Burns : journal of the International Society for Burn Injuries
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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.
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Thermal injury to skin and subcutaneous tissue is common in both civilian and combat scenarios. Understanding the change in tissue morphologies and properties and the underlying mechanisms of thermal injury are of vital importance to clinical determination of the degree of burn and treatment approach. This review aims at summarizing the research involving experimental and numerical studies of skin and subcutaneous tissue subjected to thermal injury. ⋯ The first part deals with experimental studies including burn protocols and prevailing imaging approaches. The second part deals with existing numerical models for burns of tissue and related computational simulations. Based on this review, we conclude that though there is literature contributing to the knowledge of the pathology and pathogenesis of tissue burn, there is scant quantitative information regarding changes in tissue properties including mechanical, thermal, electrical and optical properties as a result of burns that are linked to altered tissue morphology.
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Acute kidney injury (AKI) is a common and morbid complication after severe burn, with an incidence and mortality as high as 30% and 80%, respectively. AKI is a broad clinical condition with many etiologies, which makes definition and diagnosis challenging. The most recent Kidney Disease: Improving Global Outcomes (KDIGO) consensus guidelines defined stage and severity of AKI based on changes of serum creatinine and urine output (UOP) across time. ⋯ Unfortunately, no beneficial pharmacologic agents have been identified, despite multiple investigations. Of burn patients who survive AKI, the vast majority do not receive long-term hemodialysis and they are generally thought to have a good renal prognosis although this view is shifting. Preliminary data in the burn population suggest that AKI may confer an increased risk of end-stage renal disease and long-term all-cause mortality, but further research is needed.
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Thermal injuries are one of the most physically and psychologically devastating causes of pediatric trauma. Post-traumatic sequelae such as hypertrophic scars and contractures often result in long lasting morbidity and disfigurement. Conservative therapy, including pressure garments and silicone, is the gold standard for scar management in the pediatric population. Most recently percutaneous collagen induction (PCI) was introduced as an alternative treatment in adults. The aim of this report was to share our experience with PCI in children and adolescents in scar management following thermal injuries. ⋯ PCI is an enrichment of the armamentarium for scar treatment following thermal injuries in children and adolescents. Further prospective studies are recommended regarding the optimal timing for this treatment and long term outcome in the pediatric population.