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The goal of this study was to inform standards of best practice in the use of cultured epidermal autograft (CEA), manufactured in the United States, for the treatment of patients with severe burns. The study was designed using the modified Delphi technique, a method for structuring group communication among experts to promote the development of consensus-based recommendations. Known areas of variability related to the stages of CEA treatment were identified by literature review prior to the study and were confirmed through qualitative interview with the experts. The areas included Preoperative Planning/Surgical Planning, Immediate Postoperative Care, and Rehabilitation and Long-Term Care. A list of 22 questions was developed based on interviews with the experts, and a 3-round Delphi technique was used to establish consensus (≥80% agreement). Following 3 rounds (quantitative, qualitative, and virtual roundtable meeting) of the Delphi study, important guidance for the use of CEA treatment in severely burned patients gained consensus. Final key recommendations included minimum burn limit for CEA treatment (30%-50% TBSA), ideal biopsy timing (1-2 days), number of grafts (enough to cover; adjust 72 hours before application), use of dermal substrates (recommended) and wide meshed autograft underlay (recommended), optimal CEA drying time per day (open air >6 hours), slings used if CEA placed on extremities (recommended), dressing changes (performed every day, all at once, with all layers removed down to bridal veil), CEA backing removal (10-14 days after placement), heat lamps (can be used to aid the wound in drying, depending on clinical judgment), initial activity restrictions lifted (beginning 10 days after backing removal), compression garments (introduced at approximately 2 months post-CEA surgery), and lasers (CO2 laser can be introduced between 3 and 6 months post-CEA surgery). [ABSTRACT FROM AUTHOR]

Byline: Atul. Kapoor, Arpana. Jain, Goldaa. Mahajan, Amritpal. Singh, V. Bajwa, G. Brar A 24 year healthy male presented with a feeling of heaviness in the left lumbar region without [...]

Background: Increasing firearm violence has resulted in a strong drive for stricter firearm legislations. Aim of this study was to determine the relationship between firearm legislations and firearm-related injuries across states in the United States. Methods: We performed a retrospective analysis of all patients with trauma related hospitalization using the 2011 Nationwide Inpatient Sample database. Patients with firearm-related injury were identified using E-codes. States were dichotomized into strict firearm laws [SFL] or non-strict firearm laws [Non-SFL] states based on Brady Center score. Outcome measures were the rate of firearm injury and firearm mortality. Linear Regression and correlation analysis were used to assess outcomes among states. Results: 1,277,250 patients with trauma related hospitalization across 44 states were included of which, 2,583 patients had firearm-related injuries. Ten states were categorized as SFL and 34 states as Non-SFL. Mean rate of firearm related injury per 1000 trauma patients was lower in SFL states (1.3±0.5 vs. 2.1±1.4; p=0.006) and negatively correlated with Brady score (R2 linear=-0.07; p=0.04). SFL states had a 28% lower incidence of firearm related injuries compared to Non-SFL states (Beta coefficient, -0.28; 95% CI, -1.7- -0.06; p=0.04). Firearm related mortalities resulted in overall 9,722 potential life years lost and more so in the non-SFL states (p=0.001). Conclusions: States without SFL have higher firearm related injury rates, higher firearm related mortality rate, and significant potential years of life lost compared to SFL states. Further analysis of differences in the legislation between SFL and non-SFL states may help reduce firearm related injury rate. [ABSTRACT FROM AUTHOR]

Introduction: Full thickness burn injury affects the host response to burn injury differently that partial thickness burn injury. Current guidelines for initial resuscitation calculate fluid infusion based on Total Body Surface Area (TBSA) affected and patient's weight. The widely used formula does not offer guidance based on the depth of the injury. We present an investigation into relationship of full thickness burn injury on fluid resuscitation. This study was approved by our Institutional Review Board. Methods: We performed a retrospective review of patients' charts who were admitted after major burn injury of greater than 20% TBSA to a busy regional burn center. We included patients over age of 14 years admitted from year 2014-2019. We excluded patients who did not have complete resuscitation data, allowing 99 patients for analysis. We performed t test to uncover relationship of age, gender, body weight, TBSA and percent of full thickness burn with fluid received during initial resuscitation with significance set at p < 0.05. Results: The volume of fluids given during initial resuscitation was significantly affected by gender and full thickness burn injury. Fluids requirement for females was 4.6ml/kg/TBSA vs males was 3.3ml/kg/TBSA (p value 0.04). Fluid requirement for full thickness burn was 8.4ml/kg/TBSA vs 3.7ml/kg/TBSA for all patients (p=0.0004). Initial fluid resuscitation fluids did not have significant relationship with age, body weight or overall TBSA. Conclusions: This study demonstrates that full thickness burn injury has a significant impact on initial fluid resuscitation. Further research is needed to elicit the mechanism to explain the higher fluid requirement for full thickness burn injury. Applicability of Research to Practice: Our study brings attention to the effect of depth of burn injury on the actual volume of fluids needed during initial resuscitation of burn injury. This study will alert the clinician to take into account both the surface area as well as depth of the burn injury while embarking on fluid resuscitation after a major burn injury. [ABSTRACT FROM AUTHOR]