1
|
Mc Kittrick A, Kornhaber R, de Jong A, Allorto N, Vana LPM, Chong SJ, Haik J, Cleary M. The role of multiplatform messaging applications in burns care and rehabilitation: A systematic review. Burns 2024:S0305-4179(24)00083-4. [PMID: 38580579 DOI: 10.1016/j.burns.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/08/2024] [Accepted: 03/07/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Multiplatform messaging applications also referred to as cross-platform instant messaging play an important role in delivery of healthcare and education with its low cost, ease of use and accessibility. AIM To evaluate the existing evidence regarding the use of multiplatform messaging applications in facilitating consultations and decision-making processes in the context of burns care, as well as to assess the impact of such applications on burns care and rehabilitation. METHOD A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and PROSPERO protocol CRD42021265203. The CASP and JBI tools were used to evaluate the quality of the studies. Eight hundred fifty-three papers were retrieved from PubMed, CINAHL, Scopus, EMBASE and LILACS published up to July 2022 (updated August 2023) with no time restrictions applied. RESULTS An analysis of the seven studies included in this review, inclusive of 16 Multiplatform messaging applications, revealed six themes. These encompassed the utilization of social media for directing and managing clinical practice, as a mode of communication, for evaluating the quality-of-care provision, for investigating available platforms and their technological features, measuring quality of life and for examining issues related to confidentiality. CONCLUSION Multiplatform messaging applications offer a solution for individuals with burn injuries to stay in direct contact with burn specialist clinicians for their follow-up and subsequent rehabilitation phase of recovery.
Collapse
Affiliation(s)
- Andrea Mc Kittrick
- Department of Occupational Therapy, Royal Brisbane & Women's Hospital, Herston, QLD, Australia
| | - Rachel Kornhaber
- National Burns Center, Sheba Medical Center, Tel Hashomer, Israel; School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Bathurst, NSW, Australia.
| | | | - Nikki Allorto
- Pietermaritzburg Metropolitan Burn Service, South Africa
| | - Luiz Philipe Molina Vana
- Departamento de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Si Jack Chong
- Department of Plastics, Reconstructive and Aesthetics Surgery, Singapore General Hospital, Health Promotion Board Singapore, Singapore
| | - Josef Haik
- National Burns Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW, Australia
| |
Collapse
|
2
|
Chong SJ, Low ZL, Yick J, Khoo YC, Chua AWC. Achieving self-sufficiency in skin allograft: A Singapore experience. Burns 2024:S0305-4179(24)00026-3. [PMID: 38402119 DOI: 10.1016/j.burns.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/30/2024] [Indexed: 02/26/2024]
Abstract
AIM This paper describes how Singapore achieved skin allograft self-sufficiency in 2017 by adopting 5 key strategies in 2012. BACKGROUND Singapore General Hospital (SGH) established its own allograft recovery programme in 1998 but was still dependent on overseas allograft procurement. KEY STRATEGIES RESULTS: The allograft recovery programme expanded from 4 to all 20 institutions. Donor referrals increased by 42.9% from 35 in 2014 to over 50 currently. Donor numbers increased by 210%, rising from 4.5 per year before 2015 to an average of 14 per year from 2015 to 2022. The total allografts recovered increased by 223%, climbing from 13,000 to 42,000 annually. Cryopreservation was adopted, extending shelf life to 5.5 years and doubling storage capacity to more than 140,000 cm2 in 2022. CONCLUSION Singapore achieved skin allograft self-sufficiency with no overseas procurement since 2017.
Collapse
Affiliation(s)
- Si Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Zhen Luan Low
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
| | - Jialin Yick
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Yik Cheong Khoo
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Alvin Wen Choong Chua
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| |
Collapse
|
3
|
Kwong Lee MY, Beng Goh K, Xiuting Koh D, Jack Chong S, Boon Chua RS. The Telemedicine Demand Index and its Utility in Managing COVID-19 Case Surges. Telemed J E Health 2024; 30:545-555. [PMID: 37540147 DOI: 10.1089/tmj.2023.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Introduction: Telemedicine was an integral component in Singapore's COVID-19 management strategy, having been deployed at a national level in a centrally-administered program whereby patients at higher risk of developing severe COVID-19 disease were proactively assigned tele-consultations, whereas those at lower risk and seen by primary care physicians could request ad hoc tele-consultations. To better plan for fluctuations in telemedicine demand during the pandemic, the Telemedicine Demand Index (TDI) was developed. Methods: Three main factors influencing telemedicine demand were considered-characteristics of the Variant of Concern, prevailing health care policies, and the population's healthcare-seeking behaviour-from which 11 coefficients were derived for the TDI formula. The number of tele-consultations demanded is the product of the TDI and the total number of new COVID-19 cases for a given period. Results: Real-world data from January 31 to March 27, 2022 were compared with TDI estimates. A total of 148,485 tele-consultations were conducted against a backdrop of 723,675 new COVID-19 cases for the period. The TDI overestimated demand by an average 11.4%. Data from March 28 to May 1, 2022 were then used to derive new TDI values and applied to a 3-week period starting May 9, 2022, following a policy change. A total of 5,560 tele-consultations were conducted against a backdrop of 77,998 new COVID-19 cases. The TDI underestimated demand by an average of 7.2%. Conclusion: The TDI shows initial promise for quickly estimating telemedicine demand at a population level. By leveraging historical data and applying some informed assumptions, it allows for the estimation of current capabilities and future requirements. There remains scope for more research to refine the TDI's constituent components, as well as its applicability in different population contexts.
Collapse
Affiliation(s)
- Martin Yong Kwong Lee
- c/o Medical Operations and Policy Centre, Crisis Strategy and Operations Group, Ministry of Health, Singapore
| | - Kie Beng Goh
- c/o Medical Operations and Policy Centre, Crisis Strategy and Operations Group, Ministry of Health, Singapore
| | - Deanna Xiuting Koh
- c/o Medical Operations and Policy Centre, Crisis Strategy and Operations Group, Ministry of Health, Singapore
| | - Si Jack Chong
- c/o Medical Operations and Policy Centre, Crisis Strategy and Operations Group, Ministry of Health, Singapore
| | - Raymond Swee Boon Chua
- c/o Medical Operations and Policy Centre, Crisis Strategy and Operations Group, Ministry of Health, Singapore
| |
Collapse
|
4
|
Lee MYK, Koh DX, Chong SJ, Chua RSB. Potential hurdles to prescribing COVID-19 oral antivirals in primary and community care. Singapore Med J 2024:00077293-990000000-00066. [PMID: 38421121 DOI: 10.4103/singaporemedj.smj-2023-054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/02/2023] [Indexed: 03/02/2024]
Affiliation(s)
| | | | - Si Jack Chong
- Medical Operations and Policy Centre, Ministry of Health, Singapore
| | - Raymond Swee Boon Chua
- Deputy Director-General of Health (Health Regulation Group), Ministry of Health, Singapore
| |
Collapse
|
5
|
Chong SJ, Seah BZ, Jailani RI, Angeles DC, Chong XY, Lee JH. Assessment of COVID-19 Positive Rates Amongst COVID-19 Close Contacts Through the Health Risk Warning System. J Med Syst 2023; 47:54. [PMID: 37129753 PMCID: PMC10152438 DOI: 10.1007/s10916-023-01948-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/15/2023] [Indexed: 05/03/2023]
Abstract
From 6 Jan 22 to 17 Feb 22, a total of 729,367 close contacts classified into four distinct groups (i.e., household, social, school and nursing/ welfare home contacts) were managed by the Health Risk Warning system. High COVID-19-positive rates were demonstrated amongst household contacts, i.e., 10.9% (37,220/342,302) were detected via antigen rapid test kits and 56.5% (4,952/8,767) were detected via polymerase chain reaction testing. Household contacts represent the highest risk of being infected by virtue of the sustained close-proximity interactions in the household setting. Social, school and nursing/ welfare home contacts continue to remain at-risk groups for close monitoring. At a population level, household and symptomatic close contacts should be the groups of focus in the early phases of the pandemic, including future potential waves involving COVID-19 variants of concern.
Collapse
Affiliation(s)
- Si Jack Chong
- Medical Operations and Policy Centre, Ministry of Health, 1 Maritime Square #11-18 HarbourFront Centre, Singapore, 099253, Singapore
- Health Alert Task Group, Ministry of Health, Singapore, Singapore
| | - Benjamin Zq Seah
- Medical Operations and Policy Centre, Ministry of Health, 1 Maritime Square #11-18 HarbourFront Centre, Singapore, 099253, Singapore.
| | - Rehmen I Jailani
- Health Alert Task Group, Ministry of Health, Singapore, Singapore
| | - Dario C Angeles
- Medical Operations and Policy Centre, Ministry of Health, 1 Maritime Square #11-18 HarbourFront Centre, Singapore, 099253, Singapore
| | | | - Joan Hin Lee
- Health Alert Task Group, Ministry of Health, Singapore, Singapore
| |
Collapse
|
6
|
Seah BZ, Jailani RI, Law PY, Teo RS, Chong XY, Law O, Chong SJ. COVID-19 Close Contact Management: An Evolution of Operations Harnessing the Digital Edge. J Med Syst 2023; 47:24. [PMID: 36781557 PMCID: PMC9925361 DOI: 10.1007/s10916-023-01918-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/08/2023] [Indexed: 02/15/2023]
Abstract
Singapore, like many other nations globally, had to contend with significant caseloads arising from the Coronavirus disease (COVID-19) pandemic. This paper focuses on using technology as an intervention for pandemic management. With scant scientific evidence on effective medications and vaccinations (i.e., pharmaceutical interventions) initially, disease containment strategies predominated during the early phases. Non-pharmaceutical interventions were critical in slowing disease transmission and preventing public healthcare institutions from being overwhelmed. Such interventions could be broadly divided into case-based interventions (e.g., contact tracing and quarantining of close contacts) and population-based measures (e.g., mask use and social distancing). The paper describes Singapore's experience in the operational implementation of contact-based interventions, and illustrates how harnessing the digital edge enabled fast, accurate, resource-efficient, and flexible execution of ground operations. Singapore applied digital technology and developed an integrated system to facilitate issuance and acknowledgement of quarantine orders, submission of COVID-19 test results, and collection of antigen rapid test kits at the population level. Data was obtained from this proprietary centralised, automated platform. The paper demonstrates how such simple, yet elegant systems could have a direct impact on disease transmission in an outbreak setting and on population health. Moving forward, it is recommended that technology and digital solutions feature prominently in work process designs beyond COVID-19 such as in the management of emerging infectious diseases and non-communicable diseases.
Collapse
Affiliation(s)
- Benjamin Zq Seah
- Medical Operations and Policy Centre, Ministry of Health, 1 Maritime Square, #11-18 HarbourFront Centre, 099253, Singapore, Singapore.
| | - Rehmen I Jailani
- Health Alert Task Group, Ministry of Health, Singapore, Singapore
| | - Peter Yc Law
- Health Alert Task Group, Ministry of Health, Singapore, Singapore
| | - Roger Sm Teo
- Health Alert Task Group, Ministry of Health, Singapore, Singapore
| | - Xin Ying Chong
- Health Alert Task Group, Ministry of Health, Singapore, Singapore
| | - Olivia Law
- Medical Operations and Policy Centre, Ministry of Health, 1 Maritime Square, #11-18 HarbourFront Centre, 099253, Singapore, Singapore
| | - Si Jack Chong
- Medical Operations and Policy Centre, Ministry of Health, 1 Maritime Square, #11-18 HarbourFront Centre, 099253, Singapore, Singapore
- Health Alert Task Group, Ministry of Health, Singapore, Singapore
| |
Collapse
|
7
|
Koh Xiuting D, Seah Zhi Qiang B, Chong SJ, Cruz Angeles D. Management of haemodialysis patients with COVID-19 in the Omicron BA.4 and BA.5 wave. Nephrology (Carlton) 2022; 27:1005-1006. [PMID: 36251158 PMCID: PMC9874509 DOI: 10.1111/nep.14116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/26/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Deanna Koh Xiuting
- Medical Operations and Policy Cell, Ministry of HealthGovernment of SingaporeSingaporeSingapore
| | - Benjamin Seah Zhi Qiang
- Medical Operations and Policy Cell, Ministry of HealthGovernment of SingaporeSingaporeSingapore
| | - Si Jack Chong
- Medical Operations and Policy Cell, Ministry of HealthGovernment of SingaporeSingaporeSingapore
| | - Dario Cruz Angeles
- Medical Operations and Policy Cell, Ministry of HealthGovernment of SingaporeSingaporeSingapore
| |
Collapse
|
8
|
Chow SHD, Chong SJ. A strategy to make COVID-19 vaccination more accessible to the elderly. Ann Acad Med Singap 2022. [DOI: 10.47102/annals-acadmedsg.2022277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Soon Hoong Daniel Chow
- Healthier SG Task Group, Crisis Strategy and Operations Group, Ministry of Health, Singapore
| | - Si Jack Chong
- Medical Operations and Policy Centre, Crisis Strategy and Operations Group, Ministry of Health, Singapore
| |
Collapse
|
9
|
Seah BZQ, Koh ETC, Lim EWT, Vasoo S, Chong SJ. Applicability and benefits of telemedicine in the monitoring of monkeypox close contacts. J Telemed Telecare 2022:1357633X221130290. [PMID: 36245389 DOI: 10.1177/1357633x221130290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Monkeypox is a zoonotic disease caused by the monkeypox virus and classically presents as a vesicular rash accompanied by fever and lymphadenopathy. Singapore reported the first imported case of monkeypox infection on 21 June 2022, the first local unlinked case on 6 July 2022, and the first local linked case on 5 August 2022. Telemedicine was used in the management of monkeypox close contacts to (1) screen for the development of signs and symptoms consistent with monkeypox infection, (2) assess for successful post-exposure prophylaxis via direct visualisation of vaccination site morphological progression, (3) detect serious reactions arising from post-exposure prophylaxis administration, and (4) evaluate for deterioration in mental health status during the 21-day quarantine period. A case series of 13 close contacts who received post-exposure prophylaxis in the form of the ACAM2000 live Vaccinia virus preparation is presented, illustrating the safe and efficacious application of telemedicine in the clinical follow-up of quarantined close contacts throughout the 21-day incubation period, and post-exposure prophylaxis monitoring. Inherent limitations included difficulties in the assessment of sensitive areas such as the peri-genital and peri-anal regions and video quality-related issues.
Collapse
Affiliation(s)
| | | | | | - Shawn Vasoo
- 534956National Centre for Infectious Diseases, Singapore
| | - Si Jack Chong
- Medical Operations and Policy Centre, Ministry of Health, Singapore
| |
Collapse
|
10
|
Koh DX, Chen JJ, Lee MYK, Tan CS, Tan EWL, Chong SJ, Dan YY. Healthcare policy for COVID-19 patients on haemodialysis: Adapting to the changing needs of the Omicron variant. Nephrology (Carlton) 2022; 27:845-846. [PMID: 35946532 PMCID: PMC9538061 DOI: 10.1111/nep.14082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Deanna Xiuting Koh
- Medical Operations and Policy CellGovernment of Singapore Ministry of HealthSingapore
| | - James Jianhong Chen
- Hospital Services DivisionGovernment of Singapore Ministry of HealthSingapore
| | - Martin Yong Kwong Lee
- Medical Operations and Policy CellGovernment of Singapore Ministry of HealthSingapore
| | | | | | - Si Jack Chong
- Medical Operations and Policy CellGovernment of Singapore Ministry of HealthSingapore
| | - Yock Young Dan
- Hospital Services GroupGovernment of Singapore Ministry of HealthSingapore
| |
Collapse
|
11
|
Kok TWK, Chong SJ, Yau WKJ, Raj Kumar P, Chua SBR. Nationwide implementation of a centralised telemedicine platform in Singapore to fight the COVID-19 pandemic. J Telemed Telecare 2022:1357633X221122890. [PMID: 36046925 PMCID: PMC9434191 DOI: 10.1177/1357633x221122890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION This study aims to share the experience of the Ministry of Health (Singapore) in deploying a centrally managed Telemedicine service to triage, and manage COVID-19 cases in the community during the COVID-19 Omicron wave. MATERIAL AND METHODS Data from the deployed telemedicine system, Telemedicine Allocation and Reconciliation System, over a 14-week period (3 January 2022-10 April 2022) was analysed to determine the safety and efficacy of both the (i) National COVID-19 sorting logic algorithm and (ii) the use of a centralised telemedicine platform with privacy protection in a pandemic. RESULTS There was a total of 47,754 children (aged 1-11 years old), 75,702 adolescents and adult patients (aged 12-69 years old) and 55,774 geriatric patients (aged > = 70 years old) who were directly managed by this platform. Amongst them, 64,961 were from the higher-risk special populations (pregnant, end-stage renal failure and immunocompromised and geriatric population).The total number of patients requiring escalations to public health institutions were 4212. This accounts for 1.32%, 3.00% and 2.35% of the children, teenagers and adults, and geriatric population respectively.
Collapse
Affiliation(s)
- Ta Wei Kevin Kok
- Government of Singapore, Ministry
of Health, Medical Operations and Policy Cell, Singapore
| | - Si Jack Chong
- Government of Singapore, Ministry
of Health, Medical Operations and Policy Cell, Singapore
| | - Wen Kien Joachim Yau
- Government of Singapore, Ministry
of Health, Medical Operations and Policy Cell, Singapore
| | - Praveen Raj Kumar
- Government of Singapore, Ministry
of Health, Medical Operations and Policy Cell, Singapore
| | - Swee Boon Raymond Chua
- Government of Singapore, Ministry
of Health, Medical Operations and Policy Cell, Singapore
| |
Collapse
|
12
|
Tan HMG, Chung L, Chong XY, Joethy J, Chong SJ. A simple mnemonic, B.U.R.N.S., for burns first aid. Burns 2022; 48:841-845. [PMID: 34903415 DOI: 10.1016/j.burns.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Burn injuries remain common in the world, with an average of more than thousands of cases requiring medical attention each year. Singapore sees an average of 220 burns admissions annually. Given the high number of burn cases in Singapore, the authors identified that there is a need for more public awareness on first aid burn treatment. Acute management of burns can improve eventual patient outcome. The authors devised a simple mnemonic that can be used in burns education for first aid treatment, intended to be taught to trained personnel, who will have the first contact with these burn patients. The aim of the study was to assess the viability of implementing this mnemonic, B.U.R.N.S, to facilitate first aid education for burns. MATERIAL AND METHODS In this study, we presented this mnemonic as a poster to 30 full-time burn care medical professionals. Feedback was then obtained from this group of medical professionals and used to revise the mnemonic. The mnemonic was then subsequently taught to 400 medical professionals, who are predominantly involved in the pre-hospital management of burns. They are then asked to reiterate the mnemonic to test the ease of remembering the mnemonic. Objective feedback was obtained with a 5-point scoring system. RESULTS The results indicated a significant improvement in burn first aid knowledge after the implementation of the mnemonic, from a score of 3.67-4.77, The content was deemed as appropriate and easy to understand and recall, and participants were able to reiterate the content, and will recommend this mnemonic to be used for burns teaching for first aid. CONCLUSION The study results suggest that this B.U.R.N.S. mnemonic and visual aid is simple and easy to apply, especially for uniformed personnel, as these individuals may have the first contact with the burns victims, and it is important for them to render the appropriate burns first aid treatment. Overall, burns first aid awareness and education can be improved with the implementation of this mnemonic and poster. Moving forward, we aim to integrate the B.U.R.N.S. into educational programmes in professional institutions involved in responding to burns (medical and nursing schools of Singapore), as well as in schools and public institutions, for educational purpose to raise public awareness. We wish to also be able to do so on an international level when courses are conducted.
Collapse
Affiliation(s)
- Hui Min Grace Tan
- Department of Plastics, Reconstructive and Aesthetics Surgery Singapore General Hospital, Singapore.
| | - Luther Chung
- Department of Plastics, Reconstructive and Aesthetics Surgery Singapore General Hospital, Singapore
| | - Xin Ying Chong
- Department of Plastics, Reconstructive and Aesthetics Surgery Singapore General Hospital, Singapore
| | - Janna Joethy
- Department of Plastics, Reconstructive and Aesthetics Surgery Singapore General Hospital, Singapore
| | - Si Jack Chong
- Department of Plastics, Reconstructive and Aesthetics Surgery Singapore General Hospital, Singapore
| |
Collapse
|
13
|
Chong SJ, Dorajoo SR, Ang SB, Tan IB, Tan C, Foong KP, Choo JS, Hsu LY, Yeo W, Bhasker E, Goh CS, Ismadi S, Neo CY, Wong MTK. Managing the COVID-19 pandemic in non-purpose-built dormitories. Ann Acad Med Singap 2021; 50:649-651. [PMID: 34472562 DOI: 10.47102/annals-acadmedsg.202114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Si Jack Chong
- Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Heng WL, Wang QW, Sornarajah R, Tremblay J, Putri NM, Hamid SSA, Pungrasmi P, Wang HJ, Kim DC, Saito D, Nguyen NL, Sulaiman WAW, Wardhana A, Puri V, Matsumura H, Dai NT, Ahuja RB, Luo G, He W, Chong SJ, Chua AWC. A Review of Skin Banking Guidelines and Standards Worldwide: Towards the Harmonization of Guidelines for Skin Banking in Therapeutic Applications for the Regions under the Asia Pacific Burn Association (APBA). Burns Trauma 2020; 8:tkaa019. [PMID: 33123605 PMCID: PMC7573737 DOI: 10.1093/burnst/tkaa019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/16/2020] [Indexed: 11/14/2022]
Abstract
Currently, there are no harmonized guidelines which govern skin banking in the Asia Pacific region. Therefore, skin banks are either unregulated or rely on their nation's legislation or international accreditation to uphold their quality standards. A new set of skin banking guidelines was developed through a comprehensive review and collation of best international practices for the Asia Pacific Burn Association (APBA) members, from donor screening and testing, to skin recovery, processing, storage and distribution, and quality assurance. National regulatory requirements reviewed include the European directives, Australia's Therapeutic Goods Administration and Singapore's tissue banking standards. Further technical and quality management recommendations are referenced from the American Association of Tissue Banks (AATB), the United States Food and Drug Administration standards and guidance documents, various relevant European guides, Japanese Society of Tissue Transplantation guidelines and the Asia Pacific Association of Surgical Tissue Banking. Adapted mainly from the AATB standards, the new Asia Pacific Burn Association Guidelines for Skin Banking in Therapeutic Applications offer a comprehensive manual, addressing: governance and contracts; staff responsibilities; quality management; facilities, equipment and supplies management; donor consent and testing; and recommendations of good practices pertaining to skin recovery, processing, storage and distribution. Besides complementing current generic regulations, they provide technical specifications of major aspects unaddressed in most legislations. This inaugural set of new regional skin banking guidelines would be a start for regional members of the APBA to adopt, and will hopefully culminate in a set of standards so that, in the long run, skin allografts from this region can be of similar quality, which can simplify import process and facilitate the exchange of allografts between members.
Collapse
Affiliation(s)
- Wee Ling Heng
- Transplant Tissue Centre, Singhealth Duke-NUS Transplant Centre, Singapore
| | - Qi Wei Wang
- Transplant Tissue Centre, Singhealth Duke-NUS Transplant Centre, Singapore
| | - Renuka Sornarajah
- Heart Valve and Tissue Bank, Lady Ridgeway Hospital for Children, Dr Danister De Silva Mawatha, Colombo, Sri Lanka
| | | | - Nandita Melati Putri
- Burn Unit, Faculty of Medicine, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Suzina Sheikh Ab Hamid
- Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Pornthep Pungrasmi
- Plastic and Reconstructive Surgery Division, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Hsian-Jenn Wang
- Plastic and Reconstructive Surgery, Taipei Medical University, Taipei, Chinese Taipei
| | - Dong Chul Kim
- Plastic and Reconstructive Surgery, Bundang Jesaeng Hospital, Seongnam, South Korea
| | - Daizo Saito
- Division of Traumatology, Research Institute, National Defence Medical College, Saitama, Japan
| | | | - Wan Azman Wan Sulaiman
- Reconstructive Sciences Programme, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Aditya Wardhana
- Burn Unit, Faculty of Medicine, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Vinita Puri
- Department of Plastic Surgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Hajime Matsumura
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Niann-Tzyy Dai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Rajeev B Ahuja
- Plastic and Aesthetic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Gaoxing Luo
- Institute of Burn Research, Southwest Hospital, Army Medical University, Chongqing, China
| | - Weifeng He
- Institute of Burn Research, Southwest Hospital, Army Medical University, Chongqing, China
| | - Si Jack Chong
- Transplant Tissue Centre, Singhealth Duke-NUS Transplant Centre, Singapore
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Alvin Wen Choong Chua
- Transplant Tissue Centre, Singhealth Duke-NUS Transplant Centre, Singapore
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| |
Collapse
|
15
|
Feng J, Thangaveloo M, Ong YS, Chong SJ, Joethy JV, Becker DL. Connexin 43 upregulation in burns promotes burn conversion through spread of apoptotic death signals. Burns 2020; 46:1389-1397. [PMID: 32362363 DOI: 10.1016/j.burns.2020.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/04/2020] [Accepted: 03/20/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Burn wounds continue to worsen after initial injury in a process known as burn conversion, which lasts about 3-5 days. It causes burn wounds to enlarge and deepen, leading to greater morbidity. Apoptosis is one of the factors contributing to the conversion of the zone of stasis into the zone of coagulation. Suppression of apoptosis has been associated with reducing burn conversion. Connexin 43 (Cx43) gap junctions facilitate the spread of apoptotic signals from dying cells to healthy neighbouring cells in injured tissues through the bystander effect. OBJECTIVES The study is to understand the role of Cx43 in burn conversion. METHODS In our study, 15 burn tissue samples were arranged into three groups as early (beginning of burn conversion), intermediate (extensive burn conversion) and late (established burn conversion) burns. RESULTS We found a striking increase in the amount of Cx43 protein expressed in the dermal fibroblasts (identified with heat shock protein 47 (HSP47) staining) in the zone of stasis in early and intermediate burns. These dermal fibroblasts also express high levels of cleaved-Caspase 3 indicating on-going apoptosis. CONCLUSIONS Our findings suggest that elevation of Cx43 may play an active role in burn conversion spreading apoptosis in the early and intermediate burn wound.
Collapse
Affiliation(s)
- Jiajun Feng
- Department of Plastic, Reconstructive & Aesthetic Surgery, Singapore General Hospital, Singapore.
| | - Moogaambikai Thangaveloo
- Lee Kong Chian School of Medicine, Clinical Sciences Building, Nanyang Technological University 11, Mandalay Road, 308232 Singapore
| | - Yee Siang Ong
- Department of Plastic, Reconstructive & Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Si Jack Chong
- Department of Plastic, Reconstructive & Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Janna-Vale Joethy
- Department of Plastic, Reconstructive & Aesthetic Surgery, Singapore General Hospital, Singapore
| | - David L Becker
- Lee Kong Chian School of Medicine, Clinical Sciences Building, Nanyang Technological University 11, Mandalay Road, 308232 Singapore; Skin Research Institute Singapore, Clinical Sciences Building, 11, Mandalay Road, 308232 Singapore
| |
Collapse
|
16
|
Barret JP, Chong SJ, Depetris N, Fisher MD, Luo G, Moiemen N, Pham T, Qiao L, Wibbenmeyer L, Matsumura H. Burn center function during the COVID-19 pandemic: An international multi-center report of strategy and experience. Burns 2020; 46:1021-1035. [PMID: 32416984 PMCID: PMC7151262 DOI: 10.1016/j.burns.2020.04.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 11/25/2022]
Abstract
The novel coronavirus, SARS-CO V2 responsible for COVID-19 pandemic is rapidly escalating across the globe. Burn centers gearing for the pandemic must strike a balance between contributing to the pandemic response and preserving ongoing burn care in a safe and ethical fashion. The authors of the present communication represent seven burn centers from China, Singapore, Japan, Italy, Spain, the United Kingdom (UK), and the United States (US). Each center is located at a different point along the pandemic curve and serves different patient populations within their healthcare systems. We review our experience with the virus to date, our strategic approach to burn center function under these circumstances, and lessons learned. The purpose of this communication is to share experiences that will assist with continued preparations to help burn centers advocate for optimum burn care and overcome challenges as this pandemic continues.
Collapse
Affiliation(s)
- Juan P Barret
- Department of Plastic Surgery and Burns, Hospital Universitari Vall d'Hebron, Department of Surgery, School of Medicine, Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain.
| | - Si Jack Chong
- Department of Plastic Reconstructive and Aesthetic surgery, Singapore General Hospital, Academia 20 College Road, Singapore 169856, Singapore.
| | - Nadia Depetris
- Anaesthesia and Intensive Care, Città della Salute di Torino, corso Bramante, 88-10126, Torino, Italy.
| | - Mark D Fisher
- Division of Plastics and Reconstructive Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52240 USA.
| | - Gaoxing Luo
- Institute of Burn Research, Southwest Hospital Army (Third Military) Medical University, Chongqing 400038, China.
| | - Naiem Moiemen
- University Hospitals Birmingham Foundation Trust, (Heritage Building) Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK.
| | - Tam Pham
- Harborview Medical Center, 325 Ninth Ave, Box 359796, Seattle, WA, USA.
| | - Liang Qiao
- Department of Burn and Plastic Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai 200025, China.
| | - Lucy Wibbenmeyer
- Division of Acute Care Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, USA.
| | - Hajime Matsumura
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, 6-7-1 Nishishinjyuku, Shinjukuku, Tokyo, 160-0023, JAPAN.
| |
Collapse
|
17
|
Mayandi V, Wen Choong AC, Dhand C, Lim FP, Aung TT, Sriram H, Dwivedi N, Periayah MH, Sridhar S, Fazil MHUT, Goh ETL, Orive G, W Beuerman R, Barkham TMS, Loh XJ, Liang ZX, Barathi VA, Ramakrishna S, Chong SJ, Verma NK, Lakshminarayanan R. Multifunctional Antimicrobial Nanofiber Dressings Containing ε-Polylysine for the Eradication of Bacterial Bioburden and Promotion of Wound Healing in Critically Colonized Wounds. ACS Appl Mater Interfaces 2020; 12:15989-16005. [PMID: 32172559 DOI: 10.1021/acsami.9b21683] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Bacterial colonization of acute and chronic wounds is often associated with delayed wound healing and prolonged hospitalization. The rise of multi-drug resistant bacteria and the poor biocompatibility of topical antimicrobials warrant safe and effective antimicrobials. Antimicrobial agents that target microbial membranes without interfering with the mammalian cell proliferation and migration hold great promise in the treatment of traumatic wounds. This article reports the utility of superhydrophilic electrospun gelatin nanofiber dressings (NFDs) containing a broad-spectrum antimicrobial polymer, ε-polylysine (εPL), crosslinked by polydopamine (pDA) for treating second-degree burns. In a porcine model of partial thickness burns, NFDs promoted wound closure and reduced hypertrophic scarring compared to untreated burns. Analysis of NFDs in contact with the burns indicated that the dressings trap early colonizers and elicit bactericidal activity, thus creating a sterile wound bed for fibroblasts migration and re-epithelialization. In support of these observations, in porcine models of Pseudomonas aeruginosa and Staphylococcus aureus colonized partial thickness burns, NFDs decreased bacterial bioburden and promoted wound closure and re-epithelialization. NFDs displayed superior clinical outcome than standard-of-care silver dressings. The excellent biocompatibility and antimicrobial efficacy of the newly developed dressings in pre-clinical models demonstrate its potential for clinical use to manage infected wounds without compromising tissue regeneration.
Collapse
Affiliation(s)
- Venkatesh Mayandi
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
- School of Biological Sciences, Nanyang Technological University Singapore, 60 Nanyang Drive, 637551 Singapore
| | - Alvin Chua Wen Choong
- Department of Plastic Reconstructive & Aesthetic Surgery, Singapore General Hospital, 20 College Road, 169856 Singapore
- Skin Bank Unit, Singapore General Hospital, 169608 Singapore
| | - Chetna Dhand
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, 169857 Singapore
| | - Fui Ping Lim
- Alice Lee Centre for Nursing Studies, National University of Singapore, 117597 Singapore
| | - Thet Tun Aung
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
- Department of Microbiology and Immunology, National University of Singapore, 119077 Singapore
| | - Harini Sriram
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
| | - Neeraj Dwivedi
- Department of Electrical and Computer Engineering, National University of Singapore, 117583 Singapore
| | - Mercy Halleluyah Periayah
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
| | - Sreepathy Sridhar
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
| | - Mobashar Hussain Urf Turabe Fazil
- Lee Kong Chian School of Medicine, Clinical Sciences Building, Nanyang Technological University Singapore, 11 Mandalay Road, 308232 Singapore
| | - Eunice Tze Leng Goh
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz 01006, Spain
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz 01006, Spain
- University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria 01006, Spain
| | - Roger W Beuerman
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, 169857 Singapore
| | | | - Xian Jun Loh
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 138634 Singapore
| | - Zhao-Xun Liang
- School of Biological Sciences, Nanyang Technological University Singapore, 60 Nanyang Drive, 637551 Singapore
| | - Veluchamy Amutha Barathi
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, 169857 Singapore
| | - Seeram Ramakrishna
- Center for Nanofibers & Nanotechnology, National University of Singapore, 119077 Singapore
| | - Si Jack Chong
- Department of Plastic Reconstructive & Aesthetic Surgery, Singapore General Hospital, 20 College Road, 169856 Singapore
- Skin Bank Unit, Singapore General Hospital, 169608 Singapore
| | - Navin Kumar Verma
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
- Lee Kong Chian School of Medicine, Clinical Sciences Building, Nanyang Technological University Singapore, 11 Mandalay Road, 308232 Singapore
- Skin Research Institute of Singapore, Clinical Sciences Building, 11 Mandalay Road, 308232 Singapore
| | - Rajamani Lakshminarayanan
- Anti-Infectives Research Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, 169856 Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, 169857 Singapore
- Department of Pharmacy, National University of Singapore, 18 Science Drive, 117543 Singapore
| |
Collapse
|
18
|
Koniman R, Kaushik M, Teo SH, Tan CW, Li HH, Foo WYM, Tan BK, Chong SJ, Tan HK. Renal outcomes of intensive care burn patients in an Asian tertiary centre. Burns 2019; 46:400-406. [PMID: 31447203 DOI: 10.1016/j.burns.2019.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/09/2019] [Accepted: 07/27/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Acute kidney injury (AKI) is a frequent complication of severe burn injury and is associated with a high mortality rate of up to 80%. We aimed to establish the incidence, mortality rate, and factors related to mortality in adult patients with severe burn injury and AKI with renal replacement therapy (RRT) in Singapore. METHODS We performed a retrospective cohort study of severely burned patients who were admitted to the Burns Intensive Care Unit (BICU) at the Singapore General Hospital (SGH) from January 2008 to December 2016. We compared patients with AKI with RRT who survived with those who did not survive. As there were changes in the protocol for burns management after 2013, we also compared patients with AKI with RRT who survived with non-survivors in each of the 2008-2012 and 2013-2016 cohorts. RESULTS Data of 201 patients were studied. The incidence of AKI with RRT use in severe burn injury was 21.9% and their mortality rate was 50.0%. The non-survivors had significantly higher median burned total body surface area (p = 0.043), earlier AKI (p = 0.046), earlier use of RRT (p = 0.035), lower rate of renal recovery (p = <0.0001), higher rates of adult respiratory distress syndrome (ARDS) (p = 0.005) and shock with vasopressors (p = 0.009) compared to the survivors. The survival rate was 36.8% in the 2008-2012 cohort, but improved to 60.0% in the 2013-2016 cohort. In the 2008-2012 cohort, the non-survivors developed AKI earlier (day 0 admission vs. day 3 admission, p = 0.039), and were initiated on RRT at lower serum creatinine level (173.5 μmol/L vs. 254.0 μmol/L, p = 0.042), when compared to the survivors in this same cohort. On the other hand, there were no significant differences in the renal status and fluid balance parameters between the non-survivors and survivors in the 2013-2016 cohort. CONCLUSIONS The incidence of AKI with RRT in the Singapore study cohort was high, but their mortality rate was relatively lower compared to other study cohorts. Severity of AKI and use of RRT were associated with poor prognosis. Large scale study is required to further study the risk factors for mortality in this group of patients and establish cause-and-effect relationship.
Collapse
Affiliation(s)
- Riece Koniman
- Department of Renal Medicine, Singapore General Hospital, Singapore.
| | - Manish Kaushik
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Su Hooi Teo
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Chee Wooi Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Hui Hua Li
- Division of Medicine, Singapore General Hospital, Singapore
| | | | - Bien Keem Tan
- Department of Plastic, Reconstructive & Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Si Jack Chong
- Department of Plastic, Reconstructive & Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Han Khim Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| |
Collapse
|
19
|
Abstract
Inhalation injury is a serious consequence of a fire or an explosion, with potential airway compromise and respiratory complications. We present a case series of five patients with inhalational burns who presented to Singapore General Hospital and discuss our approach to their early management, including early evaluation and planning for the upper and lower airway, coexisting cutaneous burns, and monitoring their ICU (intensive care unit) severity of illness, sepsis and acute respiratory distress syndrome. All five patients suffered various grades of inhalation injury. The patients were initially assessed by nasolaryngoscopy, and three patients were prophylactically intubated before being sent to the emergency operating theatre for definitive airway and burns management with fibreoptic bronchoscopy. All patients were successfully extubated and discharged stable. Various complications can arise as a result of an inhalation injury. Based on our cases and literature review, we propose a standardised workflow for patients with inhalation injury.
Collapse
Affiliation(s)
- Suneel Ramesh Desai
- Department of Surgical Intensive Care, Singapore General Hospital, Singapore.,Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Delong Zeng
- Department of Burns and Plastic Surgery, Singapore General Hospital, Singapore
| | - Si Jack Chong
- Department of Burns and Plastic Surgery, Singapore General Hospital, Singapore
| |
Collapse
|
20
|
Joethy J, Koh K, Wong AWJ, Cheng A, Sellam S, Chong SJ. Initial impression of the CelluTome™ Epidermal Harvesting System in burns management. Burns Open 2019. [DOI: 10.1016/j.burnso.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
21
|
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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/18/2018] [Accepted: 03/09/2018] [Indexed: 12/30/2022]
|
22
|
Chong SJ, Kok YO, Tay RXY, Ramesh DS, Tan KC, Tan BK. Quantifying the impact of inhalational burns: a prospective study. Burns Trauma 2018; 6:26. [PMID: 30238012 PMCID: PMC6139897 DOI: 10.1186/s41038-018-0126-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 07/16/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Inhalational injury is a major cause of morbidity and mortality in burns patients. This study aims to analyse the clinical outcomes, complications and bacteriology of inhalational burn patients. METHODS A prospective study was done on consecutive admissions to Burn Department, Singapore General Hospital over 15 months from January 2015 to March 2016. Presence of inhalational injury, demographics, complications and outcomes was recorded. Diagnosis of inhalational injury was based on history, symptoms and nasoendoscopy. Diagnosis of acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and infective complications were according to the Berlin criteria, acute kidney injury network (AKIN) classification stage 2 and above and the American Burns Association guidelines. RESULTS Thirty-five patients (17.3%) had inhalational burns out of 202 patients (63.4% male, 57.4% Chinese population). The average age was 43 ± 16.7 years (range 16-86), and percentage of total body surface area (%TBSA) was 12.1 ± 18.0 (range 0-88). In patients with inhalational injury, age was 38.9 ± 17.2 years and %TBSA was 30.3 ± 32.3. In patients without inhalational injury, age was 44.1 ± 12.8 years and %TBSA was 8.3 ± 9.59. Compared to patients with cutaneous injury alone, patients with inhalational burns had more surgeries (3 ± 7.07 vs 1 ± 1.54, p = 0.003), increased length of stay (21 days vs 8 days, p = 0.004) and higher in-hospital mortality rate (17.1% vs 0.6%, p < 0.001). Incidence of ARDS and AKI was 48.6% and 37.1%, respectively, compared to 0.6% and 1.2% in the patients without inhalational injury (p < 0.001). Patients with inhalational injury had increased incidence of bacteraemia (31.4% vs 2.4%, p < 0.001), pneumonia (37.1% vs 1.2%, p < 0.001) and burn wound infection (51.4% vs 25.1%, p = 0.004). Inhalational injury predicted AKI with an adjusted odds ratio (OR) of 17.43 (95% confidence interval (CI) 3.07-98.87, p < 0.001); ARDS, OR = 106.71 (95% CI 12.73-894.53, p < 0.001) and pneumonia, OR = 13.87 (95% CI 2.32-82.94, p = 0.004). Acinetobacter baumannii was the most frequently cultured bacteria in sputum, blood and tissue cultures with inhalational injury. Gram-negative bacteria were predominantly cultured from tissue in patients with inhalational injury, whereas gram-positive bacteria were predominantly cultured from tissue in patients without inhalational injury. CONCLUSIONS Inhalational injury accompanying burns significantly increases the length of stay, mortality and complications including AKI, ARDS, infection and sepsis.
Collapse
Affiliation(s)
- Si Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Level 5, Academia, Singapore, 169865 Singapore
| | - Yee Onn Kok
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Level 5, Academia, Singapore, 169865 Singapore
| | - Rosanna Xiang Ying Tay
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Level 5, Academia, Singapore, 169865 Singapore
| | - Desai Suneel Ramesh
- Department of Anaesthesiology, Singapore General Hospital, Level 5, Academia, Singapore, 169865 Singapore
| | - Kok Chai Tan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Level 5, Academia, Singapore, 169865 Singapore
| | - Bien Keem Tan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Level 5, Academia, Singapore, 169865 Singapore
| |
Collapse
|
23
|
Abstract
BACKGROUND The pubic region is often involved in accidental hot water or soup-spill burns. Most of these wounds are superficial partial thickness burns. Due to their proximity to the urinary system, as well as vaginal and anal openings, these burns are easily contaminated. Daily dressings are routinely prescribed as the sole treatment. The cumbersome dressing process is uncomfortable and embarrassing for patients. Biobrane™ is a bilayered biosynthetic dressing. Its coverage of superficial partial thickness burns promotes wound healing and allows one-time application. CASE PRESENTATIONS We report two patients who suffered superficial dermal burns over their pubic region. One patient had 23% total body surface area (TBSA) burns over her lower abdomen, both thighs and pubic region. The second patient had 10% TBSA burns that involved her perineum and the medial sides of both thighs and buttocks. Both were managed with the standard resuscitation protocol in the initial phase. Their burn injuries were managed by shaving, Foley catheterization and Biobrane™ coverage. Their wounds healed uneventfully without complications. Full epithelization was achieved by post-operative day seven. Both patients consented to medical photography and academic publication. CONCLUSION Shaving and catheterization improved the hygiene of the burns of the pubic area. The Biobrane™ method circumvents the need of regular dressing changes, eliminating the pain due to dressing changes and preserving patient dignity.
Collapse
Affiliation(s)
- Jia-Jun Feng
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore.
| | - Jia Le See
- University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Abby Choke
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Adrian Ooi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Si Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
24
|
Chua AWC, Khoo YC, Truong TTH, Woo E, Tan BK, Chong SJ. From skin allograft coverage to allograft–micrograft sandwich method: A retrospective review of severe burn patients who received conjunctive application of cultured epithelial autografts. Burns 2018; 44:1302-1307. [DOI: 10.1016/j.burns.2018.01.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 01/10/2018] [Accepted: 01/30/2018] [Indexed: 12/20/2022]
|
25
|
Ho CWG, Yang SH, Wong CH, Chong SJ. High-voltage electrical injury complicated by compartment syndrome and acute kidney injury with successful limb salvage: A case report and review of the literature. Int J Surg Case Rep 2018; 48:38-42. [PMID: 29787959 PMCID: PMC6026718 DOI: 10.1016/j.ijscr.2018.04.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 04/30/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Although an uncommon form of admission to a burns centre, the deep, penetrating nature of noxious currents mean that electrical burns have the most catastrophic consequences of all burn injuries. Understanding the physics of electricity is crucial to explaining the mechanisms of tissue damage and organ failure in electrical injuries which necessitate special management above and beyond that of regular thermal burns. PRESENTATION OF CASE We present a young man who suffered significant occupation-related electrical burns that was complicated by compartment syndrome, rhabdomyolysis and acute kidney injury. He required multiple surgeries (including fasciotomy as well as soft tissue reconstruction), critical care and lengthy rehabilitation. DISCUSSION Rhabdomyolysis is common sequela of electrical burns and may result in severe and permanent metabolic and renal impairment. High cut-off dialysis membranes have shown great promise in myoglobin removal but further studies are required to determine whether this improves clinical outcomes. Debridement and decompression are the cornerstones of initial surgical intervention and are crucial to minimising infectious complications and preserving vital structures. Free tissue transfer has become increasingly popular, but the ideal timing of microsurgery is still uncertain. Nonetheless, pedicled flaps remain widely used and still have an important role in reconstruction of electrical burns. CONCLUSION Patients with electrical injuries have several unique acute manifestations that differ from other burns. Prognosticating outcomes is difficult, as the full scale of damage is seldom immediately evident. Multiple organ systems are often affected, which makes the treatment of such patients exceptionally challenging, multi-disciplinary and resource-intensive.
Collapse
Affiliation(s)
- Christopher Wei Guang Ho
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road Singapore, 169608, Singapore.
| | - Shi-Hui Yang
- Department of General Surgery, Singapore General Hospital, Outram Road Singapore, 169608, Singapore.
| | - Chu Hui Wong
- Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road Singapore, 229899, Singapore.
| | - Si Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road Singapore, 169608, Singapore.
| |
Collapse
|
26
|
Khor SN, Chong SJ, Tan KC. Electric scooter burns and the danger of personal mobility device battery. ANZ J Surg 2018; 88:250. [PMID: 29512349 DOI: 10.1111/ans.14391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/17/2017] [Accepted: 12/19/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Shao Nan Khor
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Si Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Kok Chai Tan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| |
Collapse
|
27
|
Cheah AKW, Kangkorn T, Tan EH, Loo ML, Chong SJ. The validation study on a three-dimensional burn estimation smart-phone application: accurate, free and fast? Burns Trauma 2018; 6:7. [PMID: 29497619 PMCID: PMC5828346 DOI: 10.1186/s41038-018-0109-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 01/24/2018] [Indexed: 11/16/2022]
Abstract
Background Accurate total body surface area burned (TBSAB) estimation is a crucial aspect of early burn management. It helps guide resuscitation and is essential in the calculation of fluid requirements. Conventional methods of estimation can often lead to large discrepancies in burn percentage estimation. We aim to compare a new method of TBSAB estimation using a three-dimensional smart-phone application named 3D Burn Resuscitation (3D Burn) against conventional methods of estimation—Rule of Palm, Rule of Nines and the Lund and Browder chart. Methods Three volunteer subjects were moulaged with simulated burn injuries of 25%, 30% and 35% total body surface area (TBSA), respectively. Various healthcare workers were invited to use both the 3D Burn application as well as the conventional methods stated above to estimate the volunteer subjects’ burn percentages. Results Collective relative estimations across the groups showed that when used, the Rule of Palm, Rule of Nines and the Lund and Browder chart all over-estimated burns area by an average of 10.6%, 19.7%, and 8.3% TBSA, respectively, while the 3D Burn application under-estimated burns by an average of 1.9%. There was a statistically significant difference between the 3D Burn application estimations versus all three other modalities (p < 0.05). Time of using the application was found to be significantly longer than traditional methods of estimation. Conclusions The 3D Burn application, although slower, allowed more accurate TBSAB measurements when compared to conventional methods. The validation study has shown that the 3D Burn application is useful in improving the accuracy of TBSAB measurement. Further studies are warranted, and there are plans to repeat the above study in a different centre overseas as part of a multi-centre study, with a view of progressing to a prospective study that compares the accuracy of the 3D Burn application against conventional methods on actual burn patients.
Collapse
Affiliation(s)
- A K W Cheah
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, 1 Outram Road, Bukit Merah, Singapore
| | - T Kangkorn
- 2Department of Plastic and Reconstructive Surgery, Chonburi Hospital, 69 Sukhumvit Road, Muang Chonburi, Thailand
| | - E H Tan
- Navy Medical Service, Republic of Singapore Navy, 210 Tanah Merah Coast Road, Singapore, Singapore
| | - M L Loo
- Navy Medical Service, Republic of Singapore Navy, 210 Tanah Merah Coast Road, Singapore, Singapore
| | - S J Chong
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, 1 Outram Road, Bukit Merah, Singapore
| |
Collapse
|
28
|
Song CT, Chong SJ, Joethy J, Tan BK. Long interposition vein grafts: A method for subcutaneous tunneling. JPRAS Open 2017. [DOI: 10.1016/j.jpra.2017.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
29
|
Chong SJ, Kok YO, Choke A, Tan EW, Tan KC, Tan BK. Comparison of four measures in reducing length of stay in burns: An Asian centre’s evolved multimodal burns protocol. Burns 2017; 43:1348-1355. [DOI: 10.1016/j.burns.2017.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/11/2017] [Accepted: 03/13/2017] [Indexed: 11/25/2022]
|
30
|
Chong SJ, Choke A, Tan BK. Technical tips to enhance micrografting results in burn surgery. Burns 2017; 43:983-986. [DOI: 10.1016/j.burns.2017.01.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 12/31/2016] [Accepted: 01/23/2017] [Indexed: 11/27/2022]
|
31
|
Kok YO, Sim N, Tiwari P, Wong TH, Chong SJ. Establishing a treatment protocol for concomitant major burn and trauma patients: a tropical Asian hospital's experience. Burns Trauma 2017; 5:21. [PMID: 28691038 PMCID: PMC5497379 DOI: 10.1186/s41038-017-0088-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/22/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Yee Onn Kok
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Level 5, Academia, Singapore, 169865 Singapore
| | - Nadia Sim
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Level 5, Academia, Singapore, 169865 Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 11, NUHS Tower Block, Singapore, 119228 Singapore
| | - Priya Tiwari
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Level 8, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Ting Hway Wong
- Department of General Surgery, Singapore General Hospital, Level 5, Academia, Singapore, 169865 Singapore
| | - Si Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Level 5, Academia, Singapore, 169865 Singapore
| |
Collapse
|
32
|
Tan E, Lee HJ, Chong SJ. Use of Biobrane Glove Finger Sleeves on Nonintended Burn Wounds of the Hand-A Cost-Saving Method. J Hand Microsurg 2017; 9:54-56. [PMID: 28442868 DOI: 10.1055/s-0037-1599828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/30/2017] [Indexed: 10/20/2022] Open
Affiliation(s)
- Esther Tan
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - H J Lee
- Department of Plastics Reconstructive and Aesthetics, National University Hospital, Singapore
| | - S J Chong
- Department of Plastics Reconstructive and Aesthetics, Singapore General Hospital, Singapore
| |
Collapse
|
33
|
Feng J, Yong C, Bin Kasmin MR, Tan KC, Tan BK, Chong SJ. A preliminary report: The new protocol of managing acute partial-thickness hand burns. Proceedings of Singapore Healthcare 2016. [DOI: 10.1177/2010105816632540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Optimal hand function recovery is the key to the successful management of hand burns. It starts with a timely burns coverage in the acute setting. A new hand burns protocol has been introduced to cover hand burn wounds within 24 hours after admission. BiobraneTM and split skin graft (SSG) are the coverage methods for partial-thickness burns. A three-year prospective study is being carried out to evaluate the short- and long-term clinical and functional outcomes of the two treatment modalities. This paper reports the preliminary short-term results of the first 34 hand burns of the study. Methodology: This report includes consecutive hand burns patients admitted between September 2014 and May 2015. The recruited hand burns patients underwent clinical and functional assessments seven days after the coverage with either SSG or BiobraneTM. Statistical analysis was performed to evaluate the outcomes. Results and discussion: Eleven burnt hands were treated with SSG and 23 with BiobraneTM. The clinical and functional outcomes, including range of motion, power and sensitivity, were similar in both treatment groups. Further study to recruit more patients is necessary to ascertain the significance of the above findings. More importantly, long-term functional outcomes have to be assessed to conclude the treatment efficacy of early hand burns coverage with BiobraneTM or SSG.
Collapse
Affiliation(s)
- Jiajun Feng
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Cheryl Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Kok Chai Tan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Bien-Keem Tan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Si Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| |
Collapse
|
34
|
Chua AWC, Khoo YC, Tan BK, Tan KC, Foo CL, Chong SJ. Skin tissue engineering advances in severe burns: review and therapeutic applications. Burns Trauma 2016; 4:3. [PMID: 27574673 PMCID: PMC4963933 DOI: 10.1186/s41038-016-0027-y] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/11/2016] [Indexed: 01/13/2023]
Abstract
Current advances in basic stem cell research and tissue engineering augur well for the development of improved cultured skin tissue substitutes: a class of products that is still fraught with limitations for clinical use. Although the ability to grow autologous keratinocytes in-vitro from a small skin biopsy into sheets of stratified epithelium (within 3 to 4 weeks) helped alleviate the problem of insufficient donor site for extensive burn, many burn units still have to grapple with insufficient skin allografts which are used as intermediate wound coverage after burn excision. Alternatives offered by tissue-engineered skin dermal replacements to meet emergency demand have been used fairly successfully. Despite the availability of these commercial products, they all suffer from the same problems of extremely high cost, sub-normal skin microstructure and inconsistent engraftment, especially in full thickness burns. Clinical practice for severe burn treatment has since evolved to incorporate these tissue-engineered skin substitutes, usually as an adjunct to speed up epithelization for wound closure and/or to improve quality of life by improving the functional and cosmetic results long-term. This review seeks to bring the reader through the beginnings of skin tissue engineering, the utilization of some of the key products developed for the treatment of severe burns and the hope of harnessing stem cells to improve on current practice.
Collapse
Affiliation(s)
- Alvin Wen Choong Chua
- Singapore General Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, 20 College Road, Academia Level 4, Singapore, 169845 Singapore ; Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore ; Transplant Tissue Centre, c/o Skin Bank Unit, Singapore General Hospital, Block 4 Level 3 Room A7, Outram Road, Singapore, 169608 Singapore
| | - Yik Cheong Khoo
- Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore ; Transplant Tissue Centre, c/o Skin Bank Unit, Singapore General Hospital, Block 4 Level 3 Room A7, Outram Road, Singapore, 169608 Singapore
| | - Bien Keem Tan
- Singapore General Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, 20 College Road, Academia Level 4, Singapore, 169845 Singapore ; Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore ; Transplant Tissue Centre, c/o Skin Bank Unit, Singapore General Hospital, Block 4 Level 3 Room A7, Outram Road, Singapore, 169608 Singapore
| | - Kok Chai Tan
- Singapore General Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, 20 College Road, Academia Level 4, Singapore, 169845 Singapore ; Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore
| | - Chee Liam Foo
- Singapore General Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, 20 College Road, Academia Level 4, Singapore, 169845 Singapore ; Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore
| | - Si Jack Chong
- Singapore General Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, 20 College Road, Academia Level 4, Singapore, 169845 Singapore ; Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore ; Transplant Tissue Centre, c/o Skin Bank Unit, Singapore General Hospital, Block 4 Level 3 Room A7, Outram Road, Singapore, 169608 Singapore
| |
Collapse
|
35
|
Hwee J, Song C, Tan KC, Tan BK, Chong SJ. The trends of burns epidemiology in a tropical regional burns centre. Burns 2016; 42:682-6. [PMID: 26827188 DOI: 10.1016/j.burns.2015.10.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 10/06/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Singapore General Hospital (SGH) is a regional burns centre in Southeast Asia and is the only dedicated burns facility providing specialized burns care in Singapore. METHODS A cohort study was performed for burns patients admitted to SGH from 2011 to 2013. We compared our data with earlier studies and observed the trends of burns epidemiology in Singapore. Results were analyzed using the SPSS programme. RESULTS 655 patients were admitted during this study period, a 35.9% increase from 2003 to 2005. Scalding by water and flame injury remain the top causes of burns and the mean extent of burn is 9.5%. TBSA correlates with the incidence of burn infection, bacteremia and mortality. Patients with ≥20% TBSA are at a higher risk of bacteremia, and ≥ 34% TBSA is a predictor of mortality. 4.9% (n=32) of our patients developed bacteremia. Bacteremia was associated with a surgical duration of ≥80min. Patients with bacteremia incurred longer hospitalization, and had higher mortality rates. Overall mortality rate of our burns patients has decreased from 4.5% to 2.7% (n=18). Key factors of mortality include inhalational injury, bacteremia and ≥20% TBSA. CONCLUSION This is a large epidemiology study of a tropical region burns centre. A total of 655 burns cases over a 3-year period were analyzed. We analysed the key factors associated with adverse outcomes including burns infection, bacteremia and mortality, factors associated with mortality, and discussed strategies on the optimization of burns care.
Collapse
Affiliation(s)
- Jolie Hwee
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
| | - Christopher Song
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
| | - Kok Chai Tan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
| | - Bien Keem Tan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
| | - Si Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
| |
Collapse
|
36
|
Affiliation(s)
- May Chan
- School of Medicine; The University of Adelaide; Adelaide South Australia Australia
| | - Si Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery; Singapore General Hospital; Singapore
| |
Collapse
|
37
|
Song CT, Hwee J, Song C, Tan BK, Chong SJ. Burns infection profile of Singapore: prevalence of multidrug-resistant Acinetobacter baumannii and the role of blood cultures. Burns Trauma 2016; 4:13. [PMID: 27574683 PMCID: PMC4964067 DOI: 10.1186/s41038-016-0038-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 03/31/2016] [Indexed: 04/18/2023]
Abstract
BACKGROUND With various changes implemented such as perioperative antibiotics for tangential excision, this retrospective study reviews the infection profile of burn patients at Singapore's only centralized burns unit. Worldwide, the appearance of multidrug-resistant (MDR) strains of Acinetobacter baumannii (A. baumannii) continues to worsen patient outcomes. This study also surveys the role of blood cultures in burns at our unit. METHODS Four hundred fifty-two burn patients admitted to the unit between 2011 and 2013, and with cultures performed, were included in the study. The yields of various cultures were evaluated and 2684 samples were amassed, of which 984 (36.7 %) were positive. Patient variables for predictors of MDR A. baumannii infection acquisition and bacteremia were evaluated through multivariate analyses. RESULTS Pseuodomonas aeruginosa (P. aeruginosa) (67 patients) was the most common organism in those with total body surface area (TBSA) burn <20 % while MDR A. baumannii (39 patients) was most prevalent in those with TBSA burn ≥20 %. We found a yield of 1.1 % positive blood cultures for TBSA burn <20 % and a yield of 18.6 % positive cultures in TBSA burn ≥20 %. The median time between surgery and bacteremia was 6.5 days (range -18 to 68 days, interquartile range 4.5); 2.9 and 8.8 % of bacteremic episodes occurred within 24 and 48 h, respectively. This is a decrease from a predeceasing study (45.3 % for 24 h and 60 % for 48 h). Multivariate analysis revealed that length of hospital stay and TBSA burn ≥20 % were predictors of MDR A. baumannii infection and positive blood cultures. CONCLUSIONS MDR A. baumannii infection burdens patient management, especially in those with TBSA burn ≥20 % and longer hospital stay. Prophylactic antibiotics may reduce perioperative bacteremia, but their role in MDR infections needs to be evaluated. The role of blood cultures in TBSA burn <20 % needs reconsideration.
Collapse
Affiliation(s)
| | - Jolie Hwee
- Singapore General Hospital, Singapore, Singapore
| | - Colin Song
- Cape Clinic Singapore, Singapore, Singapore
| | | | | |
Collapse
|
38
|
|
39
|
Kok YO, Hui CLY, Chong SJ, Tan BK. Early Renal Replacement Therapy and Total Body Wrap Topical Negative Pressure Wound Therapy for Severe Burns and Rhabdomyolysis: A Case Report. Proceedings of Singapore Healthcare 2014. [DOI: 10.1177/201010581402300408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Severe burns, especially with acute kidney injury (AKI) and rhabdomyolysis, are strongly associated with morbidity and mortality. We highlight a successful case salvaged with a combination of early renal replacement therapy (RRT) and negative pressure wound therapy (NPWT) total body wrap (TBW) in a case involving 38% total body surface area (TBSA) burns with rhabdomyolysis.
Collapse
Affiliation(s)
- Yee Onn Kok
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Cheryl Li Yu Hui
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Si Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Bien Keem Tan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| |
Collapse
|
40
|
Affiliation(s)
- Kimberley Liqin Kiong
- Department of Plastic and Reconstructive Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
| | - Si Jack Chong
- Department of Plastic and Reconstructive Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Bien Keem Tan
- Department of Plastic and Reconstructive Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| |
Collapse
|
41
|
Abstract
In this study, we present a preliminary pictorial report on the use of Biobrane™ in the management of patients admitted with >10% Total Body Surface Area (TBSA) partial thickness burns, using a standardised application protocol. In highlighting a successful case series with Biobrane™ application to all key areas of the body, we demonstrate promising early results; all patients showed excellent wound healing following early application of Biobrane™. This ensures pain relief, allows early mobilisation and results in a shorter length of stay (7–28 days) in the hospital.
Collapse
Affiliation(s)
- Andrew Kim Wee Cheah
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Si Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Bien Keem Tan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| |
Collapse
|
42
|
Low OW, Chong SJ, Tan BK. The enhanced Total Body Wrap—The new frontier in dressing care for burns. Burns 2013; 39:1420-2. [DOI: 10.1016/j.burns.2013.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 03/21/2013] [Indexed: 10/26/2022]
|
43
|
Chong SJ, Kan EM, Song C, Soh CR, Lu J. Characterization of early thermal burns and the effects of hyperbaric oxygen treatment: a pilot study. Diving Hyperb Med 2013; 43:157-161. [PMID: 24122191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 06/16/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND AIMS Studies investigating hyperbaric oxygen treatment (HBOT) to improve outcome in burns have been inconclusive. In this study, we aimed to characterize early thermal burns injury in adult patients with < 40% total body surface area (TBSA) and to determine the effects of HBOT administered within 24 h to 48 h of a burn injury. METHODS Seventeen subjects were randomized into control (n = 9) and HBOT treatment (n = 8) arms. Burn depth, measured by laser Doppler imaging (LDI) and histologically, white blood cell (WBC) count and plasma cytokine inflammatory markers were assessed at 24 h (pre HBOT) and 48 h (post HBOT) post burn, as were immunohistochemistry and microbiology of burns tissue samples at 48 h post burn. RESULTS WBC count and serum interleukin (IL)-1β, IL-4, IL-6, IL-10 and interferon-γ were significantly elevated 24 h after burn, but no significant changes in any of these parameters were found with HBOT. HBOT had no significant effect on burn depth. Two HBOT patients and four control patients developed positive bacterial cultures. CONCLUSIONS Slower than anticipated recruitment resulted in considerably fewer patients than planned being studied. Inflammatory markers were significantly increased at 24 h in patients with < 40% TBSA burn. Early HBOT had no apparent effects on any of the parameters measured in this small pilot study. HBOT may possibly have a broad-spectrum antimicrobial effect worthy of further study. We report our methodology in detail as a possible model for future burns studies.
Collapse
Affiliation(s)
- Si Jack Chong
- Navy Medical Services, Republic of Singapore Navy and Department of Plastic, Reconstructive and Aesthetic Surgery Singapore General Hospital Outram Road, Singapore 169608 Phone: +65-9146-7592, E-mail:
| | | | | | | | | |
Collapse
|
44
|
|
45
|
Chong SJ, Kok YO, Foo CL. Body contouring surgery for military personnel following massive weight loss. J ROY ARMY MED CORPS 2012; 157:402-4. [PMID: 22319988 DOI: 10.1136/jramc-157-04-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The burgeoning global obesity epidemic extends to the military service, where 6-53% of military personnel are overweight. Obese military personnel who adhere to a strict training and diet regime may potentially achieve and maintain significant weight loss. They may however face physical problems such as excess skin folds causing discomfort, difficulty in uniform fitting, personal hygiene, interference with full physical activities and psychological issues such as body image dissatisfaction, low self esteem and difficulty in social acceptance. We present a case report of a highly motivated military conscript who achieved and maintained significant weight loss but had physical defects following Massive Weight Loss. Body contouring surgery was successfully utilised to correct his physical defects and allowed him to return to full physical duties.
Collapse
Affiliation(s)
- S J Chong
- Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital Outram Road, Singapore 169608
| | | | | |
Collapse
|
46
|
Chong SJ, Ooi A, Kok YO, Tan MK. Full Thickness Burns over Bilateral Patella Tendons – Adjunctive Hyperbaric Oxygen Therapy and Negative Pressure Wound Therapy for Wound Bed Preparation and Improved Graft Take. Ann Acad Med Singap 2011. [DOI: 10.47102/annals-acadmedsg.v40n10p471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
47
|
Chong SJ, Ooi A, Kok YO, Tan MK. Full thickness burns over bilateral patella tendons - adjunctive Hyperbaric Oxygen Therapy and Negative Pressure Wound Therapy for wound bed preparation and improved graft take. Ann Acad Med Singap 2011; 40:471-472. [PMID: 22206058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
48
|
Ooi A, Chong SJ. Use of adjunctive treatments in improving patient outcome in Fournier's gangrene. Singapore Med J 2011; 52:e194-e197. [PMID: 22009405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Fournier's gangrene is a polymicrobial necrotising soft tissue infection (NSTI) affecting the perineum and scrotum. It is rapidly progressive and destructive, and is associated with high morbidity and mortality. Management protocol includes prompt diagnosis, early institution of antibiotic therapy and adequate wound debridement, usually requiring multiple operations. The resultant defect can be left to heal by secondary intention, or surgical coverage can be undertaken. We report Fournier's gangrene in a 60-year-old diabetic man and his successful treatment with skin grafting, which utilised a multidisciplinary approach and adjuncts, including negative-pressure wound therapy and hyperbaric oxygen therapy. We also review the literature related to these adjuncts and discuss their usefulness in the management of NSTIs.
Collapse
Affiliation(s)
- A Ooi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
| | | |
Collapse
|
49
|
Chong SJ, Kwan TM, Weihao L, Joang KS, Rick SC. Maintenance of negative-pressure wound therapy while undergoing hyperbaric oxygen therapy. Diving Hyperb Med 2011; 41:147-150. [PMID: 21948500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 07/14/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND Both negative wound pressure therapy (NPWT) and hyperbaric oxygen therapy (HBOT) are useful modalities in the treatment of problem wounds. However, none of the commercially available portable negative-pressure devices have been certified safe for use in a recompression chamber. Thus, the NPWT device is removed while the patient undergoes HBOT. The purpose of this study is to demonstrate that wound negative pressure can be effectively and safely maintained during HBOT. PATIENTS AND METHODS In a small, prospective, randomised crossover trial, we used commonly available clinical materials to connect the NPWT suction tubing to the negative suction generating device in the hyperbaric chamber. Six patients each underwent one HBOT session with continuous NPWT and one HBOT session without concurrent NPWT. We assessed the patient's pain score, the amount of exudate aspirated by the NPWT during HBOT, and the appearance of the wound dressing after each session was assessed in a blinded manner. RESULTS There were no differences in pain scores between the two HBOT sessions. The amount of exudate aspirated during HBOT with NPWT ranged from 5 to 12 ml. Five of the six patients had a better appearance scoring of their dressing when NPWT was maintained during HBOT (P = 0.006). CONCLUSION We successfully demonstrated a simple design that allows the maintenance of NPWT during HBOT without causing additional pain, and with continued extraction of exudate. The maintenance of NPWT during HBOT also allowed the dressing to be maintained undisturbed.
Collapse
|
50
|
Sun JM, Chong SJ, Por YC. A paediatric case of melioidosis in a chronic gluteal wound treated with adjunctive negative pressure wound therapy. Am J Case Rep 2011. [DOI: 10.12659/ajcr.882208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jeremy Mingfa Sun
- Department of Plastic Reconstructive and Aesthetic Surgery, KK Women’s and Children’s Hospital, Singapore
| | - Si Jack Chong
- Department of Plastic Reconstructive and Aesthetic Surgery, KK Women’s and Children’s Hospital, Singapore
| | - Yong Chen Por
- Department of Plastic Reconstructive and Aesthetic Surgery, KK Women’s and Children’s Hospital, Singapore
| |
Collapse
|