Burns : journal of the International Society for Burn Injuries
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Traditional fixation of autografts in the treatment of burns involves the use of sutures and staples. A novel fibrin sealant, Artiss, has been introduced as an alternate method of fixation and has shown promising safety and efficacy results in the adult population. Our study assessed the effectiveness of fibrin sealant to secure autologous split thickness skin grafts (ASTSG) in the pediatric burn population. ⋯ Outcomes from autograft fixation with fibrin sealant were comparable to those treated with traditional methods, with a reduction in the need for return trips to the operating room. These data suggest that fibrin sealant is a suitable alternative to traditional fixation methods in pediatric autografting.
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Randomized Controlled Trial
Negative pressure wound therapy in burns: a prospective, randomized-controlled trial.
Negative-pressure-wound-therapy (NPWT) has become a widely used tool for the coverage and active treatment of complex wounds, including burns. This study aimed to evaluate the effectiveness of NPWT in acute burns of upper and lower extremities and to compare results to the standard-of-care (SOC) at our institution. ⋯ In this study, we found no significant difference between the two groups in terms of time to detect wound healing. We also found no difference regarding further operations for wound closure, pain and/or scarring. However, dressing changes were significantly less frequent for patients that were treated with NPWT, which may be a psychological and logistical advantage.
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Cyanide poisoning poses a significant threat to burn patients exposed to smoke in residential or workplace fires, leading to central nervous system dysfunction, hemodynamic instability, cardiovascular collapse, and death. Prompt administration of an effective antidote is critical. Hydroxocobalamin, a form of vitamin B12, is the gold standard treatment for cyanide toxicity, by binding to cyanide molecules and converting them into non-toxic cyanocobalamin that is eliminated by the kidneys. This mechanism is distinct from previous cyanide antidotes, which induce the formation of methemoglobin to bind to cyanide. Recent case studies have reported elevated methemoglobin levels after hydroxocobalamin administration, raising concerns regarding its safety. The current study investigates smoke inhalation patients treated with hydroxocobalamin at a single institution Burn Unit in hopes of enhancing our understanding of the complexities surrounding cyanide antidote therapy. ⋯ Our investigation sought to assess the potential risks associated with hydroxocobalamin administration in burn patients with concomitant inhalation injury. Contrary to our initial hypothesis, we found no statistically significant differences in methemoglobinemia, lactate levels, mortality, or kidney function. The influence of other factors, such as methemoglobinemia-inducing drugs or hydroxocobalamin's interference with co-oximetry, adds complexity. Although elevated methemoglobin levels were observed in some cases, their clinical significance was limited. However, this study's limitations, particularly the rarity of inhalation injury cases with concern for cyanide toxicity, warrant consideration. Further research is required to comprehensively elucidate the impact of hydroxocobalamin administration on burn patients' outcomes.
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Major burn injuries may have long-term mental health consequences, such as posttraumatic stress disorder (PTSD). This study extended prior work to investigate DSM-5 PTSD symptoms at 6 months, 1 year, and 2 years post-burn as well as the contribution of two sets of early psychological risk factors to DSM-5 PTSD symptoms: Established PTSD risk factors (prior adjustment problems, past trauma, perception of life threat, peritraumatic emotions and dissociation) and theory-derived cognitive factors (negative appraisals of the trauma and its sequelae, memory disorganization, trauma-related rumination, and thought suppression). ⋯ The results underscore the role of early cognitive risk factors in the development and persistence of DSM-5 PTSD symptomatology following burn injury.
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The aim of this study is to investigate the dynamic changes and interrelationships between leukocyte components and inflammatory markers in the early stages and sepsis stage in severe burns, and explore their potential clinical significance. ⋯ The results of this study revealed the dynamic interrelationships between leucocyte components and inflammatory indicators in the early stages and sepsis stage in severe burns, reflecting the different weightings of inflammatory responses and immune dysfunction in different disease stages and its correlation with outcomes, which providing useful clinical information for dynamic immunomodulatory therapy. Moreover, dynamic monitoring of MLPN value can provide timely information for clinical evaluation.