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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. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life threatening unwanted side effects, mainly from medication. Pathophysiology is still being debated. The disease usually requires treatment in burn units. PATIENTS AND METHODS: In a retrospective study over 27 years we evaluated 72 patients admitted with SJS, SJS/TEN and TEN to our burns unit. Patients were evaluated for age, gender, total body surface area (TBSA) involved, causing agents, blood transfusion, dialysis, steroid administration, intubation, length of intensive care stay and death rate. Participants were grouped according to TBSA from 0 to 10, 11 to 30, and 31 to 100% and also into causing agent. Statistical analysis was done using a step-wise regression analysis. Because of small sample sizes for each drug group the percentage of related death rates for each drug group was calculated. RESULTS: The highest incidence of SJS and TEN was in the age group of 61-70 years. Overall mortality was 38%, mainly due to sepsis. For each subgroup SJS/TEN overlap had the highest mortality. The highest mortality for causing agents was found from antibiotic treatment, the lowest from using non-steroidal anti-inflammatory drugs. Most transfusions were done in the antibiotic group also the group underwent the highest number of dialysis events. Step-wise regression analysis identified dialysis, mechanical ventilation and age over 65 years as mortality high risk factors. CONCLUSION: When SJS/TEN is caused by antibiotics suspicion of developing a fatal sepsis should be high. Patients' medical condition when initiating therapy with a potential causing agent also might influence medical outcome. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life threatening unwanted side effects, mainly from medication. Pathophysiology is still being debated. The disease usually requires treatment in burn units. Patients and methods: In a retrospective study over 27 years we evaluated 72 patients admitted with SJS, SJS/TEN and TEN to our burns unit. Patients were evaluated for age, gender, total body surface area (TBSA) involved, causing agents, blood transfusion, dialysis, steroid administration, intubation, length of intensive care stay and death rate. Participants were grouped according to TBSA from 0 to 10, 11 to 30, and 31 to 100% and also into causing agent. Statistical analysis was done using a step-wise regression analysis. Because of small sample sizes for each drug group the percentage of related death rates for each drug group was calculated. Results: The highest incidence of SJS and TEN was in the age group of 61–70 years. Overall mortality was 38%, mainly due to sepsis. For each subgroup SJS/TEN overlap had the highest mortality. The highest mortality for causing agents was found from antibiotic treatment, the lowest from using non-steroidal anti-inflammatory drugs. Most transfusions were done in the antibiotic group also the group underwent the highest number of dialysis events. Step-wise regression analysis identified dialysis, mechanical ventilation and age over 65 years as mortality high risk factors. Conclusion: When SJS/TEN is caused by antibiotics suspicion of developing a fatal sepsis should be high. Patients’ medical condition when initiating therapy with a potential causing agent also might influence medical outcome. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate demographic and socioeconomic factors associated with assault burn injuries. Background: Assault by burning demonstrates a rare but severe public health issue and accounts for unique injury characteristics in the burn intensive care unit (BICU). Methods: We conducted a retrospective cohort study involving patients with thermal injuries admitted to the BICU of a university hospital. The patient cohort was divided into two groups (ABI group: patients with assault burns, n =41; Control group: population of all other burned patients admitted to the BICU, n =1202). Bivariate and multivariate analyses including demographic and socioeconomic data were used to identify factors associated with assault burns. Results: Forty-one assault-related burn victims were identified in the study period. This represents 3.3% of all significant burns admitted. Comparing battery victims with the control population, assault patients were more likely to be young (mean age 36.2 years vs. 42.2 years) and immigrants (41.5% vs. 15.1%). Furthermore, marital status (65.9% vs. 40.8% singles), employment status (36.6% vs. 9.7% unemployed) and insurance status (41.5% vs. 12.3% social insurance) were significantly different in the bivariate analysis. Logistic regression evaluation identified three variables that were independently associated with assault burns: younger age (≤25 years) (odds ratio, 2.54 [95% confidence interval, 1.29–5.02]; p =0.007), ethnic minority (odds ratio, 3.71 [95% confidence interval, 1.91–7.20]; p <0.001) and unemployment (odds ratio, 4.02 [95% confidence interval, 2.03–7.97]; p <0.001). Conclusions: The high incidence of youngsters, unemployment and the great proportion of immigrants in victims of assault might provide several opportunities for community-based psychosocial and occupational programs. A multidisciplinary approach targeting issues specific to the violent nature of the injury and the socioeconomic background of the victims may be of benefit to improve their perspectives for rehabilitation. [Copyright &y& Elsevier]

Abstract: Objective: To investigate the incidence and predisposing factors of acalculous cholecystitis (AAC) in severely burned patients. Background data: Although some studies report on AAC in critically ill patients, very little is known about AAC after severe burns. Methods: We conducted a retrospective cohort study involving patients with burns admitted to the burn intensive care unit (BICU) of a university hospital. The patient cohort was divided into two groups (AAC group: burned patients with histological proven acalculous cholecystitis, n =15; Control group: population of all other burned patients admitted to the BICU, n =1225). Univariate and multivariate analyses were used to identify predisposing factors for the development of AAC. Results: Fifteen patients with acalculous cholecystitis were identified in the study period. This represents 1.2% of all significant burns admitted. Comparing the AAC group with the Control population the following patients’ characteristics, therapeutic measures and outcome parameters were significantly different in the univariate analysis: mean age (54.0 years vs. 42.0 years), BMI (28.9kg/m2 vs. 25.6kg/m2), abbreviated burn severity index (8.3 vs. 6.4), total body surface area burn deep partial thickness (12.0% vs. 6.2%) and full thickness (10.2% vs. 6.8%), concomitant inhalation injury (80.0% vs. 28.9%), sepsis (46.7% vs. 14.9%), catecholamine (100% vs. 30.4%) and antibiotic requirement (100% vs. 58.2%), non-biliary tract operations (4.9 vs. 1.5), BICU length of stay (63.4 days vs. 21.0 days), ventilator days (50.3 vs. 11.9), packed red blood cells (PRBCs) administration (70.0units vs.13.0units) and mortality (53.3% vs. 19.7%). In the multivariate analysis however, only age, the number of administered units of PRBCs and the duration of mechanical ventilation turned out to be independent predictors for the occurrence of AAC. Conclusion: AAC is a rare complication of severely burned patients and may reflect the severity of the patient’s general conditions. Predisposing factors for AAC are advanced age, the need of blood transfusions and prolonged mechanical ventilation. In the presence of these predisposing factors, early monitoring may help to detect AAC earlier and to initiate appropriate intervention. [Copyright &y& Elsevier]