Burns : journal of the International Society for Burn Injuries
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Patients with extensive burn injuries are susceptible to a host of accompanying adverse effects should they develop perioperative hypothermia, which occurs in up to ¼ of all major burn cases. This quality improvement project aimed to reduce the incidence of perioperative hypothermia to below 10% of cases in patients with major burn (Total Body Surface Area [TBSA] >15%), within a one year period. ⋯ The inevitable drop in temperature is ameliorated by sound perioperative practices, rather than just intraoperative ones. This initiative demonstrated the potential benefits of, and motivates for, the broad application of preoperative warming in the context of major acute burn surgery. Further investigations include PDSA cycles to determine whether the duration or degree of intraoperative hypothermia is more virulent. To consolidate the pre-warming initiative, we have introduced a standard order within our admission order sets to include preoperative warming for all eligible patients.
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Cultured keratinocytes play important roles in burn wound healing and scientific research studies. We aimed to modify the isolation method to avoid over-digestion, maximize the number of isolated epidermal cells and establish a more efficient and innocuous way of cell isolation. Compared to the conventional method, the modified method combines the more dynamic process of enzymatic digestion with multiple harvestings of dissociated cells via digestion. ⋯ The number of viable cells isolated per gram of adult foreskin epidermis was (18.88±13.22)×106 cells in the control group and (67.34±30.66)×106 cells in the modified group (p<0.001). No significant differences were observed in the proportion of CD49f-positive cells between the two groups (p>0.05). The modified method was significantly more efficient in dissociating keratinocytes from each unit of skin biopsy, which is particularly important for treating severe burns when donor skin is limited.
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Extracorporeal membrane oxygenation (ECMO) is one of the most frequent forms of extracorporeal life support (ECLS) and can be used as rescue therapy in patients with severe respiratory failure resulting from burns and/or smoke inhalation injury. Experience and literature on this treatment option is still very limited, consequently results are varied. We report a retrospective analysis of our experience with veno-venous (VV) ECMO in burn patients. ⋯ VV-ECMO is a useful rescue intervention in patients with burns related severe respiratory failure. Patients in our institution benefit from having both burns and ECMO centres with major expertise in the field under one roof. The results from this small cohort are encouraging, although more cases are needed to draw more robust conclusions.
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We investigated a novel system that uses image-processing algorithms to accurately measure the hemoglobin content of discarded surgical sponges to determine how blood loss relates to the excised area when current methods to minimize bleeding are employed. The system was used during 130 procedures in adult patients having wound excisions ≥1% BSA (study group). An historic group of 105 similar cases in whom visually estimated blood was determined was also evaluated. ⋯ As demonstrated in the historic group, visual estimates of blood loss tend to be more related to the size of excision than the amount of bleeding. The actual blood loss is not well correlated with the extent of excision. Clinicians should not rely on traditional blood loss estimates. Accurate measurement is needed to inform transfusion decisions and guide care.
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In burn patients, meshed split thickness skin grafts are commonly used on large and non-flat areas whom immobilization is difficult to achieve. The frequent mobilizations of burn patients can make the graft slip and prevent the revascularization and therefore the taking of the skin graft. ⋯ Some cautions are necessary in order to avoid any infection. This original and easy-to-perform procedure answers to the difficulties of large split-thickness skin grafts in burn patients.