Burns : journal of the International Society for Burn Injuries
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The deficit of donor sites in major burns over 50% of the total body surface area has necessitated the application of methods besides traditional meshed autografting to achieve definitive skin cover. The Meek micrografting technique was introduced at this hospital in 2011, especially in the absence of a reliable source of deceased donor allograft skin. The purpose of this study was to evaluate this strategy with reference to its technical execution, efficacy and indications in the context of major paediatric burn surgery. ⋯ There is a considerable 'learning curve' associated with this technique. In order to achieve success one must ensure a completely viable, non-infected bed, obtained by tangential or fascial excision, followed by allografting as temporary coverage and to 'test the wound bed' for definitive coverage. Infection resulted in the majority of autograft loss in this series, and in addition to risk factors like burn size and inhalation injury, accounted for many of the deaths in this series. Meek micrografting offers high expansion ratios, thereby facilitating durable wound cover in the presence of limited donor sites. It is unlikely that a lethal dose, 50% (LD50) of almost 70% TBSA would have been possible in this context without the regular application of this technique. This study advocates for the widespread availability of Meek micrografting and deceased donor allograft skin in developing countries.
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Burn-related immunosuppression can promote human herpesviridae infections. However, the effect of these infections on morbidity and mortality after pediatric burn injuries is unclear. ⋯ Viral infections occur more commonly in patients suffering from larger burns, and HSV infections can contribute to mortality.
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The purpose of this systematic review and meta-analysis was to assess the clinical effectiveness of nanocrystalline silver compared to alternative silver delivery systems (silver sulphadiazine [SSD] and silver nitrate) in adults and children with superficial and deep partial thickness burns. ⋯ This comprehensive systematic review and meta-analysis of the available evidence suggest that the use of nanocrystalline silver dressings results in shorter length of stay in hospital, less pain, fewer surgical procedures and reduced infection rates compared to silver sulphadiazine/silver nitrate.
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Review Case Reports
Keeping pace with the media; Giant Hogweed burns - A case series and comprehensive review.
Phytophotodermatitis is almost exclusively reported in the dermatological literature, but may progress to a chemical burn. There has been widespread media reporting during the summer of 2015 of burns caused by giant hogweed. However, there is a lack of awareness of this mechanism of injury amongst the burn multidisciplinary team, and there have been no published articles in the surgical literature regarding plant burns, other than sporadic case reports, for 20 years. ⋯ Accurate diagnosis is straightforward with a detailed history and is important to prompt appropriate treatment, and prevent a misdiagnosis of non-accidental injury. This review and case series are timely to raise awareness of phytophotodermatitis and burns caused by plants to burns multidisciplinary teams. Prospective studies are warranted to assess the efficacy of topical treatments and surgical management.