or a 0.2-0.3-mm-thick non-perforated skin graft. The procedures helped to improve the general condition of patients, shortened their stay in hospital and also reduced expenses and lessened joint deformities and contracture deformities.
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Affiliation(s)
- Babur M Shakirov
- Samarkand State Medical Institute, Burn Department of RSCUMA, Inter-Regional Burn Center, Samarkand, Uzbekistan.
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A comparative analysis and systematic review of the wound-healing milieu: implications for body contouring after massive weight loss. Plast Reconstr Surg 2010; 124:1675-1682. [PMID: 20009855 DOI: 10.1097/prs.0b013e3181b98bb4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Wound-healing complications following body contouring for massive weight loss patients are significant, with rates exceeding 40 percent. To better understand aberrant healing in this population, the authors have performed a comparative analysis of the wound milieu literature for patient populations with similar complication rates. METHODS PubMed and Ovid databases were reviewed from January of 1985 to January of 2009 for key terms, including wound healing, obesity, cancer, burn, transplant, and body contouring. Serum and wound levels of multiple factors, including matrix metalloproteinases (MMPs) and cytokines, were assessed. RESULTS Complication rates in body contouring surgery range from 31 to 66 percent. Sixty-five studies were reviewed, and wound-healing complication rates were identified for cancer (45.8 percent), burn (30.4 percent), posttransplant (36 percent), and obese (43 percent) populations. In these groups, matrix metalloproteinases and tissue inhibitors of metalloproteinase (TIMPs) help regulate wound repair. Matrix metalloproteinase levels were elevated in cancer (4-fold increase in MMP-2), burn (20- to 30-fold increase in MMP-9), transplant (1.4-fold increase in MMP-2), and obese/chronic (79-fold increase) populations. TIMPs were increased in cancer (1.9-fold increase in TIMP-2) and burn (1.4-fold increase in TIMP-1) patients but decreased in chronic wound (55-fold decrease in TIMP-1) populations. Alterations to these regulatory proteins lead to prolonged matrix degradation, up-regulation of inflammatory mediators, and decreased growth factors, delaying the wound-healing process. CONCLUSIONS Complications after body contouring surgery are likely multifactorial; however, molecular imbalances to the massive weight loss wound milieu may contribute to poor surgical outcomes. Examining wound regulatory proteins including transforming growth factor-beta, vascular endothelial growth factor, and matrix metalloproteinases could aid in understanding the healing difficulties observed clinically.
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Wilson Jones N, Wong P, Potokar T. Electric hair straightener burns an epidemiological and thermodynamic study. Burns 2008; 34:521-4. [DOI: 10.1016/j.burns.2007.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2007] [Accepted: 07/16/2007] [Indexed: 10/22/2022]
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