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This study aims to develop an experimental treatment model effective against oxidative stress in the acute period of severe burns and to analyze the mechanisms of healing large wound defects. Five rats, including 2 females and 3 males, were used as donors to obtain adipose-derived stem cells (ADSC) from the inguinal fat pad. The stem cells were labeled with green fluorescent protein. The study included four groups of 17 rats, each with grade 3 scalding burns on 30 % of their body surface, and a control group of 10 rats with an equal number of males and females. After early excision, 106 ADSC-derived stem cells were administered subdermally to the burned wound and autografted to the stem cell group (n = 17). The early excision group (n = 17) received early excision and autograft, with 2 ml of normal saline injected subdermally into the burn wound edge. The PLM group (n = 17) was treated with a polylactic membrane (PLM) dressing after the burn. No treatment was given to the burn group (n = 17). Ten rats from all groups were sacrificed on the 4th day post-burn for oxidative stress evaluation. The control group (n = 10) was sacrificed on day 4. Blood and tissue samples were collected post-sacrifice. Oxidative stress and inflammation in the blood, as well as cell damage in the skin, liver, kidneys, and lungs, were investigated histopathologically and biochemically on the 4th day post-burn. On the 70th day after burn, wound healing was examined macroscopically and histopathologically. On the 4th day, oxidative stress results showed that the levels of Total Oxidative Capacity (TOC) in the blood were lowest in the stem cell (7.4 [6–8.8]), control (6.7 [5.9–7.6]), and early excision (7.5 [6.6–8.5]) groups, with no significant difference between them. The burn group (14.7 [12.5–16.9]) had the highest TOC levels. The PLM group (9.7 [8.6–10.7]) had lower TOC levels than the burn group but higher levels than the other groups. Histopathological examination on the 4th day revealed low liver caspase-3 immunoreactivity in the stem cell and early excision groups among the burn groups. Caspase-3 immunoreactivity levels were as follows: stem cell group (20 [10–30]), early excision group (25 [15–50]), PLM group (70 [50–100]), control group (0), and burn group (80 [60–120]). Other oxidative stress and end-organ damage outcomes were consistent with these results. All rats in the stem cell group had burn wounds that healed completely by the 70th day. Examination of the skin and its appendages from the stem cell group with an immunofluorescence microscope demonstrated green coloration, indicating incorporation of stem cells. Stem cells may have the potential to form new skin and its appendages, providing better healing for large skin defects. Early excision treatment, by removing local necrotic tissues after extensive and deep burns, can prevent end-organ damage due to systemic oxidative stress and inflammation. We also believe that when these two treatments are used together, they can achieve the best results. • Systemic inflammation and oxidative stress occur during the acute phase of severe burns, causing damage to end organs. • Wound healing is an important problem in patients with severe burns if there is not enough space to harvest the skin autograft. • Early excision treatment, which involves clearing local necrotic tissue after extensive and deep severe burns, can prevent end-organ damage. • The stem cells may have the potential to form new skin and its appendages providing better healing for large skin defects. • Combining these two treatments may yield the best results. [ABSTRACT FROM AUTHOR]

Burn disasters and mass casualty events constitute potential scenarios which require separate response plans. The sources provide several triage methods that govern burn casualty triage and evacuation from the incident. However, there are limited data with regard to the patient selection, timing of early burn excision, and surgical technique applied in the case of mass burn casualty events. The majority of burn response plans allow for the postponement of burn surgery for up to a few days, until a secondary triage is performed and the patient is transferred to a specialist burn centre as soon as possible. Tangential excision is preferred in intermediate thickness burns, whereas excision to the fascia is preferable in the cases of full thickness burns. It is recommended that a surgeon with at least three years' experience in a burn unit should perform the surgery. Enzymatic eschar removal might also be an alternative to early surgery. The aim of this overview was to analyze data available in the scientific literature and search for indications, or recommendations concerning early burn wound excision in cases of mass casualty. An internationally standardized training plan for general surgeons, anesthesiologists, and nurses should be created to facilitate the development of local burn-response teams that would be adequately trained to provide first aid and early wound excision. [ABSTRACT FROM AUTHOR]

Background: Burns are one of the most prevalent forms of wound in children and adults, although timing of surgical excision for deep partial or full thickness burns remains controversial. Objectives: To determine if early surgical intervention (excision and grafting within 7 days) improves outcomes when compared to delayed surgical intervention (excision and grafting after 7 days) in adults with thermal burns. Methods: We searched the following electronic databases: Cochrane Wound Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and CINAHL. We hand searched the references of included studies and major review articles. We contacted authors of included trials for information about any ongoing trials or unpublished studies. Selection criteria: We included randomized controlled trials, both published and unpublished, comparing early versus delayed surgical intervention for treatment of thermal burns of all degrees and percent total body surface areas (%TBSA) in adult patients. Data collection and analysis: Two authors independently, and in duplicate, screened the titles abstracts and then full texts of all citations for possible inclusion. Data from eligible studies were extracted independently and in duplicate using Microsoft Excel. We pooled outcome data according to the guidelines of the Cochrane Collaboration using Review Manager 5.3 software and random effects model. We assessed Risk of Bias (RoB) in individual studies using the Cochrane Collaboration’s tool and overall certainty of evidence for each outcome using the GRADE framework. Main results: A total of 9 RCTs were included in the systematic review; 6 in the quantitative meta-analysis. Early surgical intervention may result in a small albeit imprecise reduction in mortality (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.53 to 1.14, I2 = 46%, very low certainty) and a reduction in length of hospital stay (days) (mean difference (MD) 12.66 days fewer; 95% CI 9.80 days fewer to 15.53 days fewer, I2 = 88%, low certainty), but increased need for red blood cell (RBC) units (MD 27.11; 95% CI 20.17 to 34.06 units, I2 = 99%, low certainty) compared to delayed surgical intervention. Additionally, early excision and grafting may result in better functional and cosmetic outcomes; both based on low certainty evidence. However, no difference in scar quality and proportion of burns requiring re-operation was found (both low certainty). Conclusion: Early excision and grafting may reduce mortality and improve other patient important outcomes in adults with thermal burns, however most outcomes are based on low or very low certainty evidence. Higher quality, methodologically rigorous studies examining health-related quality of life are warranted in order to best inform this clinical question.

Advances in burn care have led to an overall improvement in mortality in high-income countries, but in low-middle income countries mortality remains relatively high. In a limited resource setting where temporary wound closure options were unavailable, it was determined whether early excision as a preliminary treatment could improve prognosis. A retrospective cohort study was conducted in Cipto Mangunkusumo Hospital Burn Unit to evaluate the outcomes of acute burn patients admitted from January 2013 to December 2018 using mortality and lethal area 50 (LA50), and to compare the outcomes between groups who underwent early excision without skin graft (EEWG), early excision with skin graft (EESG), delayed excision without skin graft (DEWG), or delayed excision with skin graft (DESG). Out of 390 patients available for screening, 256 were eligible for further study. The overall mortality was 17.9% with an increase linear with age and total body surface area (TBSA). The overall LA50 was 49%. Preliminary data showed the highest percentage of deaths in the no treatment group, with no deaths seen in treatment groups EESG and DESG. The odds ratio for mortality in the EEWG group was 2.11 (p-value 0.201, CI95% = 0.65-6.80) compared to the DEWG group. LA50 is more objective compared to crude mortality and enables future internal and external comparison. The highest mortality was in the no treatment group with mortality in the EEWG group higher than in the DEWG, but not statistically different. Early excision without skin grafting as a preliminary procedure may still be considered in a limited resource setting. [ABSTRACT FROM AUTHOR]

Introduction: While the benefits of early excision in burn surgery are clear, the advantages may be lost in low income countries with limited resources. It is important to identify the right timing of excision in different groups of patients, particularly those in low-income countries (LIC), as the burden of disease contributes to the highest global mortality and has the least resources. This systematic review and meta-analysis aims to determine the timing of excision in LICs and the outcomes associated with surgery: (1) mortality, (2) sepsis and (3) length of stay (LOS) compared to high income countries (HICs).Methodology: The PRISMA guidelines and MOOSE checklist were followed for this review. Publications in English from year 1990 to 2017 that included data on the timing and type of burn surgery and outcomes were included. Searches were done using Web of Science, Cochrane collaboration and Pubmed using keywords "Burn and surgery", "Burn and excision", "Burn and excision and grafting" and "burn and skin grafting". Trial quality was evaluated using the Newcastle-Ottawa scale. Outcomes compared for early and late excisions were length of stay (LOS), sepsis and mortality between LICs and HICs.Results: From 278 citations, we selected 41 for full text evaluation, and identified 16 eligible trials. LOS is shorter in early excision compared to late excision in both LICs and HICs. Mortality is lower in late excision compared to early excision in both LICs and HICs. Further subgroup analysis of elderly patients in HICs confirmed that mortality is lower in late excision and unchanged if the elderly are excluded. Early excision reduces sepsis in both LIC and HIC.Discussion: The variable definitions of age, timing of excision, variable nature of % TBSA comparison, mixed inclusion of inhalation injury, co-morbidities and unquantified access to resources make the data difficult to interpret and it is not possible to draw accurate conclusions on the role of early excision for burns in low-middle income countries. A prospective study is needed in order to answer this question. [ABSTRACT FROM AUTHOR]

Background: There is a common, well-known and established recommendation to excise burn wounds within 24-72 h in order to mitigate the systemic inflammatory and immunomodulatory response, shorten length of hospitalization through early grafting and optimize patient survival. Despite this apparent consensus, surprisingly few systematic studies have evaluated the actual adherence to this practice and its implications on patient outcomes. In this registry study, we sought to objectify the current status of early burn wound excision, its influencing factors and impact on patient outcomes for all German burn centers.Methods: The German burn registry ('Deutsches Verbrennungsregister') was queried for 3 consecutive years for all patients, who received at least one surgical intervention. Patients were stratified based on whether the first surgical procedure was performed early (EE, within 72 h) or late (LE, after 72 h) post-burn. Descriptive statistics and univariate regressions were performed to quantify fraction of EE vs. LE and to evaluate factors which might favor one over the other (i.e. age, inhalation injury, burn severity by total body surface area (TBSA), scald vs. other burns, obesity, time of admission). Key patient outcomes were analyzed for each group (i.e. mortality, length of hospitalization, number of surgeries) and multifactorial regression analyses were carried out to model the impact of EE on mortality. Statistical significance was accepted at p < 0.05.Results: After initial screening, 1494 complete records were included for final analysis and were stratified into EE and LE. Only 670 (44%) underwent EE within 72 h. Increasing TBSA burned (i.e. [TBSA > 30%]: 53.8% EE, [TBSA < 30%]: 43.5% EE, p < 0.01) and admission on a weekday between Sunday and Wednesday were associated with higher probability of EE (51.5% EE) versus Thursday to Sunday (37.3%, p < 0.001). Age, inhalation injury, cause of burn, and obesity had no effect on EE vs. LE. Patients with EE had significantly shorter median lengths of hospitalization (EE: 18 d, LE: 21 d, p < 0.01). The median number of operations was comparable for both groups. Gross mortality appeared higher in the EE group, but turned out to be comparable to LE after correction for age, TBSA and sex in multifactorial regression analysis.Conclusion: Despite apparent consensus among burn physicians, early excision of burn wounds is performed in less than 50% of cases in German burn centers. The relationship of EE to TBSA burned is expected and clinically sound, while a dependence on admission weekday raises administrative and infrastructural questions, especially when patients who receive EE have significantly shorter hospital stays. More analyses from other burn repositories are needed to compare and benchmark the international status quo of early burn wound excision. [ABSTRACT FROM AUTHOR]

Background: Severe burns are accompanied by an acute and prolonged hypermetabolic response typified by elevated levels of proinflammatory cytokines and acute phase proteins. When persistent, this inflammatory response can result in multi-organ dysfunction and death. Regarded as the standard of care, early removal of devitalised tissue and eschar mitigates this hypermetabolic response. Ascertaining the optimal time point for early excision, which remains controversial, has several clinical implications.Methods: This retrospective observational study included 836 adult thermal burns patients with total burned surface area ≥20% from all Burns Registry of Australia and New Zealand (BRANZ) Hospital sites, including the Victorian Adult Burns Service (VABS), from July 1 2009 to June 30 2018. Patients were divided into two groups, "early" and "delayed", based on a 24-hour excision cut-off from when the injury occurred. Outcome measurements included mortality, hospital length of stay, intensive care unit length of stay, ventilation requirements and the incidence of positive blood cultures.Results: Among all patients at BRANZ sites, excision within 24 h was associated with reduced mean length of ICU stay (6.6 ± 8.1 vs. 9.2 ± 10.6 days; p = 0.008) and lower mean mechanical ventilator hourly use (94.9 ± 160.8 vs. 159.2 ± 219.1 h; p = 0.001) in the 20-29% TBSA sub-group. Beyond this, no significant differences were observed in outcome measurements.Conclusions: While it is physiologically important to perform early burn wound excision to mitigate the inflammatory response, delaying excision beyond 24 h for surgical planning, possibly up to 72 h after injury, may be a reasonable approach for certain patient groups. [ABSTRACT FROM AUTHOR]

Objectives: To compare the outcomes of early excision and grafting between pediatric and adult patients with deep burns of less than 40% total body surface area burns (TBSA).Methods: This is a prospective comparative study. Overall, 106 patients admitted to Ghotbodin Burn Center in Shiraz, Iran from September 2012 to September 2013, were included in the study. All patients had less than 40% TBSA burn and had excision and grafting under 14 days from their injury. Patients were divided into two age groups of younger than 14 (n=49) and older than 14 (14-65) years old (n=57). During a 6-month follow-up period, the two groups were compared regarding mean percentage of graft take, total scar score, duration of hospital stay and itching score.Results: During follow-up, the two groups did not show a significant difference in graft take, total scar score and itching score (p=0.461, p=0.363 and p=0.637, respectively). Clinically, the pediatric group showed less hospital stay (12.25±9.1 vs. 16±12.9), however this was not statistically significant (p=0.091). Conclusion: Adults and elderly patients (14–65 years old) compared to pediatric patients (less than 14 years old) with less than 40% TBSA burns, can expect similar results regarding scar score, graft take, itch score and hospital stay, after excision and grafting performed less than two weeks from their initial injury.

The study of burn flora is helpful in determining current antibiotic susceptibilities and locating development of multidrug resistant bacterial strains among the unit's usual flora. In this study, we aimed to determine the bacteriological pattern of blood, urine and sputum infections and their correlation with burn wound infections. We used data from our burn registry program. All data on demographics, burn wounds and burn wound infection, bacteria isolated, sensitivity to different antibiotics, burn wound culture, sputum culture, urine culture and catheter tip culture were recorded. We had 1721 hospitalized burn patients. Mean age was 26.3+/-20.25 years old. Mean hospital stay was 14.41 days (range 0-64 days). Mean (SD) TBSA was 16.48 (20.67) years. Mortality rate was 5.9%. Burn wound infection was present in 38.54%. The most frequent species was Staphylococcus spp. (55.1%), followed by Pseudomonas (14.29%), Enterococcus (12.24%), E. coli (4%), Klebsiella and Proteus (both 2%). Urine culture was positive in 27.9%, sputum culture was positive in 1.14%, catheter tip culture was positive in 12.3% and blood culture was positive in 7.6% of the cases. There were correlations between positive wound culture and blood and urine culture, most of them with one bacteria species. The most frequent disseminated bacteria was Pseudomonas aeruginosa and the most sensitive antibiotic was Amikacin. More than 39.2% of our positive culture patients had 3 or more positive cultures, and 36.5% had similar culture results for one bacteria, which was a sign of disseminated infection. [ABSTRACT FROM AUTHOR]

Response plans for mass burn casualty events should include clear guidelines for early burn excision or debridement. Keywords: Burn wound; Early excision; Enzymatic debridement EN Burn wound Early excision Enzymatic debridement 1 2 2 09/26/22 20220809 NES 220809 Dear Editor, The aim of the letter is to stress the need of creating unified recommendations concerning early burn wound excision in cases of mass casualty burns exclusively. [Extracted from the article]

Background: Burns are a major cause of death and disability worldwide. Today biological dressings have become an integral part of modern burn care. Using this method, in otherwise healthy young adults, the size of burn relative to the total body surface area (TBSA) correlating with a 50% mortality rate has increased from 30% to 80%. Due to a lack of experience and an interest in using biological dressings in Iran, as a developing country, the aim of this study was to compare patient outcome using the biological dressing vs. conventional treatment in patients with massive burns.Methods: In this clinical trial study, 118 burn patients (30 to 75% TBSA) were enrolled. The patients were divided in two groups. Those in the conventional treatment group had not accepted treatment with a biological dressing. The second group agreed to treatment with biological dressing, a pig skin xenograft known as Xenoderm. Significant differences were evaluated using the unpaired Student's t test, the Mann-Whitney U test and the χ2 test. Results: Mortality rates in the conventional treatment group (n=53) and biological dressing group (n=65) were 35% (19) and 10.8% (7), respectively (p=0.001). Excluding those patients who died, the mean hospital stay was 31.3 days in the conventional treatment group versus 18.2 days in the biological dressing group (p=0.0005), and number of dressings was 22.1 versus 9.9 (p=0.0005), respectively. Three patients in the conventional treatment group were transferred to a tertiary-care hospital after three weeks of treatment. The most commonly burned areas were the upper limb, lower limb and trunk.Conclusions: The results of this study indicate that biological dressings give a better outcome and decrease the hospital stay and the number of dressings. A randomized clinical trial is warranted.

Background Post-traumatic heterotopic ossification (HO) around the elbow may severely impair joint function. Although surgical excision is effective at restoring range of motion (ROM), traditional surgical treatment is postponed for at least 1 year to prevent recurrence, which leads to secondary contracture of the elbow. Because the optimal timing of resection is controversial, our study was performed to compare recurrence and elbow function between early and late excision in our patients to determine whether the delay is necessary. Methods We retrospectively reviewed 164 patients during a 4-year period. In the control group (112 patients), HO was excised at an average of 23.0 months after initial injury (range, 9-204 months); in the early excision group (52 patients), resection was performed at an average of 6.1 months (range, 3-8 months). HO recurrence was assessed by the Hastings classification system. Final ROM and Mayo Elbow Performance Scores were also evaluated. Results Recurrent HO was observed in 30 of 112 patients (26.8%) in the control group and 15 of 52 (28.9%) in early excision group. No significant difference in HO recurrence was found between the 2 groups ( P = .942). Moreover, there were no notable differences regarding ROM, Mayo Elbow Performance Scores, and complications postoperatively. Conclusions Early excision associated with early exercise is effective for the treatment of HO aiming at a low recurrence rate and satisfactory function. The conventional surgical delay of more than 1 year may be shortened. [ABSTRACT FROM AUTHOR]

In the conventional method of microskin autografting, aggressive early excision is adopted, followed by coverage with a microskin–allograft complex to close extensive burn wounds. However, early excision is always associated with a defect of viable tissue, resulting in massive blood loss and causing high risk to aged patients or those with other systemic diseases. We developed a new method in which an eschar thinning operation was first adopted, followed by raising granulation tissue and microskin autografting, which was covered by a Vaseline-based moisture dressing. A total of 52 patients were included in this study and randomly assigned to the control group (n =26) and the experimental group (n =26) for the conventional method and the new method, respectively. The re-epithelisation rate on the 21st day after autografting indicated that there was no significant difference between both groups. There was also no significant difference between the two groups when the re-epithelialisation rate was compared with the type of organisms cultured. However, the Vancouver Burn Skin Score (VBSS) results demonstrated a significant improvement of cosmetic appearance in the experimental group (score=2.1) as compared to the control group (score=3.9). The new method also showed other advantages, including less blood loss, shorter surgical duration and lower cost of surgery. From this prospective study, it can be concluded that the new method can be an alternative to the conventional microskin autografting procedure. [Copyright &y& Elsevier]

Background -- hypothesis and objective: In the past decades, extensive burn care has improved to the extent that burn victims can now frequently survive. Current treatment of a severe burned patient extends beyond the preservation of life and function; the ultimate goal is the return of survivors, as full participants, back to their families, work field and communities. Methods: This paper is based on our experience in treating patients with extensive burns. We had two panels as follows: 148 subjects with extensive burns in one original retrospective study (2002-2009) and other 47 new patients with extensive burns enrolled in other original prospective study (2010-2011). We selected the subjects with extensive burns who received allotransplant (n = 59). Our study aimed to identify and quantify the main psychosocial difficulties in patients with extensive burns who received allotransplant, also taking into account the surgical procedures applied in each case. Results: One of the major problems a surgeon faces is the nature of the decision he has to make regarding a treatment (conservative versus operative), based on the exact determination of burn wound depth. In case of early excision, deep lesions and suitable grafting represent the chosen surgical treatment in our center. The benefits of skin allografts are well known due to their contribution to burn management. Conclusions & discussion: This paper is designed as a guideline and instruction manual to help those with less experience through particular situations in surgical burn care. Early excision and immediate coverage of the burn wounds represent nowadays the standard care for extensive burned patients. For patients with massive thermal injury, temporary coverage with allografts is essential. The use of allograft has multiple benefits because it plays both as physiologic and mechanical barriers. [ABSTRACT FROM AUTHOR]

Despite the fact that early excision and grafting have significantly improved burn outcomes, the management of severely burned patients whose burn size exceeds 70% total body surface area (TBSA) still represents a big challenge for burn surgeons all over the world. During the period of 1997–2010 at our centre, aggressive excision and microskin autografting were performed in 63 severely burned patients. Their burn sizes ranged from 70% to 98% TBSA with a mean of 84.9%. The average full-thickness burn was 66.3% (range, 29–94%). Thirty patients had concomitant inhalation injury. Two to 7 days after burn, these patients underwent aggressive excisions ranging from 25% to 60% TBSA and transplantation of microskin autograft overlaid with allograft. The ratios of donor-site to recipient-site surface area were between 1:6 and 1:18. Signs of epithelialization were shown within 35–55 days. The wound healing rate was 74.9% (176/235), with 51.1% of cases (120/235) healing completely and 23.8% (56/235) improving. Microskin autografting yielded an overall survival rate of 63.5%; only 23 patients died. Our clinical experience in using the microskin autografting for burn coverage suggests that the technique is very effective in covering extensive burns, and that it is particularly useful when graft donor sites are very limited due to its high utilization rate of donor site. The factors affecting the outcome of microskin autografting are discussed herein. [Copyright &y& Elsevier]

Background: A potential solution to prevent post-burn deleterious inflammatory responses is early burn wound excision. However, the most beneficial time point remains controversial. This animal study investigated the optimal time point for burn wound excision to reduce pro-inflammatory cytokines production after burn. Methods: Forty-eight male Sprague-Dawley rats received scald burns with third-degree burns of 30% body surface area, and were then divided into eight groups by day of operation for excision. Group 1 (n =6) received burn eschar excision on post-burn day (PBD) 1. Group 2 received excision on PBD2 (n =6) and so on, while group 8 was the control group (n =6) that did not undergo excision. The skin defect after excision was covered with a bovine-derived collagen dressing. Interleukin-1 (IL-1), IL-6, IL-10 and tumour necrosis factor-α were serially analysed by enzyme-linked immunosorbent assay (ELISA). Results: We found that levels of all pro-inflammatory cytokines appeared to be lower after excision of full-thickness burns, but as the excision time was delayed from group 1 to group 7, the differences showed progressive decline. Conclusions: We believe that the earlier the excision is performed, the more the level of pro-inflammatory cytokines can be lowered, and the better the post-burn inflammatory process can be modulated. [Copyright &y& Elsevier]

Abstract: Aims: This meta-analysis sought to establish if early excision and grafting is better or equivalent to the conservative treatment of burns in both children and adults with minor or major burns. The outcomes of interest are mortality, wound healing time, duration of sepsis, operating hours, complications of surgery, length of hospital stay, blood transfusion requirements and long term morbidity like joint contractures and hypertrophic scarring. Methods: We searched MEDLINE (1966–July 2004), EMBASE (1980–August 2004) and the Cochrane Central Register of Controlled Trials (CENTRAL) with the keywords ‘early excision’ and ‘burns’. This yielded 441 articles of which 15 were randomized controlled trials. Only six trials met the inclusion criteria. Results: There was a significant reduction in mortality with early excision of burns when compared with traditional treatment only in patients without inhalational injury (RR 0.36, 95% CI 0.20 to 0.65). The blood transfusion requirement is significantly higher in the early excision group but the length of hospital stay was significantly shorter (WMD −8.89, 95% CI −14.28 to −3.50). There was no conclusive evidence on the difference between the two groups in terms of duration of sepsis, wound healing time and skin graft take. Conclusion: Early excision of burns is beneficial in reducing mortality (in patients without inhalational injury), length of hospital stay. The only drawback is the greater volume of blood loss. [Copyright &y& Elsevier]

The skin banking programme was set-up in Singapore in 1998 to provide a ready source of allografts for patients with severe burns. The process and problems in establishing a local skin bank will be described together with a retrospective review of skin allograft recipients to determine the efficacy of the programme. For the skin bank set-up, pertinent issues related to legislation, methods, logistics, quality assurance and donation rate are discussed. In this retrospective review, a comparison between patients who had early complete excision with skin allograft transplantation and those who received conventional staged excision and coverage, was analysed in terms of clinical profile and outcome using statistical methods. The former group presented a significant reduction of mortality rate and hospital stay by 29% and 10 days, respectively. The establishment of the skin bank has helped in the management of severe burn patients by facilitating early excision and allografting. In a Burn Centre, therefore, it is essential to have an ample supply of skin allograft for burn victims in readiness for mass disaster situations. [Copyright &y& Elsevier]

Introduction: Early excision and skin grafting has become the standard of good burn management, but it is associated with major blood loss.Aim: To determine the haemostatic effect of terlipressin compared with placebo.Material and methods: Fifty-one patients with burns of 10–20% total body surface area had early excision and split skin grafting of deep burns. The surface area of the burn wound and of the healed graft were measured by planimetry. The patients were randomly allocated to medication, either terlipressin or placebo. Blood loss and number of transfused units of blood were recorded.Results: Twenty-one patients received terlipressin, 13 received terlipressin late (cross-over) and 17 received placebo. Six out of 21 patients exposed to terlipressin were transfused with eleven units of packed red blood cells. Seven out of 13 patients crossed over from placebo to terlipressin (late terlipressin) were transfused with 17 units of blood. Eight out of 17 patients exposed to the placebo were transfused with 22 units of blood (P<0.05). Graft healing was 1055±609 cm2 out of 1452±811 cm2 in terlipressin and 914±633 cm2 out of 1288±720 cm2 in the placebo group (n.s.).Conclusion: Terlipressin reduced the need for blood transfusion by a factor of 2.5 compared to a placebo without impairment of graft healing. [Copyright &y& Elsevier]

Advances in local wound management with early excisional therapy have decreased morbidity and mortality of massive third-degree burn patients. Although blood redistribution within burned tissue is of clinical interest, few studies have longitudinally determined the regional blood flow of various layers of the burn wound. We used a conscious ovine model in which animals were subjected to 40% third degree burn. Burned tissue was divided into the four layers (i.e. skin, panniculus carnosus, adipose tissue, and skeletal muscle), and regional blood flow was determined separately, with fluorescent microspheres, while measuring systemic hemodynamics and total burned tissue microvascular fluid flux. The subburn adipose tissue exhibited a remarkable biphasic alteration in regional blood flow, whereas the skin layer showed only decreased blood flow during the whole experimental period. The increase in blood flow to the adipose tissue seems to be related to a sustained fluid filtrate in the postresuscitation period, resulting in edema formation mainly located in the adipose tissue at the endpoint. [Copyright &y& Elsevier]

Advances in burn care have led to an overall improvement in mortality in high-income countries, but in low-middle income countries mortality remains relatively high. In a limited resource setting where temporary wound closure options were unavailable, it was determined whether early excision as a preliminary treatment could improve prognosis. A retrospective cohort study was conducted in Cipto Mangunkusumo Hospital Burn Unit to evaluate the outcomes of acute burn patients admitted from January 2013 to December 2018 using mortality and lethal area 50 (LA50), and to compare the outcomes between groups who underwent early excision without skin graft (EEWG), early excision with skin graft (EESG), delayed excision without skin graft (DEWG), or delayed excision with skin graft (DESG). Out of 390 patients available for screening, 256 were eligible for further study. The overall mortality was 17.9% with an increase linear with age and total body surface area (TBSA). The overall LA50 was 49%. Preliminary data showed the highest percentage of deaths in the no treatment group, with no deaths seen in treatment groups EESG and DESG. The odds ratio for mortality in the EEWG group was 2.11 (p-value 0.201, CI95% = 0.65-6.80) compared to the DEWG group. LA50 is more objective compared to crude mortality and enables future internal and external comparison. The highest mortality was in the no treatment group with mortality in the EEWG group higher than in the DEWG, but not statistically different. Early excision without skin grafting as a preliminary procedure may still be considered in a limited resource setting., (Copyright © 2022 Euro-Mediterranean Council for Burns and Fire Disasters.)

The study of burn flora is helpful in determining current antibiotic susceptibilities and locating development of multidrug resistant bacterial strains among the unit's usual flora. In this study, we aimed to determine the bacteriological pattern of blood, urine and sputum infections and their correlation with burn wound infections. We used data from our burn registry program. All data on demographics, burn wounds and burn wound infection, bacteria isolated, sensitivity to different antibiotics, burn wound culture, sputum culture, urine culture and catheter tip culture were recorded. We had 1721 hospitalized burn patients. Mean age was 26.3+/-20.25 years old. Mean hospital stay was 14.41 days (range 0-64 days). Mean (SD) TBSA was 16.48 (20.67) years. Mortality rate was 5.9%. Burn wound infection was present in 38.54%. The most frequent species was Staphylococcus spp. (55.1%), followed by Pseudomonas (14.29%), Enterococcus (12.24%), E. coli (4%), Klebsiella and Proteus (both 2%). Urine culture was positive in 27.9%, sputum culture was positive in 1.14%, catheter tip culture was positive in 12.3% and blood culture was positive in 7.6% of the cases. There were correlations between positive wound culture and blood and urine culture, most of them with one bacteria species. The most frequent disseminated bacteria was Pseudomonas aeruginosa and the most sensitive antibiotic was Amikacin. More than 39.2% of our positive culture patients had 3 or more positive cultures, and 36.5% had similar culture results for one bacteria, which was a sign of disseminated infection.

Objectives: To compare the outcomes of early excision and grafting between pediatric and adult patients with deep burns of less than 40% total body surface area burns (TBSA)., Methods: This is a prospective comparative study. Overall, 106 patients admitted to Ghotbodin Burn Center in Shiraz, Iran from September 2012 to September 2013, were included in the study. All patients had less than 40% TBSA burn and had excision and grafting under 14 days from their injury. Patients were divided into two age groups of younger than 14 (n=49) and older than 14 (14-65) years old (n=57). During a 6-month follow-up period, the two groups were compared regarding mean percentage of graft take, total scar score, duration of hospital stay and itching score., Results: During follow-up, the two groups did not show a significant difference in graft take, total scar score and itching score ( p =0.461, p =0.363 and p =0.637, respectively). Clinically, the pediatric group showed less hospital stay (12.25±9.1 vs. 16±12.9), however this was not statistically significant ( p =0.091)., Conclusion: Adults and elderly patients (14-65 years old) compared to pediatric patients (less than 14 years old) with less than 40% TBSA burns, can expect similar results regarding scar score, graft take, itch score and hospital stay, after excision and grafting performed less than two weeks from their initial injury., Competing Interests: None of the authors have any commercial and financial conflicts of interest to be declared regarding the manuscript.