SPECT/CT in the Evaluation of Frostbite
Frostbite remains a challenging clinical scenario with multiple treatment algorithms and variable results. Currently, frostbite management often follows a conservative approach with rewarming followed by wound care and delayed amputation. We review seven patients where single-photon emission computed tomography (SPECT) fused with conventional computed tomography was used to evaluate tissue viability for earlier directed debridement and limb salvage. The goal of this report is to evaluate SPECT/CT as an appropriate modality for the screening of necrotic bone for earlier amputation in patients with frostbite. We retrospectiv...
Source: Journal of Burn Care and Research - December 23, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Local Burn Injury Promotes Defects in the Epidermal Lipid and Antimicrobial Peptide Barriers in Human Autograft Skin and Burn Margin: Implications for Burn Wound Healing and Graft Survival
In this study, we established that epidermal lipids and respective lipid synthesis enzymes were significantly reduced in both donor skin and burn margin. We further identified diverse changes in the gene expression and protein production of several candidate skin antimicrobial peptides (AMPs) in both donor skin and burn margin. These results also parallel changes in cutaneous AMP activity against common burn wound pathogens, aberrant production of epidermal proteases known to regulate barrier permeability and AMP activity, and greater production of proinflammatory cytokines known to be induced by AMPs. These findings sugge...
Source: Journal of Burn Care and Research - December 23, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Orofacial Contracture Management: Current Patterns of Clinical Practice in Australian and New Zealand Adult Burn Units
Burn injury to the face can lead to scarring and contractures that may impair oral competence for articulation, feeding, airway intubation access, oral/dental hygiene, aesthetics, and facial expression. Although a range of therapy interventions has been discussed for preventing contracture formation, there is minimal information on current practice patterns. This research examined patterns of clinical practice for orofacial burns management during a 4-year period to determine the nature and extent of clinical consistency in current care. Allied health clinicians involved in orofacial contracture management in Australia and...
Source: Journal of Burn Care and Research - December 23, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Survey of Attitudes to Self-Harm Patients Within a Burns and Plastic Surgery Department
This study aims to build on the small body of evidence in previously published study exploring professional attitudes toward deliberate self-harm (DSH) patients from a predominantly burns and plastic surgery perspective. The authors distributed a short paper-based questionnaire within the burns and plastics department at the Queen Elizabeth Hospital, Birmingham, where the authors gathered a mixture of qualitative and quantitative data surrounding this issue. Professionals generally agree that DSH patients require input from multiple services and that surgery is not always the best option. The most common frustration among ...
Source: Journal of Burn Care and Research - December 23, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Pediatric Contractures in Burn Injury: A Burn Model System National Database Study
This study examines the incidence and severity of contractures in a large, multicenter, pediatric burn population. Associated risk factors for the development of contractures are determined. Data from the National Institute on Disability and Rehabilitation Research Burn Model System database, for pediatric (younger than 18 years) burn survivors from 1994 to 2003, were analyzed. Demographic and medical data were collected on each subject. The primary outcome measures included the presence of contractures, number of contractures per patient, and severity of contractures at each of nine locations (shoulder, elbow, hip, knee, ...
Source: Journal of Burn Care and Research - December 23, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Noninvasive Techniques for the Determination of Burn Severity in Real Time
Visual diagnosis of second-degree burns has proven inadequate for determining the appropriate treatment regimen. Although multiple noninvasive imaging techniques have shown promise for providing information about burn wound severity, the ideal technology to aid burn wound excision would provide real-time readouts. Herein, the authors examine a high-resolution infrared (IR) camera (thermography) and a multiprobe adapter system (MPAS-6; transepidermal evaporative water loss, colorimetry) to assess their usefulness in predicting burn severity. Contact burn wounds of increasing severity were created in a porcine model. Wounds ...
Source: Journal of Burn Care and Research - December 23, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Determinants of Outcome in Burn ICU Patients with Septic Shock
Infectious complications remain one of the most challenging concerns for the burn team. The goal of this study was to evaluate the diagnostic and therapeutic approaches and prognosis in burn patients with septic shock. This retrospective study included patients with severe burn injury who were admitted to a burn intensive care unit (ICU). Demographic and clinical data were recorded for each patient. The diagnostic and prognostic value of a number of clinical and laboratory parameters and various treatment options were evaluated. Sixty-four of the 378 patients (16.9%) were identified as having experienced a septic shock dur...
Source: Journal of Burn Care and Research - December 23, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Butane Hash Oil Burns: A 7-Year Perspective on a Growing Problem
This article updates our experience and highlights the increasing public health problem associated with these burns. Charts of patients who presented to the burn center with suspicion of BHO-related injuries between January 2007 and December 2014 were examined. Data collected included demographics, injury characteristics, treatment utilized, and outcomes. Charts of 101 patients were identified as having BHO-related burn injury. The mean age of these patients was 30.5 ± 10.6 years (mean ± standard deviation, range: 2–55 years) and 93.1% were male. Patients sustained a mean of 26.8 ± 24.1% TBSA burn with 14.3 ...
Source: Journal of Burn Care and Research - December 23, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Postdischarge Cause-of-Death Analysis of Combat-Related Burn Patients
This study examined the case fatality rate, causes of death, and the prevalence of suicide among 830 combat burn patients discharged from the sole burn center in the U.S. Department of Defense, between March 7, 2003 and March 6, 2013. Cause-of-death was determined through the Armed Forces Medical Examiner’s Office and the Office of the Secretary of Defense’s National Death Index. A total of 11 deaths occurred among the 830 burn survivors, for an overall case fatality rate of 1.3%. Of the 11 who died, five deaths were related to accidental poisoning by exposure to drugs; three were related to operations of war (two afte...
Source: Journal of Burn Care and Research - December 23, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Alcohol Modulation of the Postburn Hepatic Response
The widespread and rapidly increasing trend of binge drinking is accompanied by a concomitant rise in the prevalence of trauma patients under the influence of alcohol at the time of their injury. Epidemiological evidence suggests up to half of all adult burn patients are intoxicated at the time of admission, and the presence of alcohol is an independent risk factor for death in the early stages post burn. As the major site of alcohol metabolism and toxicity, the liver is a critical determinant of postburn outcome, and experimental evidence implies an injury threshold exists beyond which burn-induced hepatic derangement is ...
Source: Journal of Burn Care and Research - December 23, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Ubiquitin Urine Levels in Burn Patients
The objective of this study was to determine whether urine ubiquitin levels are elevated after burns and to assess whether urine ubiquitin could be useful as a noninvasive biomarker for burn patients. Forty burn patients (%TBSA: 20 ± 22; modified Baux scores: 73 ± 26) were included (control: 11 volunteers). Urine was collected in 2-hour intervals for 72 hours, followed by 12-hour intervals until discharge from the intensive care unit. Ubiquitin concentrations were analyzed by enzyme linked immunosorbent assay and Western blot. Total protein was determined with a Bradford assay. Patient characteristics and clinica...
Source: Journal of Burn Care and Research - December 23, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Variations in Burn Excision and Grafting: A Survey of the American Burn Association
It is unknown whether variations in burn care affect outcomes or affect the success of emerging therapeutics. The purpose of this study was to assess burn surgeons’ preferences in excision and grafting to determine if surgical technique affects outcomes. A 71-item survey evaluating skin grafting techniques and preferences was emailed to members of the American Burn Association in July and August 2015. The survey was anonymous and voluntary. Relationships between variables were evaluated using Fisher’s exact test. A P-value of ≤.05 was deemed statistically significant. The survey was sent to 607 burn surgeons, and the...
Source: Journal of Burn Care and Research - December 23, 2016 Category: Rehabilitation Tags: Original Articles: 2016 ABA Papers Source Type: research
A 6-Year Case-Control Study of the Presentation and Clinical Sequelae for Noninflicted, Negligent, and Inflicted Pediatric Burns
Inflicted burns are one of the leading causes of abuse-related fatalities in children. Between 30 and 60% of children accidentally returned to abusive homes suffer reabuse. Given the high chance for abuse recurrence and the associated morbidity/mortality, it is critical that inflicted burns are promptly identified to guide appropriate medical and child welfare management. Although previous studies proposed historical and mechanistic features using noncomparative or poorly powered data, this study utilized comparative data from a 6-year period (2009–2014) at a certified burn center along with expert analysis from Child Ad...
Source: Journal of Burn Care and Research - December 23, 2016 Category: Rehabilitation Tags: Original Articles: 2016 ABA Papers Source Type: research
A Novel Classification System for Injuries After Electronic Cigarette Explosions
Electronic cigarettes (e-cigarettes) contain lithium batteries that have been known to explode and/or cause fires that have resulted in burn injury. The purpose of this article is to present a case study, review injuries caused by e-cigarettes, and present a novel classification system from the newly emerging patterns of burns. A case study was presented and online media reports for e-cigarette burns were queried with search terms “e-cigarette burns” and “electronic cigarette burns.” The reports and injury patterns were tabulated. Analysis was then performed to create a novel classification system based on the dist...
Source: Journal of Burn Care and Research - December 23, 2016 Category: Rehabilitation Tags: Original Articles: 2016 ABA Papers Source Type: research
The Effect of Illicit Drug Use on Outcomes Following Burn Injury
Illicit drug use is common among patients admitted following burn injury. The authors sought to evaluate whether drug abuse results in worse outcomes. The National Burn Repository (NBR) was queried for data on all patients with drug testing results available. Outcomes included mortality, hospital length of stay (LOS), intensive care unit (ICU) LOS, and duration of ventilator support. Propensity score weighting was performed to control for age, alcohol use, burn size, gender, and etiology of burn. A total of 20,989 patients had drug screen data available; 11,642 (55.5%) tested positive for at least one drug of abuse. Illici...
Source: Journal of Burn Care and Research - December 23, 2016 Category: Rehabilitation Tags: Original Articles: 2016 ABA Papers Source Type: research
