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Burns : Journal of the International... Dec 2008Acute burn wounds often require early excision and adequate coverage to prevent further hypothermia, protein and fluid losses, and the risk of infection. Meshed...
Acute burn wounds often require early excision and adequate coverage to prevent further hypothermia, protein and fluid losses, and the risk of infection. Meshed autologous skin grafts are generally regarded as the standard treatment for extensive full-thickness burns. Graft take and rate of wound healing, however, depend on several endogenous factors. This paper describes a standardized reproducible porcine model of burn and skin grafting which can be used to study the effects of topical treatments on graft take and re-epithelialization. Procedures provide a protocol for successful porcine burn wound experiments with special focus on pre-operative care, anesthesia, burn allocation, excision and grafting, postoperative treatment, dressing application, and specimen collection. Selected outcome measurements include percent area of wound closure by planimetry, wound assessment using a clinical assessment scale, and histological scoring. The use of this standardized model provides burn researchers with a valuable tool for the comparison of different topical drug treatments and dressing materials in a setting that closely mimics clinical reality.
Topics: Animals; Burns; Disease Models, Animal; Graft Survival; Skin; Skin Transplantation; Surgical Mesh; Swine; Treatment Outcome; Wound Healing
PubMed: 18617332
DOI: 10.1016/j.burns.2008.03.013 -
Plastic and Reconstructive Surgery Sep 2016Wound assessment relies on visual evaluation by physicians. Such assessment is largely subjective and presents the opportunity to explore the use of emergent... (Review)
Review
BACKGROUND
Wound assessment relies on visual evaluation by physicians. Such assessment is largely subjective and presents the opportunity to explore the use of emergent technologies.
METHODS
Emergent and powerful noninvasive imaging technologies applicable to assess burn and chronic wounds are reviewed.
RESULTS
The need to estimate wound depth is critical in both chronic wound and burn injury settings. Harmonic ultrasound technology is powerful to study wound depth. It addresses the limitations of optical imaging with limited depth of penetration. What if a wound appears epithelialized by visual inspection, which shows no discharge yet is covered by repaired skin that lacks barrier function? In this case although the wound is closed as defined by current standards, it remains functionally open, presenting the risk of infection and other postclosure complications. Thus, assessment of skin barrier function is valuable in the context of assessing wound closure. Options for the study of tissue vascularization are many. If noncontact and noninvasive criteria are of importance, laser speckle imaging is powerful. Fluorescence imaging is standard in several clinical settings and is likely to serve the wound clinics well as long as indocyanine green injection is not of concern. A major advantage of harmonic ultrasound imaging of wound depth is that the same system is capable of providing information on blood flow dynamics in arterial perforators.
CONCLUSION
With many productive imaging platforms to choose from, wound care is about to be transformed by technology that would help assess wound severity.
Topics: Burns; Chronic Disease; Humans; Skin; Wound Healing; Wounds and Injuries
PubMed: 27556752
DOI: 10.1097/PRS.0000000000002654 -
Magnetic Resonance in Medical Sciences... Jan 2023RF electromagnetic wave exposure during MRI scans induces heat and occasionally causes burn injuries to patients. Among all the types of physical injuries that have... (Review)
Review
RF electromagnetic wave exposure during MRI scans induces heat and occasionally causes burn injuries to patients. Among all the types of physical injuries that have occurred during MRI examinations, RF burn injuries are the most common ones. The number of RF burn injuries increases as the static magnetic field of MRI systems increases because higher RFs lead to higher heating. The commonly believed mechanisms of RF burn injuries are the formation of a conductive loop by the patient's posture or cables, such as an electrocardiogram lead; however, the mechanisms of RF burn injuries that occur at the contact points, such as the bore wall and the elbow, remain unclear. A comprehensive understanding of RF heating is needed to address effective countermeasures against all RF burn injuries for safe MRI examinations. In this review, we summarize the occurrence of RF burn injury cases by categorizing RF burn injuries reported worldwide in recent decades. Safety standards and regulations governing RF heating that occurs during MRI examinations are presented, along with their theoretical and physiological backgrounds. The experimental assessment techniques for RF heating are then reviewed, and the development of numerical simulation techniques is explained. In addition, a comprehensive theoretical interpretation of RF burn injuries is presented. By including the results of recent experimental and numerical simulation studies on RF heating, this review describes the progress achieved in understanding RF heating from the standpoint of MRI burn injury prevention.
Topics: Humans; Heating; Radio Waves; Burns; Hot Temperature; Magnetic Resonance Imaging; Phantoms, Imaging
PubMed: 35228437
DOI: 10.2463/mrms.rev.2021-0047 -
Journal of Injury & Violence Research Jul 2011Burns are an important cause of injury to young children, being the third most frequent cause of injury resulting in death behind motor vehicle accidents and drowning.... (Review)
Review
Burns are an important cause of injury to young children, being the third most frequent cause of injury resulting in death behind motor vehicle accidents and drowning. Burn injuries account for the greatest length of stay of all hospital admissions for injuries and costs associated with care are substantial. The majority of burn injuries in children are scald injuries resulting from hot liquids, occurring most commonly in children aged 0-4 years. Other types of burns include electrical, chemical and intentional injury. Mechanisms of injury are often unique to children and involve exploratory behavior without the requisite comprehension of the dangers in their environment. Assessment of the burnt child includes airway, breathing and circulation stabilization, followed by assessment of the extent of the burn and head to toe examination. The standard rule of 9s for estimating total body surface area (TBSA) of the burn is inaccurate for the pediatric population and modifications include utilizing the Lund and Browder chart, or the child's palm to represent 1% TBSA. Further monitoring may include cardiac assessment, indwelling catheter insertion and evaluation of inhalation injury with or without intubation depending on the context of the injury. Risk factors and features of intentional injury should be known and sought and vital clues can be found in the history, physical examination and common patterns of presentation. Contemporary burn management is underscored by several decades of advancing medical and surgical care however, common to all injuries, it is in the area of prevention that the greatest potential to reduce the burden of these devastating occurrences exists.
Topics: Accidents; Burns; Burns, Chemical; Burns, Electric; Child; Child Abuse; Child, Preschool; Humans; Infant; Risk Factors; Suicide, Attempted
PubMed: 21498973
DOI: 10.5249/jivr.v3i2.91 -
Journal of Burn Care & Research :... Aug 2019Pulmonary and systemic insults from inhalation injury can complicate the care of burn patients and contribute to significant morbidity and mortality. However, recent... (Review)
Review
Pulmonary and systemic insults from inhalation injury can complicate the care of burn patients and contribute to significant morbidity and mortality. However, recent progress in diagnosis and treatment of inhalation injury has not kept pace with the care of cutaneous thermal injury. There are many challenges unique to inhalation injury that have slowed advancement, including deficiencies in our understanding of its pathophysiology, the relative difficulty and subjectivity of bronchoscopic diagnosis, the lack of diagnostic biomarkers, the necessarily urgent manner in which decisions are made about intubation, and the lack of universal recommendations for the application of mucolytics, anticoagulants, bronchodilators, modified ventilator strategies, and other measures. This review represents a summary of critical shortcomings in our understanding and management of inhalation injury identified by the American Burn Association's working group on Cutaneous Thermal Injury and Inhalation Injury in 2018. It addresses our current understanding of the diagnosis, pathophysiology, and treatment of inhalation injury and highlights topics in need of additional research, including 1) airway repair mechanisms; 2) the airway microbiome in health and after injury; and 3) candidate biomarkers of inhalation injury.
Topics: Burns, Inhalation; Humans; Needs Assessment
PubMed: 31214710
DOI: 10.1093/jbcr/irz055 -
Clinics in Plastic Surgery Oct 2009Severe burn injury is followed by a profound hypermetabolic response that persists up to 24 months after injury. It is mediated by up to 50-fold elevations in plasma... (Review)
Review
Severe burn injury is followed by a profound hypermetabolic response that persists up to 24 months after injury. It is mediated by up to 50-fold elevations in plasma catecholamines, cortisol, and inflammatory cells that lead to whole-body catabolism, elevated resting energy expenditures, and multiorgan dysfunction. All of these metabolic and physiologic derangements prevent full rehabilitation and acclimatization of burn survivors back into society. Modulation of the response by early excision and grafting of burn wounds, thermoregulation, early and continuous enteral feeding with high-protein high-carbohydrate feedings, and pharmacologic treatments have markedly decreased morbidity.
Topics: Burns; Energy Metabolism; Humans; Metabolism; Multiple Organ Failure
PubMed: 19793553
DOI: 10.1016/j.cps.2009.05.001 -
The Cochrane Database of Systematic... Dec 2014A burn wound is a complex and evolving injury, with both local and systemic consequences. Burn treatments include a variety of dressings, as well as newer strategies,... (Review)
Review
BACKGROUND
A burn wound is a complex and evolving injury, with both local and systemic consequences. Burn treatments include a variety of dressings, as well as newer strategies, such as negative pressure wound therapy (NPWT), which, by means of a suction force that drains excess fluids from the burn, tries to promote the wound healing process and minimise progression of the burn wound.
OBJECTIVES
To assess the effectiveness of NPWT for people with partial-thickness burns.
SEARCH METHODS
We searched the Cochrane Wounds Group Specialised Register (searched 04 September 2014); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 8).
SELECTION CRITERIA
All randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that evaluated the safety and effectiveness of NPWT for partial-thickness burns.
DATA COLLECTION AND ANALYSIS
Two review authors used standardised forms, and extracted the data independently. We assessed each trial for risk of bias, and resolved differences by discussion.
MAIN RESULTS
One RCT, that was an interim report, satisfied the inclusion criteria. We undertook a narrative synthesis of results, as the absence of data and poor reporting precluded us from carrying out any formal statistical analysis. The trial was at high risk of bias.
AUTHORS' CONCLUSIONS
There was not enough evidence available to permit any conclusions to be drawn regarding the use of NPWT for treatment of partial-thickness burn wounds.
Topics: Burns; Humans; Negative-Pressure Wound Therapy; Occlusive Dressings; Randomized Controlled Trials as Topic; Suction; Wound Healing
PubMed: 25500895
DOI: 10.1002/14651858.CD006215.pub4 -
Wound Repair and Regeneration :... May 2016Scarring following burn injury and its accompanying aesthetic and functional sequelae still pose major challenges. Hypertrophic scarring (HTS) can greatly impact... (Review)
Review
Scarring following burn injury and its accompanying aesthetic and functional sequelae still pose major challenges. Hypertrophic scarring (HTS) can greatly impact patients' quality of life related to appearance, pain, pruritus and even loss of function of the injured body region. The identification of molecular events occurring in the evolution of the burn scar has increased our knowledge; however, this information has not yet translated into effective treatment modalities. Although many of the pathophysiologic pathways that bring about exaggerated scarring have been identified, certain nuances in burn scar formation are starting to be recognized. These include the effects of neurogenic inflammation, mechanotransduction, and the unique interactions of burn wound fluid with fat tissue in the deeper dermal layers, all of which may influence scarring outcome. Tension on the healing scar, pruritus, and pain all induce signaling pathways that ultimately result in increased collagen formation and myofibroblast phenotypic changes. Exposure of the fat domes in the deep dermis is associated with increased HTS, possibly on the basis of altered interaction of adipose-derived stem cells and the deep burn exudate. These pathophysiologic patterns related to stem cell-cytokine interactions, mechanotransduction, and neurogenic inflammation can provide new avenues of exploration for possible therapeutic interventions.
Topics: Burns; Cicatrix, Hypertrophic; Compression Bandages; Humans; Mechanotransduction, Cellular; Pruritus; Quality of Life; Stem Cell Transplantation; Wound Healing
PubMed: 27027596
DOI: 10.1111/wrr.12432 -
Journal of Burn Care & Research :... Sep 2022Management of critically ill patients requires simultaneous administration of many medications. Treatment for patient comorbidities may lead to drug-drug interactions...
Management of critically ill patients requires simultaneous administration of many medications. Treatment for patient comorbidities may lead to drug-drug interactions which decrease drug efficacy or increase adverse reactions. Current practices rely on a one-size-fits-all dosing approach. Pharmacogenetic testing is generally reserved for addressing problems rather than used proactively to optimize care. We hypothesized that burn and surgery patients will have one or more genetic variants in drug metabolizing pathways used by one or more medications administered during the patient's hospitalization. The aim of this study was to determine the frequency of variants with abnormal function in the primary drug pathways and identify which medications may be impacted. Genetic (19 whole exome and 11 whole genome) and medication data from 30 pediatric burn and surgery patients were analyzed to identify pharmacogene-drug associations. Nineteen patients were identified with predicted altered function in one or more of the following genes: CYP2C9, CYP2C19, CYP2D6, and CYP3A4. The majority had decreased function, except for several patients with CYP2C19 rapid or ultrarapid variants. Some drugs administered during hospitalization that rely on these pathways include hydrocodone, oxycodone, methadone, ibuprofen, ketorolac, celecoxib, diazepam, famotidine, diphenhydramine, and glycopyrrolate. Approximately one-third of the patients tested had functionally impactful genotypes in each of the primary drug metabolizing pathways. This study suggests that genetic variants may in part explain the vast variability in drug efficacy and suggests that future pharmacogenetics research may optimize dosing regimens.
Topics: Burns; Child; Cytochrome P-450 CYP2C19; Genotype; Humans; Pharmaceutical Preparations; Pharmacogenetics; Pharmacogenomic Testing
PubMed: 35639664
DOI: 10.1093/jbcr/irac062 -
Journal of Burn Care & Research :... May 2022Burn injuries are a major cause of morbidity and mortality. Next to the inhalation injury, TBSA and age are strong predictors of mortality in burn victims. The novel...
Burn injuries are a major cause of morbidity and mortality. Next to the inhalation injury, TBSA and age are strong predictors of mortality in burn victims. The novel coronavirus disease 2019 (COVID-19) pandemic is associated with a fatality rate of around 3.5%. We present a case of burn victim with full-thickness burn to face, scalp, both upper extremities (27% of TBSA), inhalation injury, and active severe acute respiratory syndrome coronavirus 2 infection with concomitant pneumonia. The inhalation injury in COVID-19 positive patient was severe. A bronchoscopy revealed a diffuse erythema of the trachea and both main bronchi, the whole bronchial tree up to the distal segments was covered with carbonaceous material which could not be removed. We decided to treat the inhalation injury according to the guidelines for burns and acute respiratory distress syndrome. Accordingly, the patient did not receive any antiviral drugs or corticosteroids. The reconstruction of a full-thickness scalp defect after burn presents a challenge in large size defects and in patients with comorbidities. Double layer Integra Dermal Regeneration Template (Integra LifeSciences, Plainsboro, New Jersey) was the reconstruction method of choice. The take of dermal template and split-thickness skin graft was 100% and good scalp contour was achieved. To our knowledge this is the first case report presenting a successful treatment outcome in a burn victim with inhalation injury, active severe acute respiratory syndrome coronavirus 2 infection, and concomitant pneumonia with full-thickness burn of 27% of TBSA.
Topics: Burns; COVID-19; Humans; Pneumonia; Retrospective Studies; SARS-CoV-2; Skin Transplantation; Soft Tissue Injuries
PubMed: 35084502
DOI: 10.1093/jbcr/irac010