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Objective: The primary objective of this study is to compare the healing rate between AP soap and 4% Chlorhexidine solution in superficial second-degree burn wounds. The secondary objectives include the analgesic effect and moisturization of these two products. Materials and Methods: Data was collected between 2019 and 2021. Patients aged 18 years and above, with superficial second-degree burns including at least 20% of TBSA, and admitted to the Burn Unit within 24 hours of injury were included. They were randomly assigned to two groups: Andrographis paniculata with Perilla oil liquid soap group (AP group) and 4% Chlorhexidine group (control group). The measurements included percentage of epithelialization, pain score during wound cleansing, itching score after wound cleansing, and dry skin specified symptoms. All patients received standard care for burn wound treatment. Results: A total enrollment was 23 patients in this study (12 in the AP group and 11 in the control group). The median age was 38.5 years. There were no statistically significant differences in age, %TBSA, and initial wound size between both groups (p > 0.05). Although the healing time was similar in both groups, (18.5 vs. 20.1, p=0.347), the AP group had a significantly lower pain score than the control group (4.7 vs. 5.4, p=0.020). Moreover, the AP group demonstrated significant improvements in itching score and SRRC score at 14 days compared to the control group (5.1 vs. 6.0, p 0.039 and 1.08 vs. 1.55, p 0.020, respectively). There were no adverse effects during this study. Conclusion: Patients treated with Andrographis paniculata with Perilla oil liquid soap experienced less pain and better moisturization compared to those treated with the standard 4% chlorhexidine solution, while achieving a comparable healing rate. A future large-scale prospective trial is recommended.

Abstract Cell sheet engineering, a scaffold-free approach to fabricate functional tissue constructs from several cell monolayers, has shown promise in tissue regeneration and wound healing. Unfortunately, these cell sheets are often too small to provide sufficient wound area coverage. In this study, we describe a process to enlarge cell sheets using MEEK micrografting, a technique extensively used to expand skin autografts for large burn treatments. Human dermal fibroblast cell sheets were placed on MEEK’s prefolded gauze without any use of adhesive, cut along the premarked lines and stretched out at various expansion ratios (1:3, 1:6 and 1:9), resulting in regular distribution of many square islands of fibroblasts at a much larger surface area. The cellular processes essential for wound healing, including reattachment, proliferation, and migration, of the fibroblasts on expanded MEEK gauze were superior to those on nylon dressing which served as a control. The optimal expansion ratio with the highest migration rate was 1:6, possibly due to the activation of chemical signals caused by mechanical stretching and an effective intercellular communication distance. Therefore, the combination of cell sheet engineering with the MEEK micrografting technique could provide high quality cells with a large coverage area, which would be particularly beneficial in wound care applications.

Objectives: Adequate nutritional support is one of the challenging treatments of major pediatric burns. Parenteral nutrition (PN) is one of the options to achieve daily caloric goal. Latest nutritional guidelines recommend late PN initiation due to unclear benefit over risk based on the limited data. Our study provides the data of parenteral nutrition within 7 days post admission (early PN) and factors affecting clinical outcomes in major pediatric burn patients. Methods: A retrospective study was conducted regarding pediatric burn patients who had over 15% of their total body surface area (TBSA) with second- or third-degree burns. All the patients were classified as requiring early PN support or non-early PN support. Results: 124 major pediatric burns were reviewed. Eighty-six patients (65.2%) were male, and the median age was three years (0.3-15 years). Early PN showed no association with length of hospital stay (LOS) (p=0.480) or a 30-day mortality (p=0.529). The children’s age, wound infections, and abdominal distension were the independent associated factors of LOS (p=0.025, 0.001, and 0.003 respectively). Pneumonia and urinary tract infection were independent factors associated with 30-day mortality (p=0.025). Conclusions: Early PN in acute pediatric burns was not associated with LOS or 30-day mortality. It can be considered as options of nutritional support in acute, major pediatric burns. Effective management of wound infections and abdominal distension may reduce LOS.

The standard burn wound treatment is the application of silver zinc sulfadiazine cream, covered with sterilized gauze dressing. This method has been used for decades because of its reasonable costs and applicability for larger wound sizes. However, gauze with a large pore size may stick to the wound bed and cause wound trauma, leading to delayed healing. The patient may also experience additional pain during changing the dressing. The non-adherent property of a hydrocolloid dressing coated with herbal extract (SIHERB) can promote wound healing as well as reduce pain. This study compared the two methods of burn wound treatment in the same patients, who were split into a “treatment group”, who were applied both silver sulfadiazine cream and hydrocolloid dressing, and “control group”, who were applied only silver sulfadiazine cream. The studied outcomes were the number of days for wound closure, the percentage epithelialization, and the pain score (evaluated every three days until epithelialization was completed). In total, 24 patients at the Burn Clinic, Siriraj Hospital were enrolled on this study. The starting wound areas were ranged from 210–220 cm2. The treatment group exhibited significant results regarding faster wound healing, referring to the number of days taken for wound closure (18 days in the control group vs. 15 days in the experimental group) and the percentage epithelialization compared to the control group. The average pain score in the experimental group was also lower on days 9, 12, and 15 after treatment (p < 0.05). No adverse effects were observed during the study. In conclusion, the combination of hydrocolloid dressing and silver sulfadiazine cream could reduce the wound shearing force and wound bed injury, accelerating the rate of wound closure and decreasing the pain during changing the dressing. This technique could improve upon the standard burn wound treatment.

Objective: This study aimed to assess the accuracy of the revised BAUX score for predicting mortality among the major burn patients with acute kidney injury (AKI) compared with non-AKI group. The epidemiologic information and risk factors of AKI in major burn patients were also the point of interest. Methods: This study was a retrospective cohort study. The medical records of 144 major burn patients admitted at the burns unit of Siriraj Hospital from 2010-2016 were reviewed and important data were retrieved. Results: Age, hypertension, diabetes mellitus, severity of the burn injuries, and inhalation injuries were the factors related to AKI in major burn patients. The mortality rate due to AKI in burn patients was high (44.4%). The accuracy of the revised BAUX score in predicting the mortality among the major burn patients from our series was only fair (66.7%). Conclusion: AKI affected on mortality of the major burn patients. Until the better predictor comes up, the revised BAUX score should be considered as a predictor of mortality in these patients.

Background: Wasp stings usually cause local reactions such as itching, urticaria, angioedema and anaphylaxis. Life-threatening complications following multiple wasp stings are relatively rare and unexpected. However, rhabdomyolysis and acute respiratory distress syndrome following wasp stings are possible. Case presentation: A middle-aged male worker was stung by a swarm of wasps all over his body while attacking a wasp’s nest. He had pain, a swollen face and multiple blisters on his entire body. He initially received the standard treatment of intravenous antihistamine, anesthetic and steroid medications. On admission day, his urine output progressively decreased in volume and turned from clear to bloody in appearance, with the color tending to become progressively darker. A serum creatinine of 0.87 mg/dL and a creatinine phosphokinase of 1403 IU/L at admission confirmed rhabdomyolysis. The following day, his serum creatinine and creatinine phosphokinase rose, with the development of tachypnea with desaturation; a chest radiograph showed bilateral diffuse lung infiltration. He was subsequently diagnosed with acute respiratory distress syndrome (ARDS). A medical record review revealed that he had received only 1150 ml of intravenous fluid in 8 hours. Consequently, his ARDS may have been caused by an anaphylactic reaction to the wasp toxin rather than by a cardiogenic cause or volume overload. He was intubated and transferred from the general ward to the intensive care unit for close clinical monitoring. Mechanical ventilation and intravenous fluid support were given to achieve a minimum urine output of 1 ml/kg/hr. His clinical and biochemical pictures started to improve and normalize from the fourth day after ICU admission. Conclusions:Wasp stings may cause both rhabdomyolysis and acute respiratory distress syndrome. Early detection and immediate supportive treatment is the mainstay to reduce morbidity and mortality in such cases.

Objective: Delayed healing of facial burns can result in scarring and psychological morbidity. Epidermal growth factor may promote wound granulation and angiogenesis to enhance wound healing. We compared the effect of Chloramphenicol ointment alone with Recombinant Human Epidermal Growth Factor (rhEGF) plus chloramphenicol on facial burn wound healing. Methods: A randomized controlled trial was conducted in patients admitted to the Burn Unit. Subjects aged 18 to 65 years with acute second-degree facial burn wounds that did not require surgical treatment were enrolled. Subjects were divided equally and randomized to receive either topical chloramphenicol ointment twice daily (control) or rhEGF ointment once daily and chloramphenicol ointment twice daily. Wounds were assessed at frequent intervals. Wound size, complete healing day, pain score, infection, side effects, Vancouver Scar Scale and the cost of treatment were recorded. Results: Twenty-six wounds were enrolled. The mean wound size was similar in both groups (rhEGF plus chloramphenicol treated group 38.5±18.2 cm2 vs control group 42.1±19.4 cm2). Burn wounds in the rhEGF group healed more rapidly, though the difference was not statistically significant (8.5 ± 3.4 days vs 9.3 ± 4.4 days, p=0.3). No difference was observed in the Vancouver scar scale. Mean post-treatment pain scores were the same in both groups. There were no infections or side effects in either group. The rhEGF-treated group was more expensive (1463.1 ± 142.6 vs 19.2 ± 1.9 baht). Conclusion: There are no difference in outcomes of acute facial burn wound healing treated with rhEGF and chloramphenical ointment compared to chloramphenicol treatment alone. The further study to evaluate the effect of rhEGF in patients who have some factors that delay wound healing should be done.