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Bbaale D, Mohr C, Lindert J, Allorto N, Mabanza T, Katabogama JB, Chamania S, Elrod R, Boettcher M, Elrod J. Barriers and prospects for skin grafting in burn treatment across African countries. Burns 2024; 50:1150-1159. [PMID: 38490835 DOI: 10.1016/j.burns.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/02/2024] [Accepted: 02/21/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION The current standard management of full-thickness or deep dermal burns is early tangential excision and skin grafting. A conservative approach to deep burns without the option of skin grafting results in delayed wound healing, possibly leading to wound infection and is associated with hypertrophic scarring and increased morbidity and mortality. The aim of this study was to improve the understanding of the management and availability to perform skin grafting for burns on the African continent. It also sought to identify challenges and perceived improvements. METHODS A web-based, structured, closed-formatted, multinational survey was designed to gather information on the current state and availability of skin grafting of burn wounds on the African continent. The questionnaire consisted of 27 questions, available in English and French. It was reviewed within the GAP-Burn collaboration network and sent to 271 health care professionals who had participated in a previous study and had initially been recruited by means of the snowball system. RESULTS The questionnaire was completed 84 times (response rate: 31.0%), of which 3 were excluded. Responses originated from 22 African countries. The majority 71 (87.7%) resulted from countries with a low Human Development Index (HDI), 7 (8.6%) from medium HDI countries. Split thickness skin grafting (STSG) is performed in 51 (63.0%) centers. The majority considers STSG to reduce length of stay (72.8%) and improve scarring (54.3%), yet some indicated that STSG is associated with increased risk of donor site infection (8.6%) and severe bleeding (7.4%). Factors preventing increased grafting included lack of equipment and training. CONCLUSION Skin grafting is not performed in a significant number of hospitals treating burns. The majority of the staff believe that more skin grafting would lead to a better outcome. Advocacy and improved infrastructure, human resources coupled with introduction to well-structured health coverage for all in African countries could help to better access and affordability in burn care.
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Affiliation(s)
- Dorothy Bbaale
- Department of Plastic Surgery, Beit Cure Children's Hospital, P.O.Box 31236, Blantyre, Malawi; Department of Surgery, International Hospital Kampala, Plot 4686 Barnabas Rd, Kampala, Uganda
| | - Christoph Mohr
- Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Judith Lindert
- Department of Pediatric Surgery, University Hospital Rostock, Ernst-Heydemann Str 8, 18057 Rostock, Germany; German Society of Global and Tropical Surgery e.V., Germany
| | - Nikki Allorto
- Head Pietermaritzburg Metropolitan Burn Service, Greys Hospital 201 Townbush Road, Pietermaritzburg 3201, KwaZulu Natal, South Africa
| | - Tresor Mabanza
- Department of Surgery John F. Kennedy Medical Center/ A.M. Dogliotti College of Medicine, Sinkor 20-24th Street, Monrovia, Liberia
| | | | - Shobha Chamania
- Choithram Hospital and Research Centre, 14, Manik Bagh Rd, Indore, India
| | - Richard Elrod
- Medical Faculty, University of Leipzig, Liebigstraße 27, 04103 Leipzig, Germany
| | - Michael Boettcher
- Department of Plastic Surgery, Beit Cure Children's Hospital, P.O.Box 31236, Blantyre, Malawi
| | - Julia Elrod
- Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Souto J, Rodrigues AG. Reducing Blood Loss in a Burn Care Unit: A Review of Its Key Determinants. J Burn Care Res 2023; 44:459-466. [PMID: 36106386 DOI: 10.1093/jbcr/irac114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with a major burn injury differ considerably from the typical critical ill and trauma population. Very often, burn patients suffer from anemia throughout their hospital stay. This is caused both by combination of persistent blood loss with decreased erythropoiesis. Therefore, burn patients do have major transfusion requirements. However, transfusion is not devoid of risks or costs. We hereby review the best surgical techniques and medical approaches, aiming to reduce blood loss in a burn patient and optimize red cell production, so that we can reduce the need of RBC transfusion. The implementation of a combination of surgical techniques aiming to reduce blood loss and medical care approaches to prevent anemia, rather than single attitudes, should be adopted in burn care. There is an urgent need for clear guidelines that can easily be accepted, applied, and spread across different burn units to methodically implement measures to reduce blood loss and transfusion needs, and ultimately improve burn patients' outcome and the health care financial status.
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Affiliation(s)
- João Souto
- Faculty of Medicine, University of Porto, Portugal
| | - Acacio Goncalves Rodrigues
- Burn Unit and Department of Plastic and Reconstructive Surgery, Faculty of Medicine, S. João University Hospital Center, Porto, Portugal.,CINTESIS@RISE, Faculty of Medicine, University of Porto, Portugal
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Battistini A, Gottlieb LJ, Vrouwe SQ. Topical Hemostatic Agents in Burn Surgery: A Systematic Review. J Burn Care Res 2023; 44:262-273. [PMID: 36516423 DOI: 10.1093/jbcr/irac185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Indexed: 12/15/2022]
Abstract
Acute burn surgery has long been associated with significant intra-operative bleeding. Several techniques were introduced to limit hemorrhage, including tourniquets, tumescent infiltration, and topical agents. To date, no study has comprehensively investigated the available data regarding topical hemostatic agents in burn surgery. A systematic review was performed by two independent reviewers using electronic databases (PubMed, Scopus, Web of Science) from first available to September 10, 2021. Articles were included if they were published in English and described or evaluated topical hemostatic agents used in burn excision and/or grafting. Data were extracted on the agent(s) used, their dosage, mode of delivery, hemostasis outcomes, and complications. The search identified 1982 nonduplicate citations, of which 134 underwent full-text review, and 49 met inclusion criteria. In total, 32 studies incorporated a vasoconstrictor agent, and 28 studies incorporated a procoagulant agent. Four studies incorporated other agents (hydrogen peroxide, tranexamic acid, collagen sheets, and TT-173). The most common vasoconstrictor used was epinephrine, with doses ranging from 1:1000 to 1:1,000,000. The most common procoagulant used was thrombin, with doses ranging from 10 to 1000 IU/ml. Among the comparative studies, outcomes of blood loss were not reported in a consistent manner, therefore meta-analysis could not be performed. The majority of studies (94%) were level of evidence III-V. Determining the optimal topical hemostatic agent is limited by low-quality data and challenges with consistent reporting of intra-operative blood loss. Given the routine use of topical hemostatic agents in burn surgery, high-quality research is essential to determine the optimal agent, dosage, and mode of delivery.
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Affiliation(s)
- Andrea Battistini
- Section of Plastic & Reconstructive Surgery, University of Chicago, Chicago, IL, USA
| | - Lawrence J Gottlieb
- Section of Plastic & Reconstructive Surgery, University of Chicago, Chicago, IL, USA
| | - Sebastian Q Vrouwe
- Section of Plastic & Reconstructive Surgery, University of Chicago, Chicago, IL, USA
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Gigengack RK, Taha D, Martijn Kuijper T, Roukema GR, Dokter J, Koopman SSHA, Van der Vlies CH. Predicting blood loss in burn excisional surgery. Burns 2023; 49:566-572. [PMID: 36732103 DOI: 10.1016/j.burns.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Blood loss during burn excisional surgery remains an important factor as it is associated with significant comorbidity, mortality and longer length of stay. Blood loss is, among others, influenced by length of surgery, burn size, excision size and age. Most literature available is aimed at large burns and little research is available for small burns. Therefore, the goal of this study is to investigate blood loss and develop a prediction model to identify patient at risk for blood loss during burn excisional surgery ≤ 10% body surface area. STUDY DESIGN AND METHODS This retrospective study included adult patients who underwent burn excisional surgery of ≤ 10% body surface area in the period 2013-2018. Duplicates, patients with missing data and delayed surgeries were excluded. Primary outcome was blood loss. A prediction model for per-operative blood loss (>250 ml) was built using a multivariable logistic regression analysis with stepwise backward elimination. Discriminative ability was assessed by the area under the ROC-curve in conjunction with optimism and calibration. RESULTS In total 269 patients were included for analysis. Median blood loss was 50 ml (0-150) / % body surface area (BSA) excised and 0.28 (0-0.81) ml / cm2. Median burn size was 4% BSA and median excision size was 2% BSA. Blood loss of> 250 ml was present in 39% of patients. The model can predict blood loss> 250 ml based on %BSA excised, length of surgery and ASA-score with an AUC of 0.922 (95% CI 0.883 - 0.949) and an AUC after optimism correction of 0.915. The calibration curve showed an intercept of 0.0 (95% CI -0.36 to 0.36) with a slope of 1.0 (95% CI 0.78-1.22). CONCLUSION Median blood loss during burn excisional surgery of ≤ 10% BSA is 50 ml / % BSA excised and 0.28 ml / cm2 excised. However, a substantial part of patients is at risk for higher blood loss. The prediction model can predict P(blood loss>250 ml) with an AUC of 0.922, based on expected length of surgery, ASA-score and size of excision. The model can be used to identify patients at risk for significant blood loss (>250 ml).
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Affiliation(s)
- Rolf K Gigengack
- Departments of Trauma and Burn surgery, Maasstad Hospital, Rotterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit, Amsterdam, Department of Intensive Care, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit, Amsterdam, Department of Anesthesiology, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Diman Taha
- Department of Anesthesiology, Maasstad Hospital, Rotterdam, the Netherlands; Department of Anesthesiology, Erasmus MC, Rotterdam, the Netherlands
| | | | - Gert R Roukema
- Departments of Trauma and Burn surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Jan Dokter
- Departments of Trauma and Burn surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Cornelis H Van der Vlies
- Departments of Trauma and Burn surgery, Maasstad Hospital, Rotterdam, the Netherlands; Trauma Research unit Department of surgery, Erasmus MC, Rotterdam, the Netherlands
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Wardhana A, Aurino L, Menna C. Pre-operative Blood Loss Prediction Formulas in Burn Surgeries: A Review. J Burn Care Res 2022; 44:641-648. [PMID: 35943736 DOI: 10.1093/jbcr/irac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Indexed: 11/12/2022]
Abstract
Extensive burn surgeries lead to a considerable amount of blood loss. Predicting pre-operative blood loss is essential for blood ordering and crossmatching. Accurate amount of ordered blood units ensures patients' safety and minimizes cost. However, blood loss estimation is complicated due to a variety of factors influencing blood loss, including patient and operative-related variables. Currently, no standard method to predict blood loss exists prior to surgery. Our goal is to review factors influencing blood loss and formulas that can predict blood loss. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE databases for studies investigating blood loss in burn surgeries with a clear quantitative outcome. Fifteen studies were included, comprising 1613 subjects. All studies calculated blood loss and assessed possible related factors, and four studies proposed preoperative blood loss prediction formulas. Larger areas of tissue excised and grafted, younger age, and delayed surgery were correlated with increased blood loss. Varying decrease in blood loss was observed with tumescent usage and other bleeding control methods. Other variables produced inconsistent results. From four prediction formulas, only one formula, Dye's Formula, had been applied and proven effective in reducing unused blood units clinically by up to 40% of cross-matched blood. Various confounding factors and dissimilarities between studies make reliable prediction method construction challenging. With consideration of diverse patient characteristics, some study develops formulas to achieve optimal patient care and avoid unnecessary hospital expenditure. Further research with consistent variables should be done to construct a standardized blood loss estimation formula.
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Affiliation(s)
- Aditya Wardhana
- Head of Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Universitas Indonesia - Cipto Mangunkusumo General Hospital, Indonesia
| | - Leorca Aurino
- Faculty of Medicine, Universitas Indonesia, Indonesia
| | - Clara Menna
- Faculty of Medicine, Universitas Indonesia, Indonesia
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Fouché TW, Bond SM, Vrouwe SQ. Comparing the Efficiency of Tumescent Infiltration Techniques in Burn Surgery. J Burn Care Res 2022; 43:525-529. [PMID: 35396595 DOI: 10.1093/jbcr/irac026] [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
Tangential excision and grafting of burn wounds result in significant intraoperative blood loss, and infiltration of a dilute epinephrine solution (tumescence) is routinely performed to reduce such bleeding. Tumescent infiltration has been described using both a manual technique (syringe) and a pump device. The purpose of this study is to compare the efficiency of these two methods in terms of time and economy of motion. Consecutive adult burn patients at a single center requiring excision and grafting were enrolled in the study and randomized into either the manual or pump technique. Excisions involving less than 2% TBSA were excluded, along with specific anatomic regions (eg, head and neck). Infiltration with epinephrine solution (1:500,000) was performed to the endpoint of tumescence by a single surgeon and filmed/coded for duration, number of maneuvers, and volume of tumescence injected. Fourteen patients were enrolled, and 16 cases were randomized to either manual (N = 8) or pump infiltration (N = 8). The pump method required less time (2.0 vs 1.1 cm2/s, P < .001) and fewer maneuvers (37.8 vs 1.1 cm2/move, P < .001) to reach the desired endpoint of tumescence. Use of the infiltration pump also resulted in a reduced volume of tumescent fluid required to reach this point of tumescence (1.7 vs 2.4 mL/cm2, P = .01). Compared to the manual technique, an infiltration pump was significantly more efficient in terms of both time and economy of motion. These reductions are potentially useful for improving operating room efficiency as well as minimizing operator fatigue.
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Affiliation(s)
- Tom W Fouché
- Pritzker School of Medicine, University of Chicago, Illinois, USA
| | - Stephanie M Bond
- Section of Plastic & Reconstructive Surgery, University of Chicago, Illinois, USA
| | - Sebastian Q Vrouwe
- Section of Plastic & Reconstructive Surgery, University of Chicago, Illinois, USA
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K S A, Kumar P, Subair M, Sharma RK. Effect of single dose intravenous tranexamic acid on blood loss in tangential excision of burn wounds - A double blind randomised controlled trial. Burns 2021; 48:1311-1318. [PMID: 34952736 DOI: 10.1016/j.burns.2021.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/21/2021] [Accepted: 08/26/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION This study was carried out to evaluate role of intravenous tranexamic acid (TXA) in reducing blood loss during tangential excision of burns. METHODS This was a single center, prospective double-blinded parallel arm superiority randomized placebo-controlled trial. Patients (15-55 years) with deep dermal thermal burns <30% undergoing tangential excision were randomly assigned (1:1) to TXA and placebo groups. Patients in TXA and placebo groups received injection TXA 15 mg/kg and 10 ml saline respectively, 10 min preoperatively. Primary outcome was volume of blood loss per square centimeter area of burn excised. Secondary outcomes were total volume of blood loss, postoperative hemoglobin, intraoperative fluid requirement, blood transfusion, graft take and length of hospitalization (LOH). RESULTS Thirty patients were included. Both groups were comparable in terms of Body Mass Index (BMI) preoperative hemoglobin, area of burn excised, duration of surgery and the intraoperative temperature. The average blood loss per square centimeter burn area excised was found to be significantly lower in TXA when compared to placebo group (mean difference: 0.28 ± 0.025 ml/cm2; p = 0.000). The total volume of blood loss was lower in TXA group (258.7 ± 124.10 ml vs 388.1 ± 173.9 ml; p = 0.07). None of the patients required transfusion. The requirement of intra-operative fluids was similar between the two groups (crystalloids: p = 0.236; colloids: p = 0.238). Postoperative hemoglobin, length of hospitalization and graft-take were comparable between the two groups. CONCLUSION TXA reduced blood loss per unit burn area of tangential excision in <30%TBSA burn, however, we found no significant effect on postoperative Hb and transfusion.
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Affiliation(s)
- Ajai K S
- Department of Plastic & Reconstructive Surgery, PGIMER, Chandigarh, India.
| | - Parmod Kumar
- Department of Plastic & Reconstructive Surgery, PGIMER, Chandigarh, India.
| | - Mohsina Subair
- Department of Plastic & Reconstructive Surgery, PGIMER, Chandigarh, India.
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Stone R, Jockheck-Clark AR, Natesan S, Rizzo JA, Wienandt NA, Scott LL, Larson DA, Wall JT, Holik MA, Shaffer LJ, Park N, Jovanovic A, Tetens S, Roche ED, Shi L, Christy RJ. Enzymatic Debridement of Porcine Burn Wounds via a Novel Protease, SN514. J Burn Care Res 2020; 41:1015-1028. [PMID: 32615590 DOI: 10.1093/jbcr/iraa111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Necrotic tissue generated by a thermal injury is typically removed via surgical debridement. However, this procedure is commonly associated with blood loss and the removal of viable healthy tissue. For some patients and contexts such as extended care on the battlefield, it would be preferable to remove devitalized tissue with a nonsurgical debridement agent. In this paper, a proprietary debridement gel (SN514) was evaluated for the ability to debride both deep-partial thickness (DPT) and full-thickness burn wounds using an established porcine thermal injury model. Burn wounds were treated daily for 4 days and visualized with both digital imaging and laser speckle imaging. Strip biopsies were taken at the end of the procedure. Histological analyses confirmed a greater debridement of the porcine burn wounds by SN514 than the vehicle-treated controls. Laser speckle imaging detected significant increases in the perfusion status after 4 days of SN514 treatment on DPT wounds. Importantly, histological analyses and clinical observations suggest that SN514 gel treatment did not damage uninjured tissue as no edema, erythema, or inflammation was observed on intact skin surrounding the treated wounds. A blinded evaluation of the digital images by a burn surgeon indicated that SN514 debrided more necrotic tissue than the control groups after 1, 2, and 3 days of treatment. Additionally, SN514 gel was evaluated using an in vitro burn model that used human discarded skin. Treatment of human burned tissue with SN514 gel resulted in greater than 80% weight reduction compared with untreated samples. Together, these data demonstrate that SN514 gel is capable of debriding necrotic tissue and suggest that SN514 gel could be a useful option for austere conditions, such as military multi-domain operations and prolonged field care scenarios.
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Affiliation(s)
- Randolph Stone
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Angela R Jockheck-Clark
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Shanmugasundaram Natesan
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Julie A Rizzo
- US Army Burn Center, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Nathan A Wienandt
- Comparative Pathology, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Laura L Scott
- Epidemiology and Biostatistics, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - David A Larson
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - John T Wall
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Michelle A Holik
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Lucy J Shaffer
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Nancy Park
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Aleksa Jovanovic
- US Army Burn Center, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Shannon Tetens
- Department of Biologics and Regenerative Medicine, Sam Houston, Texas
| | - Eric D Roche
- Department of Biologics and Regenerative Medicine, Sam Houston, Texas
| | - Lei Shi
- Department of Biologics and Regenerative Medicine, Sam Houston, Texas
| | - Robert J Christy
- Department of Burn and Soft Tissue Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
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Abstract
Burn-injured patients provide unique challenges to those providing anaesthesia and pain management. This review aims to update both the regular burn anaesthetist and the anaesthetist only occasionally involved with burn patients in emergency settings. It addresses some aspects of care that are perhaps contentious in terms of airway management, fluid resuscitation, transfusion practices and pharmacology. Recognition of pain management failures and the lack of mechanism-specific analgesics are discussed along with the opioid crisis as it relates to burns and nonpharmacological methods in the management of distressed patients.
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Affiliation(s)
- Francois Stapelberg
- Department of Anaesthesia and Pain Medicine, New Zealand National Burn Centre, Auckland, New Zealand.,Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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10
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Bitterman N, Ben-Nun O, Calderon N, Brodsky A, Galis I, Matter I, Sroka G. Use of autologous dermal flap as mesh coverage in the treatment of large abdominal-wall defect in patients following massive weight loss: presentation of a novel surgical technique. Hernia 2020; 24:387-393. [PMID: 32062712 DOI: 10.1007/s10029-020-02127-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Reconstruction of large abdominal-wall defects (AWD) in patients after massive weight loss (MWL) can be challenging. Patients are left with a sizeable amount of excess skin and subcutaneous tissue which can serve as a natural and readily available source of mesh coverage. In this article, we present our experience in the reconstruction of large AWD in patients after MWL, using autogenous dermal flaps combined with a synthetic mesh. METHOD All patients with large AWD and MWL, diagnosed between January 2012 and December 2016, were considered to be candidates for the procedure. During the operation, an attempt was made to attain full closure of the defect above the mesh. In those patients for whom such closure was not possible, a dermal flap technique was used. Patients were closely monitored for at least 1 year. Outcome measures included early and late postoperative complications. Data are presented as mean ± standard deviation (SD). RESULTS Over the study period, a total of 14 patients underwent a surgery involving combined mesh and dermal flap technique. Early post-operative complications included three patients who suffered from minor wound disruption and were treated with local dressings. One patient had an abdominal-wall hematoma that required an evacuation. Two patients suffered from an epidermal cyst and chronic sinuses that required surgical debridement. None of the patients experienced intra-abdominal complication, respiratory failure, or required ICU treatment. No mesh contamination or hernia recurrence was observed during the follow-up period of 22.25 ± 6.4 months. CONCLUSION Autologous dermal flap combined with mesh technique may serve as an effective surgical alternative in patients after MWL with large AWD for whom full muscular coverage of the underlying prosthesis is not possible.
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Affiliation(s)
- N Bitterman
- The Unit of Plastic Surgery, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Bnai-Zion Hospital, 47 Golumb St., Haifa, Israel.
| | - O Ben-Nun
- The Unit of Plastic Surgery, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Bnai-Zion Hospital, 47 Golumb St., Haifa, Israel
| | - N Calderon
- The Unit of Plastic Surgery, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Bnai-Zion Hospital, 47 Golumb St., Haifa, Israel
| | - A Brodsky
- General Surgery Department, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - I Galis
- General Surgery Department, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - I Matter
- General Surgery Department, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - G Sroka
- General Surgery Department, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Weis HB, Meinhardt KE, Minhajuddin A, Viroslav H, Colletti M, Weis JJ, Taveras LR, Madni TD, Imran JB, Clark AT, Pickett ML, Phelan HA, Ambardekar AP. Administration of Tumescence in Pediatric Burn Patients Causes Significant Hypertension. J Burn Care Res 2019; 40:752-756. [DOI: 10.1093/jbcr/irz081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AbstractThe effects of injecting tumescence containing phenylephrine in pediatric burn patients are unknown, but anecdotally our clinicians note a high incidence of hypertension requiring treatment. This study sought to determine whether tumescence with phenylephrine was associated with hypertension requiring treatment in our pediatric burn patients. This was a retrospective cohort study of pediatric burn patients who underwent tangential excision with split-thickness autografting, excision alone, or autografting alone from 2013 to 2017. Records were reviewed for hypertensive episodes, defined as ≥2 consecutive blood pressure readings that were >2 SD above normal. Published intraoperative age- and sex-adjusted standards were used to define reference values. Parametric and nonparametric tests were used when appropriate. In total, 258 operations were evaluated. Mean patient age was 7.6 ± 5.2 years, and 64.7% were male. Patients were predominately white (69.8%). Overall, there was a 62.8% incidence of hypertension. On univariate logistic regression analysis, duration of operation, estimated blood loss, treated TBSA, and weight-adjusted volume of tumescence were significant predictors of intraoperative hypertension (P < .01). On multivariate analysis, weight-adjusted volume of tumescence alone was significantly associated with the presence of hypertension with an odds ratio of 2.0 (95% confidence interval: 1.33–3.04). Of the 162 operations which exhibited at least one episode of significant hypertension, 128 cases (79%) were treated. Intraoperative administration of phenylephrine-containing tumescence in pediatric burn patients is associated with clinically significant hypertension requiring treatment. This practice should be conducted with caution in pediatric burn operations until its clinical implications are defined.
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Affiliation(s)
- Holly B Weis
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Kyle E Meinhardt
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas
| | - Abu Minhajuddin
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Hannah Viroslav
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas
| | - Meaghan Colletti
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Joshua J Weis
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Luis R Taveras
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Tarik D Madni
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Jonathan B Imran
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Audra T Clark
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Maryanne L Pickett
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Herb A Phelan
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Aditee P Ambardekar
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas
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Bhatia N, Sen I, Kumari K, Kumar P, Bharti N. Impact of single dose intravenous tranexamic acid on peri-operative blood transfusion requirements in burn patients: A prospective, randomized trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2017.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Nidhi Bhatia
- Department of Anaesthesia & Intensive Care, PGIMER, Chandigarh, India
| | - Indu Sen
- Department of Anaesthesia & Intensive Care, PGIMER, Chandigarh, India
| | - Kamlesh Kumari
- Department of Anaesthesia & Intensive Care, Dr. SN Medical College, Jodhpur, India
| | - Parmod Kumar
- Department of Plastic Surgery, PGIMER, Chandigarh, India
| | - Neerja Bharti
- Department of Anaesthesia & Intensive Care, PGIMER, Chandigarh, India
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Ho CWG, Kok YO, Chong SJ. Photographic evaluation of different adrenaline-containing tumescent solutions on skin graft donor site bleeding: A prospective randomised trial. Burns 2018; 44:2018-2025. [DOI: 10.1016/j.burns.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/18/2018] [Accepted: 03/09/2018] [Indexed: 12/30/2022]
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Farny B, Fontaine M, Latarjet J, Poupelin J, Voulliaume D, Ravat F. Estimation of blood loss during adult burn surgery. Burns 2018; 44:1496-1501. [DOI: 10.1016/j.burns.2018.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/31/2018] [Accepted: 04/27/2018] [Indexed: 12/17/2022]
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Muniz Castro J, Burton K, Thurer RL, Bernal NP. How does blood loss relate to the extent of surgical wound excision? Burns 2018; 44:1130-1134. [DOI: 10.1016/j.burns.2018.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/22/2018] [Accepted: 04/10/2018] [Indexed: 12/31/2022]
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Carneiro JMGVDM, Alves J, Conde P, Xambre F, Almeida E, Marques C, Luís M, Godinho AMMG, Fernandez-Llimos F. Factor XIII-guided treatment algorithm reduces blood transfusion in burn surgery. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 29269148 PMCID: PMC9391805 DOI: 10.1016/j.bjane.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background and objectives Major burn surgery causes large hemorrhage and coagulation dysfunction. Treatment algorithms guided by ROTEM® and factor VIIa reduce the need for blood products, but there is no evidence regarding factor XIII. Factor XIII deficiency changes clot stability and decreases wound healing. This study evaluates the efficacy and safety of factor XIII correction and its repercussion on transfusion requirements in burn surgery. Methods Randomized retrospective study with 40 patients undergoing surgery at the Burn Unit, allocated into Group A those with factor XIII assessment (n = 20), and Group B, those without assessment (n = 20). Erythrocyte transfusion was guided by a hemoglobin trigger of 10 g.dL−1 and the other blood products by routine coagulation and ROTEM® tests. Analysis of blood product consumption included units of erythrocytes, fresh frozen plasma, platelets, and fibrinogen. The coagulation biomarker analysis compared the pre- and post-operative values. Results and conclusions Group A (with factor XIII study) and Group B had identical total body surface area burned. All patients in Group A had a preoperative factor XIII deficiency, whose correction significantly reduced units of erythrocyte concentrate transfusion (1.95 vs. 4.05, p = 0.001). Pre- and post-operative coagulation biomarkers were similar between groups, revealing that routine coagulation tests did not identify factor XIII deficiency. There were no recorded thromboembolic events. Correction of factor XIII deficiency in burn surgery proved to be safe and effective for reducing perioperative transfusion of erythrocyte units.
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Algoritmo de tratamento guiado pelo fator XIII reduz a transfusão sanguínea na cirurgia de queimados. Braz J Anesthesiol 2018; 68:238-243. [DOI: 10.1016/j.bjan.2017.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/30/2017] [Accepted: 11/20/2017] [Indexed: 11/19/2022] Open
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Comparative Analysis of Early Excision and Grafting vs Delayed Grafting in Burn Patients in a Developing Country. J Burn Care Res 2018; 37:278-82. [PMID: 23816999 DOI: 10.1097/bcr.0b013e31827e4ed6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The present study attempts to compare how the patients who undergo early excision and grafting behave as compared with patients who are treated along usual conservative lines of management in centers where the resources are less than optimal. The data of 20 female patients were analyzed. Age of the patients ranged between 20 and 30 years, percentage area burn ranged between 20 and 40%, and percentage area resurfaced by skin grafting 5 to 10%. The patients were divided into two groups of 10 patients each. Group I included those patients who underwent early excision and grafting within 5 days of burn injury. Group II included those patients who were treated conservatively and the residual raw area was grafted 3 weeks or more after sustaining the burn. The two groups were compared for the amount of blood loss, transfusion requirement, graft take, and the total hospital stay. Statistical significance was tested by the application of Mann-Whitney U test. The mean percentage area burn was 29.1 ± 5.6% in group I and 24.7 ± 4.9% in group II. Mean percentage area resurfaced by skin grafting in group I was 9.4 ± 2.3% and 8.1 ± 1.6% in group II. Graft take in group I was 90 ± 7.8%, whereas that in group II was 95 ± 6.7%. Mean blood loss in group I and group II was 346 ± 17.6 ml and 241 ± 14.7 ml respectively. (P = .001). Mean transfusion requirement in the perioperative period was 1.6 pints in group I and 1.1 pints in group II. The mean hospital stay in the patients who underwent early excision and grafting was 15.1 ± 4.1 days, whereas that in the patients who underwent delayed grafting was 36.2 ± 6.3 days (P = .001). Early excision and grafting decreases the hospital stay of burn patients. The present study suggests that it has a definite applicability even in places where the resources might be less than optimal.
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Determinants and time to blood transfusion among thermal burn patients admitted to Mulago Hospital. BMC Res Notes 2017; 10:258. [PMID: 28683773 PMCID: PMC5501556 DOI: 10.1186/s13104-017-2580-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 06/28/2017] [Indexed: 11/28/2022] Open
Abstract
Background Blood transfusion, a practice under re-evaluation in general, remains common among thermal burn patients due to the hematological alterations associated with burns that manifest as anemia. Today advocacy is for restrictive blood transfusion taking into account individual patient characteristics. We went out to identify the parameters that may determine transfusion requirement and the time to blood transfusion for thermal burn patients in Mulago Hospital in order to build statistics and a basis to standardize future practice and Hospital protocol. Methods 112 patients with thermal burns were enrolled into a prospective cohort study conducted in the Surgical Unit of the Accidents and Emergency Department and Burns Unit of Mulago Hospital. Relevant data on pre-injury, injury and post-injury factors was collected including relevant laboratory investigations and treatment modalities like surgical intervention. Patients were clinically followed up for a maximum period of 28 days and we identified those that were transfused. Results 22.3% of patients were transfused. The median time to transfusion was 17 days from time of injury and varied with different patient characteristics. The median pre-transfusion hemoglobin (Hb) level was 8.2 g/dL. Transfusion was significantly related to; admission to the intensive care unit (p = 0.001), a body mass index (BMI) <2 kg/m2 (p = 0.021), % total burn surface area (TBSA) >20 (p = 0.049), pre-existing illness (p = 0.046), and white blood cell (WBC) count <4000 or >12,000/μL (p = 0.05). Conclusion Pre-existing illnesses, a low BMI, TBSA of >20%, admission to the intensive care unit and abnormalities in the WBC count are useful predictors of blood transfusion among thermal burns patients admitted to Mulago Hospital. The precise time to transfusion from time of burns injury cannot be generalized. With close monitoring of each individual patient lies the appropriateness and timeliness of their management.
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Explain the epidemiology of severe burn injury in the context of socioeconomic status, gender, age, and burn cause. 2. Describe challenges with burn depth evaluation and novel methods of adjunctive assessment. 3. Summarize the survival and functional outcomes of severe burn injury. 4. State strategies of fluid resuscitation, endpoints to guide fluid titration, and sequelae of overresuscitation. 5. Recognize preventative measures of sepsis. 6. Explain intraoperative strategies to improve patient outcomes, including hemostasis, restrictive transfusion, temperature regulation, skin substitutes, and Meek skin grafting. 7. Translate updates in the pathophysiology of hypertrophic scarring into novel methods of clinical management. 8. Discuss the potential role of free tissue transfer in primary and secondary burn reconstruction. SUMMARY Management of burn-injured patients is a challenging and unique field for plastic surgeons. Significant advances over the past decade have occurred in resuscitation, burn wound management, sepsis, and reconstruction that have improved outcomes and quality of life after thermal injury. However, as patients with larger burns are resuscitated, an increased risk of nosocomial infections, sepsis, compartment syndromes, and venous thromboembolic phenomena have required adjustments in care to maintain quality of life after injury. This article outlines a number of recent developments in burn care that illustrate the evolution of the field to assist plastic surgeons involved in burn care.
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Mohammadi AA, Mohammadi S. Early excision and grafting (EE&G): Opportunity or threat? Burns 2017; 43:1358-1359. [PMID: 28412130 DOI: 10.1016/j.burns.2017.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Ali Akbar Mohammadi
- Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Soheil Mohammadi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Butts CC, Bose K, Frotan MA, Hodge J, Gulati S. Controlling intraoperative hemorrhage during burn surgery: A prospective, randomized trial comparing NuStat® hemostatic dressing to the historic standard of care. Burns 2017; 43:374-378. [DOI: 10.1016/j.burns.2016.08.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 08/24/2016] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
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Koljonen V, Tuimala J, Haglund C, Tukiainen E, Vuola J, Juvonen E, Lauronen J, Krusius T. The Use of Blood Products in Adult Patients with Burns. Scand J Surg 2016; 105:178-85. [DOI: 10.1177/1457496915622127] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/11/2015] [Indexed: 11/15/2022]
Abstract
Introduction: Burn anemia represents a common complication following a burn injury. Burn anemia etiology carries distinct features occurring at each stage of the post-injury and treatment periods resulting from different causes. We aimed to analyze the use of blood components in Finnish burn victims and to identify patient- and injury-related factors influencing their use. Methods: To study the use of blood products in burn patients, we used data collected from the Optimal Use of Blood registry, developed through co-operation between 10 major hospital districts and the Finnish Red Cross Blood Service. Burn patients ⩾18 years treated at the Helsinki University Hospital between 2005 and 2011 with an in-hospital stay ⩾1 day who received at least one transfusion during their hospital stay were included in this study. Results: Among all 558 burn patients, 192 (34%) received blood products during their hospital stay. The transfused cohort comprised 192 burn patients. The study cohort received a total of 6087 units of blood components, 2422 units of leukoreduced red blood cells, 1728 units of leukoreduced platelets, and 420 units of single-donor fresh frozen plasma or, after 2007, 1517 units of Octaplas® frozen plasma. All three types of blood components were administered to 29% of patients, whereas 45% received only red blood cells and 6% received only Octaplas. Transfused patients were significantly older (p < 0.001), experienced fire-/flame-related accidents and burns to multiple locations (p < 0.001), and their in-hospital mortality exceeded that for non-transfused burn patients fivefold (p < 0.05). Discussion: We show that Finnish adult burn patients received ample transfusions. The number of blood components transfused varied according to the anatomical location of the injury and patient survival. Whether the additional mortality is related directly to transfusions or is merely a manifestation of the more severe burn injury remains unknown.
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Affiliation(s)
- V. Koljonen
- Department of Plastic Surgery, University of Helsinki and Töölö Hospital, Helsinki University Hospital, Helsinki, Finland
| | | | - C. Haglund
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
| | - E. Tukiainen
- Department of Plastic Surgery, University of Helsinki and Töölö Hospital, Helsinki University Hospital, Helsinki, Finland
| | - J. Vuola
- Department of Plastic Surgery, University of Helsinki and Töölö Hospital, Helsinki University Hospital, Helsinki, Finland
| | - E. Juvonen
- Finnish Red Cross Blood Service, Helsinki, Finland
| | - J. Lauronen
- Clinical Consultations Unit, Finnish Red Cross Blood Service, Helsinki, Finland
| | - T. Krusius
- Finnish Red Cross Blood Service, Helsinki, Finland
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Hyland EJ, Lawrence T, Harvey JG, Holland AJA. Management and outcomes of children with severe burns in New South Wales: 1995-2013. ANZ J Surg 2015; 86:499-503. [PMID: 26678373 DOI: 10.1111/ans.13398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND As a result of improvements in injury prevention, severe burns appear increasingly uncommon in Australian children. Such injuries continue to have devastating impacts, with major consequences for the patient, their family, treating clinicians and the caring institution. METHODS A retrospective review was undertaken of Australian children who presented to our institution between 1995 and 2013 with burn injuries ≥30% total body surface area (TBSA). RESULTS Ninety children were identified. Their median age was 3.9 years and 57% (n = 52) were male. Most injuries occurred at home (n = 63) due to fires (n = 49). The majority received inadequate first aid (n = 56) and 40 became hypothermic during initial resuscitation. A total of 79% were transferred from other institutions. The median TBSA burnt was 40% and the majority of burns were full thickness (n = 51). All but nine were managed in the Paediatric Intensive Care Unit with a mean initial hospital admission of 43.5 days. Two thirds of children were intubated, over half of those prior to transfer, with 26 having an inhalational injury and 33 escharotomies. Compared with estimated fluid requirements, most children were over-resuscitated by a median of 26.9 mL/kg. There were seven mortalities. Wound infections were common (n = 65) and 36 suffered sepsis. The median number of dressing changes was 13 (range 0-100), operations were six and packed cells transfused was 95.7 mL/kg. Overall, 54 developed hypertrophic scarring and 45 scar contractures that have required subsequent reconstructive surgery. CONCLUSION Severe burn injuries in children have significant morbidity and mortality. They would appear expensive to manage and impact substantially on health care resources.
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Affiliation(s)
- Ela J Hyland
- Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Torey Lawrence
- Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - John G Harvey
- Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J A Holland
- Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Osuka A, Kuroki Y, Ueyama M. A haemostatic technique using silicone gel dressing for burn surgery. Int Wound J 2015; 13:1354-1358. [PMID: 26671454 DOI: 10.1111/iwj.12532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/29/2015] [Indexed: 11/29/2022] Open
Abstract
Significant blood loss and high rates of transfusion remain ongoing concerns in burn surgery. We have reported a haemostatic technique using silicone gel dressing to minimise bleeding during tangential excision in burn surgery. The purpose of this study was to identify the efficacy of our novel haemostatic technique for burn surgery. This study was a retrospective observational study. From 1 April 2011 to 31 March 2015, we collated data including pre- and 24-hour postoperative haemoglobin levels from patients over 15 years of age who underwent tangential excision for burn injuries. We also collected data on the amounts of measured blood loss, blood transfusions, excised areas, harvest areas and duration of surgeries. The collected data were divided into a conventional group and a silicone gel dressing group. Then, we analysed the differences between the two groups. During the study period, 357 patients were admitted to our burn centre, and 60 operations (44 patients) were performed by tangential excision. The conventional group comprised 28 operations (20 patients), and the silicone gel dressing group comprised 32 operations (26 patients). Excised areas and harvested areas were significantly larger in the silicone gel dressing group than in the conventional group. The amount of blood loss per percent excised and the number of units of blood transfused were significantly lower in the silicone gel dressing group. Duration of the surgeries was almost the same between the two groups. Application of our new technique during tangential excision for burn injuries resulted in a remarkable reduction in blood loss and transfusion requirements.
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Affiliation(s)
- Akinori Osuka
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Yuichi Kuroki
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Masashi Ueyama
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
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Song G, Jia J, Ma Y, Shi W, Wang F, Li P, Gao C, Zuo H, Fan C, Xin N, Wu Q, Shao Y. Experience and efficacy of surgery for retaining viable subcutaneous tissue in extensive full-thickness burns. Burns 2015; 42:71-80. [PMID: 26546384 DOI: 10.1016/j.burns.2015.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/14/2015] [Accepted: 06/21/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM For adult patients with extensive full-thickness burns (EFTB), a fascial excision is mostly used but it causes a very significant deformity. This study aims to summarize experience and efficacy of surgery for retaining viable subcutaneous tissue in EFTB. METHOD Clinical data were reviewed for 31 consecutive adult patients with full-thickness burn (FTB) over 70% total body surface area (TBSA) and undergoing first tangential excision and skin grafting on subcutaneous tissue wound (TESGSTW) within 7 days post burn at our burn center between 2002 and 2013. RESULTS Average age, total burn area, and FTB area of 31 patients were 32.4 ± 12.8 years, 89.0 ± 6.2% and 80.4 ± 7.6% TBSA, respectively. Of these, 80.6% combined with inhalation injury and 71.0% supervened early shock. Eighteen patients who survived (58.1%) totally underwent 121 times of surgery, of which TESGSTW and autologous skin grafting were 41 and 88 times, respectively. Their average time and area of first tangential excision was 4.1 ± 0.6 days post burn and 33.8 ± 7.6% TBSA, respectively, and accumulated tangential excision area was 58.4 ± 10.8% TBSA. In 39 times of TESGSTW within 14 days post burn, cryopreserved alloskin or fresh young pigskin was applied on 84.6%, and average time and take rate of autologous skin grafting instead of grafted alloskin or xenoskin was 14.6 ± 0.7 days and 89.5 ± 1.4%, respectively. Scalp was the main donor site for autologous skin, especially microskin grafting. Systemic wound healing time roughly was 67.3 ± 1.9 days post burn, meanwhile, viable subcutaneous tissue was retained. Healed wounds were plump, and their extensibility and sensitivity were better by follow-up. CONCLUSION The surgical treatment in EFTB is practicable and effective.
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Affiliation(s)
- Guodong Song
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Jun Jia
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Yindong Ma
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Wen Shi
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Fang Wang
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Peilong Li
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Cong Gao
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Haibin Zuo
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Chunjie Fan
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Naijun Xin
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Qiuhe Wu
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Yang Shao
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
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Vasoconstrictor clysis in burn surgery and its impact on outcomes: Systematic review and meta-analysis. Burns 2015; 41:1140-6. [DOI: 10.1016/j.burns.2015.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 01/30/2015] [Accepted: 03/13/2015] [Indexed: 11/18/2022]
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Prasetyono TOH, Koswara AF. Retrospective Analysis of the One-per-Million Tumescent Technique in Post-Burn Hand Deformity Surgeries. Arch Plast Surg 2015; 42:164-72. [PMID: 25798387 PMCID: PMC4366697 DOI: 10.5999/aps.2015.42.2.164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/20/2014] [Accepted: 12/01/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The use of a tourniquet in hand surgery is generally accepted as necessary to create a clear visualization of the operative field. This study aims to determine the effectiveness of one-per-million tumescent solution (1:1,000,000 epinephrine concentration) in creating a bloodless operative field in post-burn hand deformity surgeries performed without a tourniquet. METHODS This retrospective observational study was conducted on a series of 12 patients with post-burn hand deformities who underwent surgery between February 2013 and January 2014. A total of 29 operative fields were recorded. The one-per-million tumescent solution was used for hemostatis instead of a tourniquet. The clarity of the operative field, volume of solution injected, duration of surgery, scar thickness and density, and functional outcomes at least three months after the surgery were observed. The relationship of scar thickness and density with the clarity of the operative field was analyzed with the chi-square test. RESULTS Of the 29 operative fields in which the one-per-million tumescent technique was used, 48.2% were totally bloodless, 44.8% had minimal bleeding, and 6.9% had an acceptable level of bleeding. Both scar thickness and density were shown to have a significant relationship with operative field clarity (P<0.05). CONCLUSIONS The one-per-million tumescent technique is effective in facilitating post-burn hand deformity surgeries involving meticulous, multiple, and lengthy procedures by creating a relatively clear operative field without the use of a tourniquet. Although scar thickness and density are associated with the clarity of the operative field, this technique can be considered safe and effective in creating a clear operative field.
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Affiliation(s)
- Theddeus OH Prasetyono
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, University of Indonesia and Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Akinbami BO, Onajin-Obembe B. Assessment of Intraoperative Blood Loss during Oral and Maxillofacial Surgical Procedures in a Nigerian Tertiary Health Care Center. JOURNAL OF BLOOD TRANSFUSION 2014; 2014:301467. [PMID: 25258698 PMCID: PMC4167214 DOI: 10.1155/2014/301467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/22/2014] [Accepted: 08/09/2014] [Indexed: 11/18/2022]
Abstract
Background. Reports on estimated amount of blood loss in maxillofacial surgical procedures will guide clinicians through units of blood required for each procedure. The aim of the study was to assess the amount of blood loss and duration of surgery. Methods. All cases of maxillofacial surgical procedures done under GA in the MFU theatre, from January 2007 to December 2013, were included in the study. Pre- and postoperative haematocrit values, number of units of whole blood requested and used, amount of blood loss, and duration of surgery were recorded. Results. 139 patients were analyzed, of which 75 (54.0%) were males and 64 (46.0%) were females. Fifty-six (40.3%) cases involved soft tissues. Eighty-three cases involved hard tissues. Age range was 2 months to 78 years; mean ± (SD) was 21.3 ± (18.5) years. Isolated unilateral cleft lip had the lowest mean value of estimated blood loss of 10.4 ± 10.8 mLs and also the lowest duration of surgery of 58 (76) minutes. There was no significant relationship between both parameters for cleft lip. Fractures of the mandible had mean blood loss of 352 mLs and duration was 175 min. Conclusion. In this study, there was significant relationship between estimated blood loss and duration of surgery for mandibular and zygomatic complex fractures.
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Affiliation(s)
- Babatunde O. Akinbami
- Department of Oral and Maxillofacial Surgery, University of Port Harcourt Teaching Hospital, Choba, PMB 6173 Port Harcourt, 500004 Rivers State, Nigeria
| | - Bisola Onajin-Obembe
- Department of Anaesthesia, University of Port Harcourt Teaching Hospital, PMB 6173 Port Harcourt, 500004 Rivers State, Nigeria
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Effect of subcutaneous epinephrine/saline/local anesthetic versus saline-only injection on split-thickness skin graft donor site perfusion, healing, and pain. J Burn Care Res 2013; 34:e80-6. [PMID: 23237817 DOI: 10.1097/bcr.0b013e31825d5414] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The technique for split-thickness skin graft harvest varies among surgeons. Even though there is scientific evidence that the subcutaneous injection of modified tumescent solution reduces blood loss during burn surgery, the technique has not been unanimously adapted because of, in part, fear of healing retardation. This study prospectively examines the effect of tumescent injection on donor site perfusion, healing, and pain. Ten burn patients in need of grafting with a need for two distinctly different donor sites were included. During the grafting procedure, the two donor areas were randomly assigned to receive either modified tumescent solution or warm sterile saline solution subcutaneously before skin graft harvest with a dermatome. Perfusion, pain, pruritus, and donor site healing were measured, and a follow-up evaluation on scar quality was performed. Baseline perfusion on day 1 was significantly less in the donor site injected with modified tumescent solution (62.26 vs 95.71 perfusion units; P = .031), whereas the response to heat was similar in both sites. The physiologic response to injury (hyperemia) on days 2 and 3 was not suppressed in the modified tumescent group. Pain reported on day 1 was 2.38/10 in the tumescent site and 3.38/10 in the saline site (P = .21). On all other days, measurements showed no difference between the two sites. Donor sites healed in an average of 16.1 days with modified tumescent solution and in 16.4 days with saline. Late follow-up showed no difference in scar quality. The subcutaneous injection of modified tumescent solution before split-thickness donor site harvest has no adverse effect on donor site perfusion past day 1 or donor site healing. The addition of a local anesthetic may decrease pain for 24 hours postoperatively, but the difference in this study group was not significant. This technique should be universally recommended.
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Osuka A, Kuroki Y, Nakajima S, Sakai T, Kojima H, Yamada M, Okuma S, Onishi S, Ueyama M. Haemostatic technique using a novel silicone gel dressing for tangential excisions in burn surgery. Burns 2013; 40:165-6. [PMID: 23953831 DOI: 10.1016/j.burns.2013.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 06/19/2013] [Indexed: 11/15/2022]
Affiliation(s)
- Akinori Osuka
- Department of Trauma, Critical Care Medicine and Burn Center, Social Insurance Chukyo Hospital, Japan.
| | - Yuichi Kuroki
- Department of Trauma, Critical Care Medicine and Burn Center, Social Insurance Chukyo Hospital, Japan
| | - Shinji Nakajima
- Department of Trauma, Critical Care Medicine and Burn Center, Social Insurance Chukyo Hospital, Japan
| | - Tomohiko Sakai
- Department of Trauma, Critical Care Medicine and Burn Center, Social Insurance Chukyo Hospital, Japan
| | - Hiroki Kojima
- Department of Trauma, Critical Care Medicine and Burn Center, Social Insurance Chukyo Hospital, Japan
| | - Mami Yamada
- Department of Trauma, Critical Care Medicine and Burn Center, Social Insurance Chukyo Hospital, Japan
| | - Seigo Okuma
- Department of Trauma, Critical Care Medicine and Burn Center, Social Insurance Chukyo Hospital, Japan
| | - Shinya Onishi
- Department of Trauma, Critical Care Medicine and Burn Center, Social Insurance Chukyo Hospital, Japan
| | - Masashi Ueyama
- Department of Trauma, Critical Care Medicine and Burn Center, Social Insurance Chukyo Hospital, Japan
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Schaden E, Kimberger O, Kraincuk P, Baron D, Metnitz P, Kozek-Langenecker S. Perioperative treatment algorithm for bleeding burn patients reduces allogeneic blood product requirements. Br J Anaesth 2012; 109:376-81. [DOI: 10.1093/bja/aes186] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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33
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Abbott AM, Miller BT, Tuttle TM. Outcomes after Tumescence Technique versus Electrocautery Mastectomy. Ann Surg Oncol 2012; 19:2607-11. [DOI: 10.1245/s10434-012-2304-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Indexed: 11/18/2022]
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34
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Maani CV, Hansen JJ, Fortner PA, Cancio LC, DeSocio PA. Perioperative Anesthetic Considerations for Burn Patients. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.cpen.2011.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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35
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Fayolle-Pivot L, Meunier S, Tissot S, Magnin C, Bertin-Maghit M, Allaouchiche B. Management of a child with von Willebrand disease (type 2A) and extensive burns: a case report. Burns 2011; 38:e1-4. [PMID: 22119447 DOI: 10.1016/j.burns.2011.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 09/21/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Laure Fayolle-Pivot
- Centre de Traitement des Brûlés, Pavillon I, Hôpital Edouard Herriot, Lyon, France.
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36
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Schaden E, Hoerburger D, Hacker S, Kraincuk P, Baron DM, Kozek-Langenecker S. Fibrinogen function after severe burn injury. Burns 2011; 38:77-82. [PMID: 22113102 DOI: 10.1016/j.burns.2010.12.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 11/14/2010] [Accepted: 12/05/2010] [Indexed: 01/07/2023]
Abstract
BACKGROUND Evidence regarding hypercoagulability in the first week after burn trauma is growing. This hypercoagulable state may partly be caused by increased fibrinogen levels. Rotational thrombelastometry offers a test which measures functional fibrinogen (FIBTEM(®)). To test the hypothesis that in patients with severe burn injury fibrinogen function changes over time, we simultaneously measured FIBTEM(®) and fibrinogen concentration early after burn trauma. METHODS After Ethics Committee approval consecutive patients with severe burn trauma admitted to the burn intensive care unit of the General Hospital of Vienna were included in the study. Blood examinations were done immediately and 12, 24 and 48 h after admission. At each time point fibrinogen level (Clauss) and 4 commercially available ROTEM(®) tests were performed. RESULTS 20 consecutive patients were included in the study. Fibrinogen level and FIBTEM(®) MCF were within the reference range until 24 h after burn trauma but increased significantly 48 h after trauma. There was a significant correlation between FIBTEM(®) MCF and fibrinogen level (R=0.714, p<0.001). CONCLUSION The results of this prospective observational clinical study show that fibrinogen function changes early after burn trauma and can be visualized by ROTEM(®) with the fibrinogen-sensitive FIBTEM(®) test.
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Affiliation(s)
- Eva Schaden
- Dept. of Anesthesiology, General Intensive Care and Pain Control, Medical University Of Vienna, Austria.
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37
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Early Escharectomy and Concurrent Composite Skin Grafting over Human Acellular Dermal Matrix Scaffold for Covering Deep Facial Burns. Plast Reconstr Surg 2011; 127:1533-1538. [DOI: 10.1097/prs.0b013e31820a63e8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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38
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Sterling JP, Heimbach DM. Hemostasis in burn surgery--a review. Burns 2010; 37:559-65. [PMID: 21194843 DOI: 10.1016/j.burns.2010.06.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 06/29/2010] [Indexed: 10/18/2022]
Abstract
Over the past 30 years, techniques of early excision and grafting along with enhancement of critical care have significantly improved survival following burn injury. Despite these advancements, large volume blood loss associated with surgical intervention continues to be a challenging aspect of burn surgery. This review article will examine the methods of limiting blood loss during surgical procedures.
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Affiliation(s)
- Jose P Sterling
- University of Texas, Southwestern Medical School, Dallas, TX, USA
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39
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Abstract
The aim of the study was to reassess surgical protocols developed and introduced in 2005; to examine the changes that have been made and to understand why they have been necessary or felt to be an improvement on the original; and to introduce a new protocol to assist with burn depth assessment. A discussion of how the protocols were developed and the environment in which they are used is undertaken. Four years of experience using the protocols has been accrued. An examination of alterations is performed. The protocols have allowed a single-handed practitioner to deal successfully with a large caseload and enabled a greater understanding of time and resource management. The original development of the protocols was worthwhile but their continued evolution by frequent audit and evaluation of innovations in burn care is mandatory.
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Affiliation(s)
- John E Greenwood
- Burns Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia
| | - Sheila Kavanagh
- Burns Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia
| | - Ian P Mackie
- Burns Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia
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40
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Posluszny JA, Gamelli RL. Anemia of thermal injury: combined acute blood loss anemia and anemia of critical illness. J Burn Care Res 2010; 31:229-42. [PMID: 20182361 DOI: 10.1097/bcr.0b013e3181d0f618] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Joseph A Posluszny
- Loyola University Medical Center Burn and Shock Trauma Institute, Maywood, Illinois, USA
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41
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Abstract
Early excision of the burn eschar has been one of the most significant advances in modern burn care. Historical advances in understanding of the pathophysiology of burn injury and the systemic inflammatory response fueled by the burn wound, and refinements in the techniques of tangential and fascial excision, have led to earlier excision and grafting of the burn wound with improvements in morbidity and mortality. Efforts to control blood loss, and good operative planning and attention to special areas, can lead to the safe excision and grafting of large burns.
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Affiliation(s)
- Michael J Mosier
- Department of Surgery, Harborview Medical Center, University of Washington Regional Burn Center, Seattle, 98104, USA
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42
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Kamolz LP, Kitzinger HB, Karle B, Frey M. The treatment of hand burns. Burns 2009; 35:327-37. [DOI: 10.1016/j.burns.2008.08.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 08/12/2008] [Indexed: 12/12/2022]
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43
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Recombinant Thrombin: Safety and Immunogenicity in Burn Wound Excision and Grafting. J Burn Care Res 2009; 30:371-9. [DOI: 10.1097/bcr.0b013e3181a28979] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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Affiliation(s)
- Dennis P Orgill
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
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45
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Gacto P, Miralles F, Pereyra JJ, Perez A, Martínez E. Haemostatic effects of adrenaline-lidocaine subcutaneous infiltration at donor sites. Burns 2008; 35:343-7. [PMID: 18950945 DOI: 10.1016/j.burns.2008.06.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 06/30/2008] [Indexed: 11/17/2022]
Abstract
This study sought methods in burn surgery to reduce postoperative pain and blood loss at donor sites. A prospective, randomised, controlled, blinded trial included 56 people undergoing burn surgery, divided into two groups. Both groups received subcutaneous infiltration at donor sites, with either 1:500,000 adrenaline solution containing added lidocaine or with 0.45% normal saline (controls). Outcome measurements included amount of intraoperative bleeding, need for electrocautery, days the hydrocolloid dressing remained on donor sites, percentage of re-epithelialised skin at donor sites 1 week after surgery and viability of skin grafts. Results indicated that subcutaneous adrenaline-lidocaine infiltration at donor sites reduced intraoperative bleeding, decreased postoperative pain, shortened the duration of surgery and general anaesthesia and accelerated re-epithelialisation at the donor site. The overall graft take in both groups was similar.
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Affiliation(s)
- P Gacto
- Department of Plastic and Reconstructive Surgery, Virgen del Rocío University Hospitals, Sevilla, Spain.
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46
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47
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Improved Survival Following Thermal Injury in Adult Patients Treated at a Regional Burn Center. J Burn Care Res 2008. [DOI: 10.1097/bcr.0b013e31815f6efd] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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49
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Recombinant FVIIa decreases perioperative blood transfusion requirement in burn patients undergoing excision and skin grafting—Results of a single centre pilot study. Burns 2007; 33:435-40. [DOI: 10.1016/j.burns.2006.08.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2005] [Accepted: 08/14/2006] [Indexed: 11/23/2022]
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50
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Vogt PM, Jokuszies A, Niederbichler A, Busch K, Choi CY, Kall S. [Early surgical management of severe burns]. Unfallchirurg 2007; 109:270-7. [PMID: 16575555 DOI: 10.1007/s00113-006-1073-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The success of modern burn therapy is based on an understanding of the pathophysiology and application of burn intensive care implying fluid resuscitation and management of pulmonary or other organ failure. With the development of early eschar excision and wound closure by immediate grafting, survival and cosmetic outcome were further improved. Especially in post-acute therapy, early physical rehabilitation, early reintegration, and early plastic surgical correction of the sequelae are indispensable for the outcome.
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Affiliation(s)
- P M Vogt
- Klinik und Poliklinik für Plastische, Hand- und Wiederherstellungschirurgie, Zentrum für Schwerbrandverletzte, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover.
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