New Treatment modality for Burn Injury Related ARDS : High-Flow Nasal Oxygen Therapy in Major Burns

Pulmonary insufficiency is the primary cause of death in cases of major burns accompanied by inhalation damage. It is important to consider the impact on the face and neck in flame burns. Early implementation of bronchial hygiene measures and oxygenation treatment in inhalation injury can reduce mortality. This case series presents the effects of high-flow nasal oxygen application on patient outcomes in major burns and inhalation injury. This report discusses three different patients. One patient, a 29-year-old male with 35% TBSA burns, received high-flow nasal oxygen (HFNO) treatment for inhalation injury on the sixth day after the trauma. After 72 hours of HFNO application, the patient's pulmonary symptoms improved. The second patient had 60% TBSA burns and developed respiratory distress symptoms on the fifth day after the trauma. After 7 days of HFNO application, all symptoms and findings of acute respiratory distress syndrome (ARDS) were resolved. HFNO has used for the treatment of ARDS releated to major burn ( 60% of burned TBSA) 28 years-old patient and improvement was achived. The use of HFNO in pulmonary insufficiency among burn patients has not been reported previously. This series of patient cases demonstrates the successful application of HFNO in treating inhalation injury and burn-related ARDS. However, further clinical studies are necessary to increase its clinical utilization.

Physical Medicine Applications in Hand Burns: Treatment or Rehabilitation

The aim of this study is to investigate the contribution of concurrent physical therapy to the preservation of hand function in patients with hand burns. This retrospective cohort study included the records of adult patients who presented with hand burns between July 1, 2020, and December 1, 2021. A total of 67 of 1578 burn patients who attended the clinic were included in this study. The patients' age, sex, total BSA with burns, causative agent, depth of burn on the hand, right or left hand, location of the burned area on the hand, treatment applied, healing time of the burn on the hand, limitation of movement, the joint restrictions, contractures, and compliance with physical therapy were assessed and recorded. Among the 67 patients included, 82.1% (n = 55) had no limitation in terms of their joint range of motion, whereas 17.9% (n = 12) had a limitation of movement in their finger joints. When the prevalence of movement limitation was examined by gender, such limitation was found to be more common in females (P = .041). Moreover, contractures were found to occur more frequently in patients with full-thickness burns (P = .032). It was also found that the limitation of movement was more severe in patients with skin grafts (P = .044). In addition, it was observed that the recovery time of the burn area was longer in those patients who had movement limitations (P = .004). In this study, we found that applying early physical therapy to patients after burn injuries facilitated the recovery of hand functions.

Oxygen transmission rates of skin substitutes and graft survival

AIM

Oxygen is required for cell migration into the scaffold and for the survival of the overlying graft in the use of a single-layer scaffold. In the absence of diffusion from the avascular wound base, such as in areas above the bone/tendon, oxygen delivery from the lateral edges of the scaffold is important. This study compared the oxygen permeability of skin scaffolds, currently commercially available in Turkey (Nevelia®, MatriDerm®, and Pelnac®), in the lateral plane.

MATERIALS AND METHODS

To measure oxygen permeability, an interconnected closed system was created. Oxygen permeability was evaluated based on the color change that occurred as a result of the reaction of iron with oxygen. After the dermal matrices placed in the closed system were exposed to oxygen, the color change on the surface of the dermal matrices was measured, and electron microscopic images were recorded to compare deformation before and after the procedure.

RESULTS

Two scaffolds did not show deformation after the procedure while Pelnac® had minimal deformation. The oxygen rates on the nitrogen side of the test apparatus were found to be 29%, 34%, and 27% for Nevelia®, MatriDerm®, and Pelnac®, respectively; and the oxygen transmission lengths (length of color change) of these scaffolds in the lateral plane were 1, 2, and 0.5 cm, respectively.

CONCLUSION

Although none of the scaffolds showed significant deformation, and all continued to exhibit their scaffold properties after the procedure, MatriDerm® was determined to be the most suitable scaffold for use in avascular areas, with a 2-cm oxygen transmission length in terms of lateral oxygenation.

Comparison of the Efficiency of Epidermal Growth Factor and Negative Pressure Wound Therapy in Diabetic Foot Patients

Advanced modalities are used for wounds where conventional treatment is insufficient in diabetic foot patients. In this study, we investigated the effects of using Epidermal growth factor (EGF) and NPWTmodalities alone or in combination on the frequency and level of amputation. In the retrospective study, which included 286 patients in total, 76 patients were referred with the decision of amputation or amputation was planned during hospitalization. After the treatments, amputation and distalization of amputation were found 73.3% and 33.3% in the conventional treatment patients. While 86.4% amp and 18.2% amp distalization were found in negative pressure wound therapy (NPWT) only patients, this rate was 52.4% and 90.5% in EGF + NPWT patients, 50% and 83.3% in EGF only patients. While amp and distalization rates were found to be significantly better in those receiving only EGF or EGF + NPWT (P = .015, P = .017 respectively for amputation and P = .000 for distalization), no difference was found in those receiving EGF and EGF + NPWT. As a result of our study, although npwt contributed positively to the number and level of amputations compared to conventional treatment, a significant improvement was found in the number and level of amps when EGF was used alone or combined with NPWT. With this result, EGF was thought to be an important treatment modality that should be evaluated in diabetic foot ulcers (DFUs) without amputation decision.

Evaluation of liver injury in a tertiary hospital: a retrospective study

BACKGROUND

Liver is the most frequently injured intraabdominal organ following abdominal trauma. Liver injury in polytraumatized patients can vary from minor contusions to major lacerations and is associated with morbidity and mortality. The objective of this study was to evaluate the outcome of liver injury in polytraumatized patients.

METHODS

Only surgically treated 82 patients with liver injury over an eight year period (2005-2013) were included in this study and analyzed retrospectively. Data collected included demographics, laboratory findings, intraoperative findings, operative management, and outcome. The patients were divided into two groups and the mortality and survival data were compared.

RESULTS

The overall mortality rate was 18.3% (15 of 82 patients). 34 (41.5%) patients had blunt, forty-eight (48.5%) had penetrating trauma. There were multiple traumas in forty-seven (57%) patients. Forty-seven (57%) patients had total of seventy one coexisting intraabdominal injuries. Forty-six (56.1%) patients had stable and thirty-six (43.9%) had unstable hemodynamics on admission. In mortality group AST, ALT, LDH, APTT, PT, INR, and creatinine levels were high, fibrinogen levels and platelet counts were low on admission.

CONCLUSION

Hemodynamic instability, coexisting musculoskeletal and chest injury, high APTT, PT, INR, AST, ALT, LDH levels, and low fibrinogen levels and platelet counts on admission should be considered as predictive factors for mortality.