Burns : journal of the International Society for Burn Injuries
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The quality of burn care is highly dependent on the initial assessment and care. The aim of this systematic review was to investigate the agreement of clinical assessment of burn depth and %TBSA between the referring units and the receiving burn centres. ⋯ Overestimation of %TBSA at referring hospitals occurs very frequently. The overall certainty of evidence for accuracy of clinical estimations in referring centres is low for burn size and very low for burn depth. The findings suggest that the burn community has a significant challenge in educating and communicating better with our colleagues at referring institutions and that high-quality studies are needed.
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The aim of this review was to summarise the current evidence regarding the effectiveness of rehabilitation interventions in improving hand function, range of motion (ROM), hand strength, scar outcome, return to work, level of impairment/disability, level of burn knowledge and decreasing edema following hand burns in adult burn survivors. This review provides evidence-based support for the use of rehabilitation interventions for burn rehabilitation professionals. The following data sources were searched: MEDLINE, EMBASE and CINAHL from their inception up to February 2021, reference lists from all the included full-text articles were screened for additional relevant publications and monthly Google Scholar searches until December 23rd 2021 to make sure all new pertinent published articles after February 2021 would be included. Thirty-five studies were included in this review including 14 RCTs. ⋯ This review supports the clinical practice of the following interventions: 1) The use of adhesive compression wraps for patients who have increased edema to increase hand function and ROM; 2) The use of compression (adhesive compressive wrap, compression bandage or intermittent compression pump) to decrease hand edema following burn injury; 3) Participating in general rehabilitation to increase hand function and patient perceived level of disability; 4) The use of an orthosis to increase ROM and a dynamic MCP orthosis to increase hand function; 5) If available, incorporate the use of VR based rehabilitation to increase hand function and hand strength; 6) The use of paraffin to increase hand PROM; 7) The use of gels to reduce hand scar thickness; 8) The use of an education component in rehabilitation to increase the level of burn knowledge. The limitations of this study are also discussed. Further research with robust methodology is needed to investigate the potential benefits of treatment interventions included in this review.
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Research on coagulation dysfunction following burns is controversial. This study aimed to describe the coagulation changes in severe burn patients by examining coagulation parameters. ⋯ Coagulation dysfunction was most prominent in severe burn patients 1 week after injury and presented as hypercoagulability. Large-area burn injury, large amounts of fluid resuscitation, inhalation injury, and sepsis may all contribute to coagulation dysfunction, which can further develop into DIC and even death in severe burns patients.
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Ablative fractional resurfacing is clinically an efficient treatment for burn scar management. The aim of this pilot study was to investigate the poorly understood mechanisms underlying ablative fractional CO2 laser (AFL-CO2) therapy in relation to biomarkers S100 and 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1). S100 stains for Langerhans cells and neuronal cells, potentially representing the pruritus experienced. 11β-HSD1 catalyses the interconversion of cortisol and cortisone in cells, promoting tissue remodelling. ⋯ Neuronal cells were overexpressed before treatment in the scar tissue by 91% but levels returned to that resembling normal skin. 11β-HSD1 expression in keratinocytes was significantly higher after laser treatment compared to before in scar tissue (p <0.01). No clear correlation was found in dermal fibroblast numbers throughout the treatment course. Whilst the role of the explored mechanisms and their association with clinical outcomes cannot conclusively be stated, this pilot study demonstrates promising trends that encourages investigation into this relationship.
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Circular RNAs (circRNAs) are identified as important regulators in human diseases, including keloid. The purpose of this study is to reveal the role and molecular mechanism of circSLC8A1 in keloid formation. ⋯ Our data showed that circSLC8A1 regulates the miR-181a-5p/HIF1AN axis to restrain HKFs biological functions, confirming that circSLC8A1 might serve as a novel therapeutic target for keloids.