Burns : journal of the International Society for Burn Injuries
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Ablative fractional resurfacing is clinically an efficient treatment for burn scar management. The aim of this pilot study was to investigate the poorly understood mechanisms underlying ablative fractional CO2 laser (AFL-CO2) therapy in relation to biomarkers S100 and 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1). S100 stains for Langerhans cells and neuronal cells, potentially representing the pruritus experienced. 11β-HSD1 catalyses the interconversion of cortisol and cortisone in cells, promoting tissue remodelling. ⋯ Neuronal cells were overexpressed before treatment in the scar tissue by 91% but levels returned to that resembling normal skin. 11β-HSD1 expression in keratinocytes was significantly higher after laser treatment compared to before in scar tissue (p <0.01). No clear correlation was found in dermal fibroblast numbers throughout the treatment course. Whilst the role of the explored mechanisms and their association with clinical outcomes cannot conclusively be stated, this pilot study demonstrates promising trends that encourages investigation into this relationship.
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The aim of this review was to summarise the current evidence regarding the effectiveness of rehabilitation interventions in improving hand function, range of motion (ROM), hand strength, scar outcome, return to work, level of impairment/disability, level of burn knowledge and decreasing edema following hand burns in adult burn survivors. This review provides evidence-based support for the use of rehabilitation interventions for burn rehabilitation professionals. The following data sources were searched: MEDLINE, EMBASE and CINAHL from their inception up to February 2021, reference lists from all the included full-text articles were screened for additional relevant publications and monthly Google Scholar searches until December 23rd 2021 to make sure all new pertinent published articles after February 2021 would be included. Thirty-five studies were included in this review including 14 RCTs. ⋯ This review supports the clinical practice of the following interventions: 1) The use of adhesive compression wraps for patients who have increased edema to increase hand function and ROM; 2) The use of compression (adhesive compressive wrap, compression bandage or intermittent compression pump) to decrease hand edema following burn injury; 3) Participating in general rehabilitation to increase hand function and patient perceived level of disability; 4) The use of an orthosis to increase ROM and a dynamic MCP orthosis to increase hand function; 5) If available, incorporate the use of VR based rehabilitation to increase hand function and hand strength; 6) The use of paraffin to increase hand PROM; 7) The use of gels to reduce hand scar thickness; 8) The use of an education component in rehabilitation to increase the level of burn knowledge. The limitations of this study are also discussed. Further research with robust methodology is needed to investigate the potential benefits of treatment interventions included in this review.
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Little is known about treatment decision-making experiences and how/why particular attitudes exist amongst specialist burn clinicians when faced with patients with potentially non-survivable burn injuries. This exploratory qualitative study aimed to understand clinicians' decision-making processes regarding end-of-life (EoL) care after a severe and potentially non-survivable burn injury. ⋯ The process of EoL decision-making for a patient with a potentially non-survivable burn injury was layered, complex, and tailored. Processes and approaches varied, although most used protocols to guide EoL decisions. Despite the reported complexity of EoL decision-making, palliative care teams were rarely involved or consulted.
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Weight loss is difficult to quantify in critically ill burn patients, as the presence of edema can mask changes in dry body weight. We sought to estimate dry body weight using measured weights adjusted for reported extremity edema. We evaluated patients with at least 20% total body surface area (TBSA) burns admitted to our intensive care unit over a 3½-year period. ⋯ Logistic regression yielded the following formula for estimating dry weight (in kg): 0.66 x measured body weight + 25 - (3 for 1 + pitting edema or 4 for 2 + or 3 + pitting edema of either upper extremity) - (4 for any pitting edema to either lower extremity) (p < 0.01, R2 = 0.81). These results may allow us to better estimate dry body weight changes in our edematous patients with severe burns. Nutrition goals can be adjusted earlier, when appropriate, based on these estimated dry body weight changes.