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Hand burns have major impacts on daily activities. An interdisciplinary and multifaceted approach is necessary to effectively treat these burns. Generally, hands are common sites for burn injuries. It is known that Early Excision and Grafting (EEG) of deep burn wounds can decrease scar and subsequent contracture formation compared with Delayed Excision and Grafting (DEG) method. Accordingly, this study aimed to compare the effects of these procedures on function of hands with deep burns, by using the Michigan Hand Questionnaire (MHQ). In this double-blind randomized clinical trial, we evaluated a total of 50 patients (age range: 15-70 years) with deep second-degree burns of both hands from January 2013 to December 2015. The subjects were randomly divided into two groups, treatment (EEG) and control (DEG) groups (25 patients per group). They followed up postoperatively for 3 months. MHQ was completed for each of them to determine the function of the hands, pain sensation, limitation of daily activities, overall satisfaction, and cosmetic appearance during follow-up. Data were analyzed in the groups using SPSS version 16. Baseline characteristics of the groups were matched. In early postoperation, hand functions and daily activities, gross appearance, and pain sensation were better in EEG group. After 1 and 3 months, no significant difference was detected between the groups except for patient satisfaction which was better in EEG group. Also, EEG group was associated with a significant shorter hospital stay and lower treatment costs compared with DEG group. Graft take rate was similar in both groups. EEG is recognized as the standard treatment for deep skin burns, but we did not find any significant difference between effects of EEG and DEG on hand functions although EEG group had shorter hospital stay and lower treatment costs compared with DEG. The main goal of treatment of hand burns is restoration of the hand functions. Based on our findings, hand function was not related to the type of surgery. Also, as all wounds in both surgical groups healed less than 3 weeks, the authors suggest that the excision time limit could be change in our burn center from 10 days to 2 to 3 weeks when we use sheet graft as for hands., (© American Burn Association 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: There is controversy regarding whether increasing isolated soy protein (ISP) with or without flaxseed oil (FO), as functional foods, would lead to reduce muscle catabolism and cachexia in burn patients., Methods: One hundred and eighty-eight patients were assessed for eligibility in this randomized controlled trial. Of these, seventy-three eligible patients (total burn surface area 20-50%) were randomly assigned to three groups, labeled as Control (wheat flour [WF] + corn oil [CO]), ISP + FO, and ISP + CO, to receive these nutrients for three weeks. Weight, body mass index (BMI), serum hepatic enzymes (alanine transaminase [ALT], aspartate transaminase [AST], alkaline phosphatase [ALP]), systemic inflammatory response syndrome (SIRS), 24-h urinary urea nitrogen excretion (UUN), serum creatinine, 24-h urinary creatinine (UUC) excretion, fasting blood sugar (FBS), triglyceride (TG), and cholesterol were measured., Results: Using analysis of covariance models in the intention-to-treat population (n = 73), we found that at three weeks, patients in the ISP groups had lost significantly less in weight and BMI compared to those in the control group (all P < 0.01). Nitrogen retention and serum creatinine (primary outcomes) increased significantly in the ISP groups compared with the control group. Even after controlling for potential covariates in ANCOVA models, changes in these indices were still statistically significant (P = 0.008 and P = 0.005 for nitrogen balance and serum creatinine, respectively). However, no such significant differences were found between the ISP groups. On the other hand, 24-h UUN, and UUC excretion, serum hepatic enzymes, FBS, TG, and cholesterol were not significant between the groups (P > 0.05)., Conclusion: ISP and FO compared to WF and CO reduced muscle catabolism and increased body weight in burn patients., Trial Registration: Iranian Registry of Clinical Trials, IRCT2014051817740N1 . Registered on 27 June 2014.

Introduction: The objective was to determine the effect of isolated soy protein (ISP) and flaxseed oil (FO) on inflammatory and oxidative stress indices, acute phase proteins, and wound healing of burn patients., Methods: One hundred eighty-eight patients were assessed for eligibility in this randomized controlled trial. Of these, seventy-three eligible patients (total burn surface area 20-50%) were randomly assigned to 3 isocaloric groups, labeled as control (wheat flour+corn oil (CO)), ISP+FO, and ISP+CO, to receive these nutrients for 3 weeks. We used intention to treat analysis to overcome bias. Because of the large perturbation in water compartments, patients received nutrients from 4th to 25th day of admission. Serum high sensitivity C-reactive protein (hs-CRP), malondialdehyde (MDA), superoxide dismutase (SOD), ferritin, albumin, and transferrin were measured. The wound area was evaluated by stereological test., Results: During the 3-week intervention, hs-CRP (-19.4±5.6, -11.7±4.7μg/ml) and ferritin (-83.8±20.5, -80.1±19.6ng/ml) levels changes significantly reduced compared to the control group (P<0.05). MDA level (-0.05±0.21μmol/l) significantly decreased in group A (P<0/05) but was not significant in groups B and control (P>0.05). Albumin level (0.59±0.14, 0.30±0.12g/dl) significantly increased in group A compared to the control group (P<0.05), but no significant relationship was found between other groups (P>0.05). Transferrin level (4.9±3.6, 2.9±5.1g/dl) significantly increased in ISP groups compared to the control (P<0.05). SOD improved in all groups with no significant difference between them (P>0.05). The stereology examination showed significant improvement in wound healing in the ISP groups on days 22 and 25 compared to the control group., Conclusion: Nutritional supplements with ISP may attenuate post-burn oxidative stress and inflammation, leading to improved wound healing in burn patients. Flaxseed oil may not exert a beneficial effect over the ISP., (Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.)

Background: Burns are among the most devastating forms of injury. Nowadays the standard treatment for deep partial thickness and full-thickness burn is early excision and grafting, but this technique is not always feasible; and this leads to chronicity and microbial colonization of burn wounds. Interesting properties of human amniotic membrane made us use it in management of chronic infected burn wounds., Methods: From January 2008 to September 2010, in a prospective clinical trail, 38 patients (76 limbs) with symmetric chronic burn wounds in both upper or lower limbs included in this study. Tissue cultures were taken from all the wounds. For the right, after debridement of granulation tissue and meshed split thickness skin grafting, the graft surfaces were covered with amniotic membrane dressing and in left limb wounds, after debridement, skin grafting was done in conventional method. 21 days later, the success rate of graft take was compared between two groups., Results: The study group was composed of 76 limbs in 38 patients with mean age of 27.18±6.38 and burn in 29.18±7.23 TBSA%. The most common causes of the burn wounds chronicity in the selected patients was delayed admission due to poor compliance of the patients (44.8%). Staphylococcus was the most frequent isolate in wounds in our patients (62.85%). Mean graft take was observed in 90.13% of right upper limbs, and 67.36% of left upper limbs; which was significantly different (P<0.001)., Conclusions: Our study showed that human amniotic membrane dressing significantly increases the success rate of graft take in chronic wounds, and it can be recommended as an important dressing in chronic burn wounds management, due to interesting anti-microbial, and better graft take effects., (Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.)

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