Annals of burns and fire disasters
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Ann Burns Fire Disasters · Dec 2019
Post-burn neck contracture: effectively managed with supraclavicular artery flap.
Post-burn neck contracture is one of the most common burn sequels. These contractures affect the patient significantly causing both functional limitations and esthetic disfigurements, which lead to cosmetic, functional and social problems. Our objective was to determine the role of supraclavicular artery island (SAI) flap as an option for the reconstruction of soft tissue defect of the neck after release of post-burn contracture. ⋯ Complete flap necrosis was observed in 1 (3.2%), distal necrosis in 2 (6.4%) cases, postoperative hematoma of the neck was found in 1 (3.2%) and wound dehiscence was reported in 2 (6.4%) cases. Donor site was closed primarily in 25 (81%) cases while the rest were skin grafted. Supraclavicular artery flap is an effective choice with impressive recovery, acceptable skin color match and restoration of anatomic function at the recipient site without any major complications.
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Ann Burns Fire Disasters · Sep 2019
Factors affecting length of stay among pediatric and adult patients admitted to the Lebanese Burn Centre: a retrospective study.
Burn injuries are serious lesions requiring specialized medical care, and are associated with prolonged length of hospital stay (LOS). This study aims to elucidate the epidemiological and clinical factors affecting the LOS of pediatric and adult patients with burn wounds. A single-centre retrospective study was conducted at the Hopital Libanais Geitawi Burn Centre in Lebanon. ⋯ Multivariate analysis showed that both pediatric and adult LOS was significantly associated to number of operations, need for burn excision and skin grafting, and receiving a blood transfusion. Adult LOS was further affected by mechanical ventilation, infection and age. Our study demonstrated the differential influence of epidemiological and clinical factors among adult and pediatric populations, which allows better prediction of LOS and management of patients with burn injuries.
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Ann Burns Fire Disasters · Jun 2019
Respiratory and coagulation dysfunctions on admission as independent predictors of in-hospital mortality in critically ill burn patients.
Mortality rate for burns patients in developing countries is approximately 34%. Data show that most patients in burn units will likely experience organ dysfunction. Sequential Organ Failure Assessment (SOFA) score assesses organ dysfunction and is frequently used in the ICU, but there are no previous studies regarding SOFA score in burn units in Indonesia specifically. ⋯ SOFA score had very good discrimination (AUC 96.4%, CI 95% 0.933 - 0.995) and good calibration (Hosmer-Lemeshow p = 0.561). SOFA variables which had a statistically significant effect on 30-day mortality in the Burn Unit were PaO2/FiO2 ratio < 400, PaO2/FiO2 ratio < 300, PaO2/FiO2 ratio < 200 with mechanical ventilation and platelet count < 150,000/mm3. SOFA score was a valid instrument for predicting 30 day mortality of critically ill burn patients in the Burn HDU and ICU of Cipto Mangunkusumo General Hospital, especially respiration and coagulation variables.
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Ann Burns Fire Disasters · Mar 2019
ARDS among cutaneous burn patients combined with inhalation injury: early onset and bad outcome.
Our aims are to determine the clinical and preclinical characteristics and outcome of ARDS among burn patients with inhalation injury. A retrospective study was conducted on 66 selected patients with ARDS, treated in the ICU of the National Burns Hospital from 11/2013 to 10/2016. The patients were divided into two groups and matched by age and burn extent: the study group consisted of 33 patients with inhalation injury and the control group 33 patients without inhalation injury. ⋯ Mortality rate until 28 days post burn was significantly higher among the study group (69.7% vs. 54.6% respectively; p < .001). In addition, time from admission and from ARDS onset to death was shorter in the study group (P < .05). In conclusion, compared to cutaneous burn-induced ARDS, ARDS in patients with inhalation injury has earlier onset, causes more severe oxygenation disorder and has a higher mortality rate.
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Toxic epidermal necrolysis is a rare, potentially fatal disorder that involves large areas of skin desquamation. Patients with toxic epidermal necrolysis are frequently referred to burn centres for expert wound management and early comprehensive critical care as this has been shown to improve patient outcome and mortality. The authors describe the first report of medication-induced toxic epidermal necrolysis occurring in a patient during acute burn management in a tertiary burn care facility. ⋯ She required extensive debridement and allografting to manage burn injured areas and additional areas of epidermal loss from subsequent toxic epidermal necrolysis, amounting to a total body surface area of 90%. Definitive burn wound closure was achieved using autologous split-thickness skin grafting once donor sites healed and became suitable for harvest 3 weeks after the onset of toxic epidermal necrolysis. Grafts achieved complete take and the patient was discharged home following rehabilitation..