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Aim Corneal alkali burns are a severe disease and commonly encountered in the emergent clinic. A rapid medical treatment for the burn is very important. Gly-thymosin β4 (Gly-Tβ4) is a biomimic derivative of natural thymosin β4. The aim of this study is to evaluate the corneal recovery effects of Gly-Tβ4 topical therapy on alkali burns in rabbit corneas. Methods Rabbit alkali burns were induced with NaOH-contained filter paper. Phosphate-buffered solutions at pH 7.0, Gly-Tβ4 solutions, blank in situ hydrogels, and Gly-Tβ4 in situ hydrogels were dropped on the burned corneas. The treatments were continued for 14 days. Conjunctiva hyperemia, corneal edema, intraeye extravasation, hemorrhaging, corneal neovascularization (CNV), and corneal opacity were observed. Corneal immunohistochemistry and histopathology were performed. Results Gly-Tβ4 solutions led to a lower corneal burn index than the other regimens. Hydrogels may stimulate the burned corneas due to the direct contact of them, and prevent the rapid release of Gly-Tβ4. Gly-Tβ4 significantly inhibited CNV according to the images of the corneas, CNV areas, and CD31 expression. Furthermore, Gly-Tβ4 improved corneal epidermal recovery according to the histopathological result. Conclusion Gly-Tβ4 solutions are a promising formulation for topical treatment of corneal alkali burns.

The lack of autograft donor site is one of the greatest limiting factors for the treatment of extensive burn. Micrografting is an important revolution in burn surgery where autografts are cut into small pieces for wide and rapid coverage of burn wound. Our early experiences with the current standard micrografting technique were fraught with poor graft take as well being time and labor intensive. We have improvised our technique, where we combined the use of allograft to serve as a carrier for the micrograft. The objective of this paper is to share our experience in micrografting and several technical tips which had enhanced our micrografting results. The improvisation in our technique includes: (1) Single-stage ‘micrograft-allograft sandwich method’ where allograft served as a direct carrier for the micrografts. Micrografts were laid uniformly 1 cm apart onto allograft sheets, creating a 1:9 expansion ratio. This technique replaced the original two stage method. (2) The use of the Meek device (Humeca, Netherlands) to prepare micrograft. The Meek device can rapidly produce 3 mm micrografts for easy transfer with a fine forceps. (3) The use of slow-acting fibrin sealant to promote graft take and hemostasis. (4) A two-team approach for micrograft preparation where one team processes micrograft and another prepares the allograft sheets. This reduces the lag time between micrograft preparation and grafting, and reduces the overall surgery time. Micrografting remains an important treatment for major burn surgery. The aim of micro-allograft combination is to allow autografts re-epithelization under a reliable temporary skin coverage in a single stage procedure. A prospective study is warranted to measure the objective outcome of this renewed technique.

Introduction Since the introduction of e-cigarettes to the UK market in 2007 their popularity amongst young adults has significantly increased. These lithium-ion powered devices remain unregulated by the Standards Agency and as a result burns centres across the world have seen an increasing number of patients presenting with significant burns, resulting from poor quality batteries that appear to be liable to explode when over-heated, over-charged or incorrectly stored. Methods Retrospective and perspective review of all e-cigarette related burns presenting to the Southwest Burns Network; South Wales Burns Centre (Morriston Hospital) or to Bristol burns centre (Southmead Hospital) between Oct 15–July 16, followed by a review of available literature performed and eligible papers identified using PRISMA 2009 Checklist. Results South Wales Burns Centre (Morriston Hospital) (N = 5), Bristol burns centre (Southmead Hospital) (N = 7). 92% of injuries were seen in male patients with a mean age of 34.58 (±12.7). The mean TSBA sustained 2.54% of mixed depth, most common anatomical area is the thigh 83% (n = 10) with a mean 23.1(±5) days to heal with conservative management. The literature search yielded 3 case series (Colaianni et al., 2016; Kumetz et al., 2016; Nicoll et al., 2016) [8,9,12] and 4 case reports (Jablow and Sexton, 2015; Harrison and Hicklin, 2016; Walsh et al., 2016; Shastry and Langdorf, 2016) [6,7,10,11]. We compare our findings with the published studies. Conclusion The import and sale of e-cigarettes remains unrestricted. This increases the risk of devices being available in the UK market that do not meet the British Standard Specification, potentially increasing their risk of causing fire and exploding. Consumers should be made aware of this risk, and advised of adequate charging and storage procedures. In case lithium ion compounds leak following a breach in the battery, first aid with mineral oil use is advocated to avoid a further chemical reaction.

Posttraumatic growth after burn is a relatively new area of study with only a small number of studies that have examined this phenomenon. It is important to understand the presentation of posttraumatic growth and coping in burn survivors, how it changes over time and the components which influence growth so that we can understand how to promote posttraumatic growth in burn survivors. The aim of this review was to assess these three parameters. Studies were identified through multiple databases with specific search terms to identify posttraumatic growth after burn. From the 813 articles found, 57 were identified as potentially useful, and 8 as eligible for review; three qualitative, one mixed methods, two quantitative, one discussion paper and part of a review which assessed all psychosocial outcomes. Growth presented as realising personal strength, reprioritising, spirituality, humanity, changed relationships, and compassion and altruism. Styles of coping included feelings of gratefulness and downward comparison, humour and planning. Suddenness of the event, and the severity and location of injury might affect the amount of growth experienced. Overall function, quality of life, social support and optimism, hope and new opportunities are influences on growth after burn, all of which have the potential for improvement through targeted intervention strategies. Further research is indicated in many areas related to growth, intervention and measurement.

Introduction Excisional surgical debridement (SD) is still the gold standard in the treatment of deeply burned hands, though the intricate anatomy is easily damaged. Previous studies demonstrated that enzymatic debridement with the bromelain debriding agent NexoBrid® (EDNX) is more selective and thus can preserve viable tissue with excellent outcome results. So far no method paper has been published presenting different treatment algorithms in this new field. Therefore our aim was to close this gap by presenting our detailed learning curve in EDNX of deeply burned hands. Methods We conducted a single-center prospective observational clinical trial treating 20 patients with deeply burned hands with EDNX. Different anaesthetic procedures, debridement and wound treatment algorithms were compared and main pitfalls described. Results EDNX was efficient in 90% of the treatments though correct wound bed evaluation was challenging and found unusual compared to SD. Post EDNX surprisingly the majority of the burn surface area was found overestimated (18 wounds). Finally we simplified our process and reduced treatment costs by following a modified treatment algorithm and treating under plexus anaesthesia bedside through a single nurse and one burn surgeon solely. Suprathel® could be shown to be an appropriate dressing for wound treatment after EDNX. Complete healing (less 5% rest defect) was achieved at an average of day 28. Conclusion EDNX in deep burned hands is promising regarding handling and duration of the treatment, efficiency and selectivity of debridement, healing potential and early rehabilitation. Following our treatment algorithm EDNX can be performed easily and even without special knowledge in burn wound depth evaluation.

Introduction The diffuse epidermal exfoliation seen in Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) is similar to skin loss in second degree burns, and many of these patients are referred for treatment at burn centers. Treatment can differ markedly from center to center, and mortality can range from 25% to 70%, including a considerable morbidity. However, our experience over a 15-year period from 2000 to 2015 with 40 patients found a mortality rate of only 10% (4/40). The purpose of this paper is to discuss our treatment algorithm as a model for other centers treating SJS/TENs patients. Methods Records were reviewed for all patients admitted to the LAC + USC burn unit between 2000 and 2015 and 40 patients were identified with biopsy-proven SJS or TENS. These cases were reviewed for age, gender, initial and greatest TBSA, causative drug, pre-existing medical conditions, and morbidity and mortality. All data were entered into the SPSS statistical software package and all statistical analyses were performed using this program. Results Our treatment algorithm focused on early referral to a specialty burn unit, immediate discontinuation of the offending drug, fluid resuscitation, nutritional supplementation, and meticulous wound care. Average time to transfer to a burn unit was 3.36 days. Silver-releasing antimicrobial dressings were applied to the affected skin surface and changed every 3 days. Mupirocin coated petroleum gauze was used for facial involvement. Steroids were tapered and discontinued if initiated at an outside facility (58% of patients), and starting after 2001, all patients received a course of IVIG. All patients received fluid resuscitation and the majority received supplemental tube feedings (69%). Average length of total stay was 17.1 days and length of ICU stay 15.9 days. While 44% were transferred to another facility for further rehabilitative care, 37% of patients discharge to home. In patients discharged home with complete resolution of skin lesions, time to healing was an average of 14 days. Discussion With our 10% mortality rate in 40 patients, our study represents a relatively large study population while maintaining a relatively low mortality rate. The demographic data from our study largely aligns with the existing literature, and we therefore feel that our low mortality rate is due to our treatment algorithm, rather than to a less severe pathology in our patient population. This claim is supported by a standard mortality ratio of 1.68. This ratio proves a significantly improved mortality than would be expected based on disease severity on admission.

Dear Professor Wolf, Re: “Mixed messages” — Ongoing confusion with hydrogel dressings in burn 1st aid. Commentary on the trial report from Holbert et al. 2018/19 which was a comment on the protocol paper entitled “Effectiveness of a hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric thermal burn injuries: study protocol for a randomised controlled trial”

Introduction Since 2005, the Western Australian paediatric burn unit has provided a state-wide clinical consultancy and support service for the assessment and management of acute and rehabilitative burn patients via its telehealth service. Since then, the use of this telehealth service has steadily increased as it has become imbedded in the model of care for paediatric burn patients. Primarily, the service involves acute and long term patient reviews conducted by the metropolitan-located burn unit in contact with health practitioners, advising patients and their families who reside outside the metropolitan area thereby avoiding unnecessary transfers and inpatient bed days. A further benefit of the paediatric burn service using telehealth is more efficient use of tertiary level burn unit beds, with only those patients meeting clinical criteria for admission being transferred. Aim To conduct a retrospective audit of avoided transfers and bed days in 2005/06–2012/13 as a result of the use of the paediatric Burns Telehealth Service and estimate their cost savings in 2012/13. Method A retrospective chart audit identified activity, avoided unnecessary acute and scar review patient transfers, inpatient bed days and their associated avoided costs to the tertiary burn unit and patient travel funding. Results Over the period 2005/06–2012/13 the audit identified 4,905 avoided inpatient bed days, 364 avoided acute patient transfers and 1,763 avoided follow up review transfers for a total of 1,312 paediatric burn patients as a result of this telehealth service. This paper presents the derivation of these outcomes and an estimation of their cost savings in 2012/13 of AUD 1.89 million. Conclusion This study demonstrates avoided patient transfers, inpatient bed days and associated costs as the result of an integrated burns telehealth service.

Introduction Current methods of assessing burn depth are limited and are primarily based on visual assessments by burn surgeons. This technique has been shown to have only 60% accuracy and a more accurate, simple, noninvasive method is needed to determine burn wound depth. Forward-looking infrared (FLIR) thermography is both noninvasive and user-friendly with the potential to rapidly assess burn depth. The purpose of this paper is to determine if early changes in burn temperature (first 3 days) can be a predictor of burn depth as assessed by vertical scarring 28 days after injury. Methods While under general anesthesia, 20 burns were created on the backs of two female Yorkshire swine using a 2.5cm×2.5cm×7.5cm, 150g aluminum bar, for a total of 40 burns. FLIR imaging was performed at both early (1, 2 and 3 days) and late (7, 10, 14, 17, 21, 24 and 28 days) time points. Burns were imaged from a height of 12 inches from the skin surface. FLIR ExaminIR © software was used to examine the infrared thermographs. One hundred temperature points from burn edge to edge across the center of the burn were collected for each burn at all time points and were exported as a comma-separated values (CSV) file. The CSV file was processed and analyzed using a MATLAB program. The temperature profiles through the center of the burns generated parabola-like curves. The lowest temperature (temperature minimum) and a line midway between the temperature minimum and ambient skin temperature at the burn edges was defined and the area of the curve calculated (the "temperature half-area"). Results Half-area values 2 days after burn had higher correlations with scar depth than did the minimum temperatures. However, burns that became warmer from 1 day to 2 days after injury had a lower scar depth then burns that became cooler and this trend was best predicted by temperature minima. When data were analyzed as a diagnostic test for sensitivity and specificity using >3mm scarring, i.e. a full-thickness burn, as a clinically relevant criterion standard, temperature minima at 2 days after burn was found to be the most sensitive and specific test. Conclusions FLIR imaging is a fast and simple tool that has been shown to predict burn wound outcome in a porcine vertical injury progression model. Data showed that more severe burn wounds get cooler between 1 and 2 days after burn. We found four analytic methods of FLIR images that were predictive of burn progression at 1 and 2 days after burn; however, temperature minima 2 days after burn appeared to be the best predictive test for injury progression to a full-thickness burn. Although these results must be validated in clinical studies, FLIR imaging has the potential to aid clinicians in assessing burn severity and thereby assisting in burn wound management.

Recent publications on treatment options in critically ill patients change beliefs and clinical behaviors. Many dogmas, which the modern management of critical illness relies on, have been questioned. These publications (consensus articles, reviews, meta-analysis and original papers) concern some fundamental issues of critical care: interventions in acute respiratory distress syndrome (ARDS), hemodynamic monitoring, glucose control and nutritional support and revise our views on many key points of critical care of burn patients.

Summary On 13 January, 1973, there was a petrol flash fire in central Kampala. Seventy-one people were admitted to Mulago Hospital, 26 of whom died as a result of their burns. The general management of the burned patients has been dealt with in a previous paper ( Carswell and Rambo, 1976 ); this paper deals more specifically with the bacteriology of the burned patients and the problems caused by the presence of organisms resistant to available antibiotics.

Summary On 13 January, 1973, there was a petrol flash fire in central Kampala. Seventy-one of those burned in this fire were admitted to Mulago Hospital and their treatment has been described in two previous papers ( Carswell and Hathaway, 1976; Carswell and Rambo, 1976 ). This paper details the results of follow-up of the 46 survivors.

In the first paper the history of the management of burns of bone has been described with reference to the principle papers. The aetiology and incidence of the injury has been recorded and illustrated from a series of cases treated in Birmingham over the last 25 years. In the second paper the results of treating these patients have been assessed using the criteria of operations required, healing time and mortality. Wound closure with free grafts after bone excision, and with skin flaps with or without excision have been described, and the factors favouring each method discussed. Finally, early cover with skin flaps over dead bone is encouraged.

B A C K G R O U N D [N a recent paper (Moores et al., 1975a) it was shown that the statistical technique of discriminant analysis could be used for producing estimates of the probability that a patient will survive after suffering burns serious enough to warrant his hospitalization in a regional burns unit. A second paper (Moores et al., 1975b), which concentrated on the predictability of the patient's length of stay, revealed that whether or not a patient contracted pseudornonas had a significant effect on this measure. It was shown, for example, that those 31 per cent of patients who contracted pseudomonas stayed in the unit for an average of 60 days, whereas the corresponding figure for those who did not was only 30. The two cumulative probability distributions are depicted in Fig. 1. It seems reasonable to postulate that those characteristics of burns patients which appear to significantly affect their chance of surviyal, and which are incorporated into the discriminant function, might also be the same factors which influence the likelihood of their contracting pseudomonas.

Objectives This paper investigates severe partner perpetrated burn (SPPB) in India and associated social correlates. Methods Data are from the National Family Health Survey (NFHS-3), a cross-sectional nationally representative household-based survey. Age, wealth index, education, urban/rural status, region, in-law violence, parental abuse, father abuse of mother, presence of a son, and age at marriage were examined for relationships with SPPB. Models with two reference groups were created (women without intimate partner violence; women with other non-burn intimate partner violence). Logistic regression analyses were computed. Results Prevalence of SPPB was 1.00% (n = 429). When compared to women with no intimate partner violence (IPV), greater wealth and rural status were protective of SPPB, but having a father who abused the participant's mother increased odds of SPPB over three times. When compared to women who had experienced IPV, presence of a son was protective of SPPB, as was not living in the South. Similarities between models included increased odds of SPPB associated with in-law violence and younger age at marriage. Conclusions SPPB was associated with measures that impacted odds of its occurrence. Prevention efforts should consider these and other cultural factors.

PURPOSE: In this paper an automatic system to diagnose burn depths based on colour digital photographs is presented. JUSTIFICATION: There is a low success rate in the determination of burn depth for inexperienced surgeons (around 50%), which rises to the range from 64 to 76% for experienced surgeons. In order to establish the first treatment, which is crucial for the patient evolution, the determination of the burn depth is one of the main steps. As the cost of maintaining a Burn Unit is very high, it would be desirable to have an automatic system to give a first assessment in local medical centres or at the emergency, where there is a lack of specialists. METHOD: To this aim a psychophysical experiment to determine the physical characteristics that physicians employ to diagnose a burn depth is described. A Multidimensional Scaling Analysis (MDS) is then applied to the data obtained from the experiment in order to identify these physical features. Subsequently, these characteristics are translated into mathematical features. Finally, via a classifier (Support Vector Machine) and a feature selection method, the discriminant power of these mathematical features to distinguish among burn depths is analysed, and the subset of features that better estimates the burn depth is selected. RESULTS: A success rate of 79.73% was obtained when burns were classified as those which needed grafts and those which did not. CONCLUSIONS: Results validate the ability of the features extracted from the psychophysical experiment to classify burns into their depths. Language: en

Most test methods use skin burn prediction to evaluate the thermal protective performance of clothing. In this paper, we reviewed different burn prediction methods used in clothing evaluation. The empirical criterion and the mathematical model were analyzed in detail as well as their relationship and limitations. Using an empirical criterion, the onset of skin burn is determined by the accumulated skin surface energy in certain periods. On the other hand, the mathematical model, which indicates denatured collagen, is more complex, which involves a heat transfer model and a burn model. Further studies should be conducted to examine the situations where the prediction methods are derived. New technologies may be used in the future to explore precise or suitable prediction methods for both flash fire tests and increasingly lower-intensity tests.

a b s t r a c t Background/purpose: Pediatric burns research has increasingly been recognized as a subspecialty of its own. The aim of this study was to assess and analyze the publication patterns of the pediatric burns literature over the last six decades. Methods: A search strategy for the Web of Science database was designed for pediatric burns publications, with output analyzed between two periods: 1945‐1999 (period 1) and 2000‐2013 (period 2). Results: There were 1133 and 1194 publications for periods 1 (1945‐1999) and 2 (2000‐2013), respectively. The mean citation counts of the top 50 publications were 77 (range 45‐278) and 49 (range 33‐145) for periods 1 and 2, respectively. There were 26 and 20 authors with two or more publications in the top 50 list in periods 1 and 2, respectively. Of these there are two authors that have published 47 papers in both combined time-periods. There were 29 and 9 journals that have published 50% of the publications for time-period 1 and 2 respectively. In period 2, there were two burns journals that have published 37.2% of the total articles. Conclusions: Pediatric burns research has evolved from an associated, dispersed entity into a consolidated sub-specialty that has been successfully integrated into mainstream burns journals.

Introduction Burn care innovations have vastly reduced mortality rates and improved prognoses, fostering the need for multi-disciplinary input in holistic recovery. Consequently psychological and social considerations post-burn are included in National Burn Care Standards and have featured increasingly in burns literature. Aim To identify the key findings of the rapidly expanding literature base for psychosocial adjustment post-burn, highlighting the most important knowledge and future directions for both practice and research. Method MEDLINE, CINAHL, EMBASE, PsycINFO, BNI, HMIC databases were searched from January 2003 to September 2013 using search terms regarding psychosocial adjustment post-burn. After exclusions 24 papers underwent critical appraisal. Results Studies were categorised by the element of adjustment that they examined; psychopathology, quality of life, return to work, interpersonal, post-traumatic growth. Strengths, weaknesses, and significant findings within each category were presented. Discussion Although psychopathology and quality of life were well-researched compared to other categories, all would benefit from methodological improvements such as sample size or dropout rates. Coping strategies, premorbid psychopathology, and personality consistently featured as predictors of adjustment, although research should now move from identifying predictors, to clarifying the concept and parameters of psychosocial adjustment while developing and evaluating interventions to improve outcomes.

Introduction Most cases of burns occurring in medical institutions are associated with activities involving heat. It is very difficult to detect these burns. To date, there are few reports on burns occurring in medical institutions. The purpose of this paper was to analyze the etiology of burns occurring in medical institutions and to elucidate the factors affecting burn depth. Methods We conducted a retrospective analysis of the medical records of patients who visited our center from April 2008 to February 2013. This study enrolled all patients with burns occurring in the medical institution during or related to treatment. We excluded burn patients whose burns were not related to treatment (for example, we excluded patients with scalding burns that occurred in the hospital cafeteria and pediatric patients with hot water burns from the water purifier). However, patients with burns that occurred in the recovery room after general anesthesia were included. Results A total of 115 patients were enrolled in this study. The average patient age was 41.5 years, with more women than men (M:F = 31:84). There were 29 cases (25.3%) of superficial burns (first-degree and superficial second-degree) and 86 cases (74.7%) of deep burns (deep second-degree and third-degree). Hot packs were the most common cause of burns (27 cases, 23.5%), followed by laser therapy, heating pads, and grounding pads, accounting for 15 cases each. There were 89 cases (77.4%) of contact burns and 26 cases (22.6%) of non-contact burns. The most common site of burns was the lower extremities (41 cases, 35.7%). The burn site and contact burns were both factors affecting burn depth. The rate of deep burns was higher in patients with contact burns than in those with non-contact burns (odds ratio 4.26) and was associated with lower body burns (odds ratio 2.85). Conclusion In burns occurring in medical institutions, there is a high probability of a deep burn if it is a contact burn or occurs in the lower body. Therefore, safety guidelines are needed for the use of hot packs, heating pads, and grounding pads to prevent such incidents.

Surgical burn treatment depends on accurate estimation of burn depth. Many methods have been used to asses burns, but none has gained wide acceptance. Hyperspectral imaging technique has recently entered the medical research field with encouraging results. In this paper we present a preliminary study (case presentation) that aims to point out the value of this optical method in burn wound characterization and to set up future lines of investigation. A hyperspectral image of a leg and foot with partial thickness burns was obtained in the fifth postburn day. The image was analyzed using linear spectral unmixing model as a tool for mapping the investigated areas. The article gives details on the mathematical bases of the interpretation model and correlations with clinical examination pointing out the advantages of hyperspectral imaging technique. While the results were encouraging, further more extended and better founded studies are being prepared before recognizing hyperspectral imaging technique as an applicable method of burn wound assessment.

Hydrofluoric acid (HF), a dangerous inorganic acid, can cause severe corrosive effects and systemic toxicity. HF enters the human body via where it contacts, such as skin and mucosa, alimentary and respiratory tracts, and ocular surfaces. In the recent years, the incidence of HF burn has tended to increase over time. The injury mechanism of HF is associated primarily with the massive absorption of HF and the release of hydrogen ions. Correct diagnosis and timely treatment are especially important for HF burns. The critical procedure to treat HF burn is to prevent on-going HF absorption, and block the progressive destruction caused by fluoride ions. Due to the distinct characteristics of HF burns, the topical treatment, as well as systemic support, has been emphasised. Whereas, management of patients with HF burns remains a great challenge in some situations. To date, there has been no widely accepted protocol for the rescue of HF burns, partly due to the diversity of HF burns. This paper overviews the current status and problems of treatment strategies for HF burns, for the purpose of promoting the future researches and improvement.

Keloids and hypertrophic scars occur anywhere from 30 to 90% of patients, and are characterized by pathologically excessive dermal fibrosis and aberrant wound healing. Both entities have different clinical and histochemical characteristics, and unfortunately still represent a great challenge for clinicians due to lack of efficacious treatments. Current advances in molecular biology and genetics reveal new preventive and therapeutical options which represent a hope to manage this highly prevalent, chronic and disabling problem, with long-term beneficial outcomes and improvement of quality of life. While we wait for these translational clinical products to be marketed, however, it is imperative to know the basics of the currently existing wide array of strategies to deal with excessive scars: from the classical corticotherapy, to the most recent botulinum toxin and lasers. The main aim of this review paper is to offer a useful up-to-date guideline to prevent and treat keloids and hypertrophic scars.

a b s t r a c t Background: Burns are a challenge for trauma care and a contribution to the surgical burden. The former Soviet republic of Ukraine has a foundation for burn care; however data concerning burns in Ukraine has historically been scant. The objective of this paper was to compare a new burn database to identify problems and implement improvements in burn care and prevention in this country. Methods: Retrospective analyses of demographic and clinical data of burn patients including Tukey’s post hoc test, analysis of variance, and chi square analyses, and Fisher’s exact test were used. Data were compared to the American Burn Association (ABA) burn repository. Results: This study included 1752 thermally injured patients treated in 20 hospitals including Specialized Burn Unit in Municipal Hospital #8 Lviv, Lviv province in Ukraine. Scald burns were the primary etiology of burns injuries (70%) and burns were more common among children less than five years of age (34%). Length of stay, mechanical ventilation use, infection rates, and morbidity increased with greater burn size. Mortality was significantly related to burn size, inhalation injury, age, and length of stay. Wound infections were associated with burn size and older age. Compared to ABA data, Ukrainian patients had double the length of stay and a higher rate of wound infections (16% vs. 2.4%). Conclusion: We created one of the first burn databases from a region of the former Soviet Union in an effort to bring attention to burn injury and improve burn care.

Methods In this cross-sectional retrospective study, frequency, type, time of occurrence and atiology of seizures in children with burn was investigated. All cases were under 18 years and were hospitalized in Shahid Motahari Burns Hospital during 2006–2011. Extracted data from patients’ medical records was reviewed and statistically analyzed. Results Among 1103 patients, 69 (6.2%) had seizures, more frequently in the first 24 h following burn. Thermal burn, especially with boiling water was the cause of burn in most of the children. Seizures occurred more commonly in children less than 3 years old and was generalized (tonic–clonic). Seizure was found to be primarily associated with febrile seizure, while hyponatremia was diagnosed as the second cause. Previous seizure history and seizure with unknown cause were identified as other etiologies. This paper summarizes the key information about seizure following burn, which health professionals, especially those in burn centers, should be aware. However, since this study was single-center more investigations in other centers are needed.

Scar formation after injury is a big problem, which influences the skin function and esthetic appearances. Recent researchers have hinted many directions, one of which has shown that scar formation is related to the loss of integrity in dermal tissues. The structure of dermal tissue, which contains mostly collagen, is not only crucial for the mechanical stability of skin, but also acts as a dermal template, providing contact guidance for regulating cell behavior and restoring normal structure and function to skin that has been damaged by injury. These findings suggest a series of questions. How does contact guidance regulate cell behavior? What is the three-dimensional (3D) architecture of the dermal tissue? How does the native 3D architecture influence cell behavior in vivo? In this paper, combing our recent research, we will review the recent advances in this field, that is, the phenomenon of contact guidance and explore the possible mechanism behind it.

Background During critical illness, the demand for glutamine may exceed that which can be mobilized from muscle stores. Infections increase mortality, morbidity, length-of-stay, antibiotic usage and the cost of care. This is a major health care issue. Methods RCTs were identified from the electronic databases: the Cochrane Library, MEDLINE, PubMed web of knowledge and hand searching journals. The trials compared the supplementation with glutamine and non-supplementation in burn. Statistical analysis was performed using RevMan5.1 software, from Cochrane Collaboration. Results 216 papers showed a match, in the keyword search. Upon screening the title, reading the abstract and the entire article, only four RCTs, involving 155 patients, were included. For both the glutamine group and control group, total burn surface area (TBSA) (MD = 2.02, 95% CI −2.17, 6.21, p = 0.34) was similar. Glutamine supplementation was associated with a statistically significant decrease in the number of patients with gram-negative bacteremia (OR 0.27, 95% CI 0.08–0.92, p = 0.04) and hospital mortality (OR = 0.13, 95% CI 0.03, 0.51, p = 0.004), however, no statistical difference was noted between groups, for the other results. Conclusion Glutamine supplemented nutrition can be associated with a reduction in mortality in hospital, complications due to gram-negative bacteremia in burn patients. Further larger and better quality trials are required, in order to determine whether any differences are statistically and clinically important.

Background Electrosurgical instruments – one of the useful and most-used instruments within the surgeon's armamentarium – are potentially dangerous by causing unanticipated direct burns; fire occurring as a result of electrosurgical instruments and electromagnetic interference with a pacemaker, defibrillator, or cardiac monitoring device. Methods The Mega 2000 Patient Return Electrode System produced by Megadyne Medical Products is a noncontact electrode designed to provide adequate electrical return to facilitate function of electrocautery devices. We used this noncontact device in 67 patients (28 women, 39 men) with large burns during their stay in our burn unit and in 11 of these patients (4 women, 7 men) for escharotomies during admission in our burn care. Results The device functioned well in all cases, no additional cutaneous burns on the patients’ body were noticed. Conclusion This paper is a review of our experience with this noncontact electrosurgical grounding in burn surgery highlighting its advantages comparing with the conventional electrosurgical instruments.

Thermal effects of laser irradiation on skin are investigated in this paper. The main purpose is to determine the damage level induced by a laser exposure. Potential burns induced by two lasers (wavelength 808nm and 1940nm) are studied and animal experimentations are performed. Several exposure durations and laser powers are tested. Based on previous works, a mathematical model dedicated to temperature prediction is proposed and finite-element method is implemented. This numerical predictive tool based on the bioheat equation takes into account heat losses due to the convection on skin surface, blood circulatory and also evaporation. Thermal behavior of each skin layer is also described considering distinct thermal and optical properties. Since the mathematical model is able to estimate damage levels, histological analyses were also carried through. It is confirmed that the mathematical model is an efficient predictive tool for estimation of damage caused by lasers and that thermal effects sharply depend on laser wavelength.

For 2010, roughly 1446 original burn research articles were published in scientific journals using the English language. This article reviews those with the most impact on burn treatment according to the Editor of one of the major journals (Burns) and his colleagues. As in previous reviews, articles were divided into the following topic areas: epidemiology, demographics of injury, wound characterisation and treatment, critical care, inhalation injury, infection, metabolism and nutrition, psychological considerations, pain and itching management, rehabilitation and long-term outcomes, and burn reconstruction. Each paper is considered very briefly, and the reader is referred to full manuscripts for details.

Purpose: Primary wound closure of large defects after burn scar excision may be facilitated by intraoperative stretching of the adjacent skin. In a randomized controlled trial (RCT), the effect of skin stretching for wound closure after scar excision (SS) was compared to scar excision without additional techniques (SE). Short-term results already showed that in the SS group larger scars could be excised in a one-step procedure. In this paper, the long-term scar outcome using reliable and valid measurement tools was evaluated. Basic procedures: The percentage of total remaining scar area (i.e. remaining scar compared to preoperative scar), the percentage of linear scarring (i.e. surface area of linear scar compared to excised scar) and scar hypertrophy was measured at 3 and 12 months postoperatively. Main findings: At 12 months postoperatively, the percentage of total remaining scar area was significantly lower in the SS group (26%) compared to the SE group (43%). The percentage of linear scarring (SS: 21%, SE: 25%) and the incidence of hypertrophy (SS: 29%, SE: 40%) were not significantly different between the treatment groups. Conclusions: This RCT demonstrates the long-term beneficial and sustainable effect skin stretching for wound closure after scar excision without leading to wider linear scars or more scar hypertrophy. (C) 2011 Elsevier Ltd and ISBI. All rights reserved

Background In China, large sample research directed at the epidemiology of burns is still scarce. Given the leading position of Chinese military hospitals in domestic clinical practice pertaining to burns, a look into their cases would help shed light on the incidence and hospital care of burns in China today. Methods Data were collected from information systems of all the Chinese military hospitals, for the years 2001–2007 inclusive. Retrospective analyses on the epidemiology characteristics of burns from those in patients admitted to all the Chinese military hospitals within this period were conducted. Results A total of 172,256 cases were studied, with a total number of 1384 fatalities, and the median length of hospital stay (LOS) 11.00 days (interquartile range 6.00–19.00 days). Rate of burn incidence remained high in May, June, July and August. Children of preschool aged and adults in the labor force were at the highest risk of injury. Scalds constituted the majority of injuries (80.5%). Multiple body site burns are the most commonly seen category (31.98%) in terms of injured body region distribution. In fire-related burns, major burns (TBSA > 30%) represented a significant proportion. Males with TBSA > 30%, fire-related burns resulted in the greatest number of fatalities. Gender, age, site of injury, burn size and outcome are all correlated with the length of hospitalization. Conclusion Although this paper cannot provide information on population estimates of burns due to the absence of data on burns attending civilian hospitals, it finds that the epidemiology of burns in China shows distinct characteristics compared with previous studies of other country and regions, including that of other developing or low and middle-income countries (LMICs), irrespective of China's inclusion in that group.

Introduction Self-immolation remains a significant contemporary problem. Its epidemiology and causes, and the intervention strategies these suggest vary significantly between higher- and lower-income countries. We summarize what is known about suicide by self-immolation in terms of its demographic and psychiatric risk factors, causes, local patterns and means employed, and points of possible intervention. Methods We reviewed the literature for all published papers on self-immolation between 1973 and 2010. Epidemiologic and psychiatric risk factors and aspects of method, locale and timing of self-immolation were compared between higher- and lower-income countries. Results In higher-income countries self-immolation tends to be rare and the majority of self-immolation patients are male. In lower-income countries, the incidence of self-immolation is much higher, and the majority of patients are female. Self-immolation was more frequently associated with a history of mental illness or substance abuse history in higher-income countries than in lower-income countries. Conclusion Reports in the literature of self-immolation divide most informatively into two groups according to the higher- or lower-income of the societies affected. This classification is not arbitrary, as it correlates with other measures of development, and the epidemiologic patterns revealed show distinct differences, suggesting differing causes and intervention strategies. Analytical studies are needed to distinguish associations from underlying causes and identify efficient points of intervention.

The Burn Specific Health Scale (BSHS) is the most commonly used instrument used to evaluate burn survivors' quality of life (QOL). Multiple forms of the instrument exist; however, the literature lacks clarity in regard as to why a particular version of the BSHS was used and how the instrument performed in a variety of samples. This paper provides a review of the literature of the variations of the BSHS, its utility for research and clinical practice, and scoring concerns.

Mass casualty incidents involving victims with severe burns pose difficult and unique problems for both rescue teams and hospitals. This paper presents an analysis of the published reports with the aim of proposing a rational model for burn rescue and hospital referral for Switzerland.Literature review including systematic searches of PubMed/Medline, reference textbooks and journals as well as landmark articles.Since hospitals have limited surge capacities in the event of burn disasters, a special approach to both prehospital and hospital management of these victims is required. Specialized rescue and care can be adequately met and at all levels of needs by deploying mobile burn teams to the scene. These burn teams can bring needed skills and enhance the efficiency of the classical disaster response teams. Burn teams assist with both primary and secondary triage, contribute to initial patient management and offer advice to non-specialized designated hospitals that provide acute care for burn patients with Total Burn Surface Area (TBSA)20-30%. The main components required for successful deployments of mobile burn teams include socio-economic feasibility, streamlined logistical implementation as well as partnership coordination with other agencies including subsidiary military resources.Disaster preparedness plans involving burn specialists dispatched from a referral burn center can upgrade and significantly improve prehospital rescue outcome, initial resuscitation care and help prevent an overload to hospital surge capacities in case of multiple burn victims. This is the rationale behind the ongoing development and implementation of the Swiss burn plan.

Burn trauma ranges from the minor burn to the devastating injury, which can impact on all aspects of a person's life including aesthetic appearance, relationships with others and psychological, social and physical functioning. Measurement of outcome in burns patients is therefore complex and multi-faceted. The increasing numbers of major burn survivors implies that understanding health outcomes in these patients has assumed high priority. This paper sets out a conceptual framework for unifying outcome measurement, which may be useful to all members of the multidisciplinary team who are contemplating outcome assessment in their burn patients. It outlines seven core domains of assessment which are (i) skin; (ii) neuromuscular function; (iii) sensory and pain; (iv) psychological function; (v) physical role function; (vi) community participation; and (vii) perceived quality of life. Within each domain, we present a brief clinical review of the most commonly administered measurement tools that have been, or potentially could be, used to assess aspects of these core domains. Where possible, the psychometric properties and clinical utility of these tools are presented. A concise discussion of key methodological issues which should be addressed in this assessment process is then provided, together with suggestions for future research.

It has been accepted for many years that the cost of care for the burn-injured patient is high. There is, however, little published data to show how "expensive" it is. At the Welsh Centre for burns we have undertaken a costing exercise in an attempt to define the true cost to the treatment of burns. Using our current cost base and activity, we established a cost per health related group (HRG) for burns and also prospectively calculated costs for three inpatients to determine whether HRG-based burn tariffs accurately represent these costs. The NHS is under increasing pressure to provide evidence to support budgetary requirements; we feel this paper offers a framework for burn care costing upon which calculations could be based.

The face is the central point of the physical features of the human being. It transmits expressions and emotions, communicates feelings and allows for individual identity. It contains complex musculature and a pliable and unique skin envelope that reacts to the environment through a vast network of nerve endings. The face hosts vital areas that make phonation, feeding, and vision possible. Facial burns disrupt these anatomical and functional structures creating pain, deformity, swelling, and contractures that may lead to lasting physical and psychological sequelae. The management of facial burns may include operative and non-operative treatment or both, depending on the depth and extent of the burn. This paper intends to provide a review of the available options for topical management of facial burns. Topical agents will be defined as any agent applied to the surface of the skin that alters the outcome of the facial burn. Therefore, the classic concept of topical therapy will be expanded and developed within two major stages: acute and rehabilitation. Comparison of the effectiveness of the different treatments and relevant literature will be discussed.

Lightning is an uncommon but potentially devastating cause of injury in patients presenting to burn centers. These injuries feature unusual symptoms, high mortality, and significant long-term morbidity. This paper will review the epidemiology, physics, clinical presentation, management principles, and prevention of lightning injuries.

A large proportion of burns in developing countries are related to the nature of domestic appliances used for cooking, heating, and lighting. Our overview of the problem elucidated the need for better surveillance with epidemiologic studies, which will more accurately assess the true incidence in vulnerable populations. This paper will create a framework for envisaging new approaches to the problem and begin to evaluate the strengths and weaknesses of proposed interventions. We used the Haddon Matrix to accumulate proposed interventions that encompass a pre-event, event, and post-event timeline. We propose an initial strategic outline plan for interventions based on values that are suited to the problem and the setting, are culturally appropriate, and can be employed in a reasonable period of time for a sustained period to ensure success. Recommended action steps include promoting the use of alternative energy sources, encouraging an integrated approach to finding interdisciplinary solutions, devising a better system of kerosene containerization, re-engineering appliance designs, legislating for enforcement of health and safety standards, taking a holistic approach through government inter-departmental collaboration, formally discouraging corruption, encouraging ventilation of cooking or living areas, implementing building codes, educating consumers, and training caregivers and health and emergency workers.

As part of a larger study involving burned adults and parents of burned children, family members were asked for their views regarding the impact of burn on themselves and the family (N = 50). The aim is to describe the range of psychosocial issues that psychosocial support programmes may need to address. This paper reports on the content analysis of specifically designed self-completion questionnaires. The results reveal commonalities within support needs across the three study groups (siblings, children, and partners). These are recommended as key elements in a family support programme: (i) normalising of family member's reactions to the burn. (ii) Advice, support, and information regarding scar permanence, realistic outcome expectations, acceptance of altered appearance, and potential after-effects of burn. (iii) Support in understanding how a burned individual may change or respond following injury and advice regarding constructive methods of coping with altered family dynamics and after-effects of burn. (iv) Advice to enable family members and their burned relative to effectively deal with potentially uncomfortable social encounters.

A retrospective and prospective management of 665 patients of electrical burn injuries out of 10,000 burn cases admitted between 1996 and 2004 (9 years) was analyzed. The problems encountered and their solutions are presented. One hundred and fifty-five (155) of them had their limbs amputated, i.e. (24%). The pathophysiology of electrical injury is reviewed. Serial and multiple debridement of wounds were performed, preserving the nerves, tendons, joints and bones even if denatured to preserve the continuity as these could regenerate partially if covered with vascularised skin. Functional outcome of an electrical burn wound is inversely proportional to the time lapsed before start of reconstructive procedure/s. Infrastructural limitations like severe shortage of blood, and surgical materials due to a disparity between demand and supply added to the poor general condition of the patient unfavorably delayed the start of reconstruction and precipitated "an unusual clinical situation". The aim of management has been to obtain a healthy wound, which could support an inset of a skin edge. Under these situations, a stable wound was obtained on the 12th day [average]. Split skin grafts and loco-regional flaps, using time-old principles of rotation, advancement, transposition served well in most of our cases. Through this paper, some unusual wounds in unusual clinical situations, which were managed with various methods of reconstruction, following the reconstructive ladder are presented.

Hypertrophic scarring and contractures that distort the position of facial features and actual loss of facial parts due to burn present a unique reconstructive problem because of the wide variation of skin color and texture present [1–3]. Early reconstruction is indicated in cases with severe disfigurement of face or functional impairment. Small to medium facial skin defects can be reconstructed with local or regional flaps taken above the clavicle [2,4,5]. Large surface defects, however, often require skin grafts, distant flaps, or free flap reconstruction [6–9]. A wide variety of distant flaps now exist for facial reconstruction, although not all provide an adequate tissue match with respect to texture, color, thickness, and pliability [6–8]. Although there are various local and regional flap choices advocated in the literature for reconstruction of nasal defects [3,10–12] but usually the burn is extensive and eliminates most of potential donor sites. A very specific reconstructive problem is the facial hair-bearing skin in the male patients [13–15]. In this situation skin graft and flaps without hair bearing capacity are not suitable. Because of these subtle complexities, careful thought must be given to the selection and planning of flaps to achieve both an aesthetic and functional repair [2,6–8]. In this paper we represent our planning for reconstruction of nostrils, upper and lower lip, chin and cheek in a man with

The prospect of being able to replace damaged tissue by the process of regeneration would dramatically and irrevocably change the impact, management and outcome of burns. The current understanding of stem cell-based modulation and therapy together with their potential developments do bring this prospect ever closer to a clinical reality. This paper gives a background to stem cell strategies in burns care and identifies actual or prospective applications which, collectively, will forever change burns care throughout the world.

a b s t r a c t Burn scars are frequently accompanied with sensory deficits often remaining present months or even years after injury. Clinimetric properties of assessment tools remain understudied within burn literature. Tactile sense of touch can be examined with the touch pressure threshold (TPT) method using the Semmes Weinstein monofilament test (SWMT). There is in recent research no consensus on the exact measurement procedure when using the SWMT. The aim of this paper was to determine the interrater and intrarater reliability of TPT within burn scars and healthy controls using the ‘ascending descending’ measurement procedure. We used the newly developed guidelines for reporting reliability and agreement studies (GRRAS) as a basis to report this reliability study. In total 36 individuals were tested; a healthy control group and a scar group. The interrater reliability was excellent in the scar group (ICC = 0.908/SEM = 0.21) and fair to good in the control group (ICC = 0.731/SEM = 0.12). In the scar group intrarater ICC value was excellent (ICC = 0.822/SEM = 0.33). Within the control group also an excellent intrarater reliability (ICC = 0.807/SEM = 0.27) was found. In conclusion this study shows that the SWMT with the ‘ascending descending’ measurement procedure is a feasible and reliable objective measure to evaluate TPT in (older) upper extremities burn scars as well as in healthy skin.

The incidence of extensive full thickness scalp burn involving the calvaria is rare and can be very difficult to reconstruct, as the application of local or free tissue transfer is limited. Although wound closure can be achieved with bone debridement and immediate or delayed split-thickness autografting, the result may be problematic due to unstable skin graft surface. The use of artificial dermis that may provide stable thick coverage in the treatment scalp and skull burn has rarely been reported in literature. We encountered two patients who suffered from severe head burns involving the calvarium. Following debridement including the necrotic bone, the artificial dermis (Integra) was used for immediate wound coverage which was 15 cmx10 cm in one case and 5 cmx6 cm in another. Three weeks later, ultra-thin skin grafting was placed on the neodermis. Compared to split-thickness skin graft, this technique provides a thicker coverage for wound closure. Neither skin breakdown nor ulceration was noted in the 1-year follow-up. This paper reports the successful use of artificial dermis for reconstruction of severe scalp burn with calvarial bone involvement.

Pressure garments have been the mainstay of hypertrophic scar treatment since the 1970s. However, there are many problems associated with their use. This is the first in a series of papers on pressure garments that will review the literature published to date on the origins of pressure garments for hypertrophic scar treatment and the problems associated with current pressure garment use.

A new instrument, the Versajet system, based on fluid jet technology has recently been advocated as an alternative to standard surgical excisional technique for burn wounds. In this paper we describe our experience with this tool, the technique employed as well as its clinical feasability for debriding partial thickness burn wounds. Seventeen patients were evaluated for clinical efficacy of debridement of their burn wounds using the Versajet system. Burn wound areas of between 0.5 and 5% total body surface (TBSA) involving the face, arm, hand, leg and foot underwent debridement using the Versajet system. The Versajet system was able to sufficiently debride superficial partial thickness and mid-dermal partial thickness wounds for subsequent placement of Biobrane. Deeper partial thickness wounds could be excised for successful autografting. The Versajet system demonstrated some particular advantage in the surgical treatment of superficial to mid-partial thickness burns in areas like the face, hand and foot which can often be difficult to reach and contour with conventional modalities.