Burns : journal of the International Society for Burn Injuries
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Burn injuries can cause traumatic and debilitating physical trauma, with burn wounds prone to bacterial infection. This study examined in vitro the effectiveness of the silver nanoparticle based antimicrobial dressing, Acticoat™, in combination with a range of antimicrobial compounds against Staphylococcus aureus and Pseudomonas aeruginosa and investigated potential cytotoxic effects in multi-layered differentiated keratinocyte models. Acticoat™ with chlorhexidine was found to be highly effective against S. aureus and P. aeruginosa across a 3 day incubation period on pig skin models. ⋯ The bacterial strains used in this study showed a substantial tolerance to Acticoat™ with biofilm-like communities observed on the dressing surfaces. This could be mitigated with chlorhexidine, albeit with an increase in cytotoxicity. The clinical significance of these findings in terms of infection control and wound healing remain to be determined; the potential benefit of bactericidal activity must be balanced against cytotoxicity, and the prevalence and potential transmission of the silver tolerant phenotype must also be assessed.
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Social isolation, imposed by the COVID-19 pandemic, may imply changes in the clinical-demographic and epidemiological profiles of burn trauma victims. ⋯ The pediatric population was heavily impacted by the imposed period of social isolation, presenting a greater severity of burns. In contrast, the epidemiology of burns for the adult population was slightly altered during the pandemic period.
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Much of the recent literature on bromelain based enzymatic debridement of burn injury has focused on its use in smaller burn injury and specialist areas such as the hands or genitals (Krieger et al., 2012; Schulz et al., 2017a,b,c,d). This is despite the original papers describing its use in larger burn injury (Rosenberg et al., 2004, 2014). The current EMA license for Nexobrid™ advises that it should not be used for burn injuries of more than 15% TBSA and should be used with caution in patients with pulmonary burn trauma and suspected pulmonary burn trauma. The original safety and efficacy trial of NexoBrid™ limited its use to 15% TBSA aliquots with concern regarding the effect of bromelain on coagulation. In a European consensus paper of experienced burns clinicians, now on its second iteration, 100% of respondents agreed that "up to 30% BSA can be treated by enzymatic debridement based on individual decision" (Hirche et al., 2017). Hofmaenner et al.'s recent study on the safety of enzymatic debridement in extensive burns larger than 15% provides some further evidence that "bromelain based enzymatic debridement can be carried out safely in large-area burns" (Hofmaenner et al., 2020) but the literature is scant in these larger debridement areas. In our centre we have been using enzymatic debridement for resuscitation level burn injury since 2016. We have gained significant learning in this time; this article aims to describe our current protocol for enzymatic debridement in this patient population and highlight specific learning points that might aid other centres in using enzymatic debridement for larger burn injury. ⋯ Much of the literature has described the use of enzymatic debridement in smaller burns, and specialist areas. However, it is our opinion that the advantages of enzymatic debridement appear to be greater in larger burns with a facility for whole burn excision on the day of admission in the ICU cubicle. We have demonstrated significantly reduced blood loss, improved dermal preservation, reduced need for autografting, and a reduction in the number of trips to theatre. We would advocate that both the team and the patient need to be as prepared as they would be for a traditional surgical excision. The early part of our learning curve for enzymatic debridement in resuscitation level injuries was steep, and we were able to build on experience from managing smaller injuries. We recommend any team wishing to using enzymatic debridement gain experience in the same way and develop robust local pathways prior to attempting use in larger burn injuries.
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Due to medical advances, care for patients that experience burns has shifted from saving life to improving quality of life. Reintegrating into the community and maintain body image satisfaction may be difficult after a severe burn. Several studies have analyzed these two variables independently, but none have addressed a potential interrelationship. ⋯ The finding that symptoms of distress and social stigma account for the relationship between body image satisfaction and community integration support the potential for interventions that ameliorate distress to improve community integration and quality of life in people recovering from burn injuries.
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Increased body weight has been associated with reduced muscle wasting in the early catabolic phase after a severe burn. Yet, overweight and obese non-burn children often exhibit impaired musculoskeletal function, which may lead to poor physical function (PF). We aimed to determine the association between body mass index (BMI) at discharge and self-reported PF and caregiver proxy-reported PF during recovery of burned children. ⋯ A greater BMI at discharge was associated with improved self-reported PF at 12 months after burn but not at 6 months or 24 months, which suggests a faster recovery of PF in paediatric patients of larger body weight. Our data suggests that a larger body weight does not compromise the recovery of PF after burn.