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1.
Chinese Journal of Burns ; (6): 332-338, 2018.
Article in Chinese | WPRIM | ID: wpr-806692

ABSTRACT

Objective@#To summarize the measures and experience of treatment in mass extremely severe burn patients.@*Methods@#The clinical data and treatment of 8 extremely severe burn patients in August 2 Kunshan factory aluminum dust explosion accident who were admitted in the 100th Hospital of PLA on August 2nd, 2014, were retrospectively analyzed. There were 4 males and 4 females, aging 22-45 (34±7) years, with total burn area of 55%-98% [(89±15)%] total body surface area (TBSA) and full-thickness burn area of 45%-97% [(80±21)%] TBSA. All the 8 patients were accompanied with severe shock, inhalation injury, and blast injury. According to the requirements of former PLA General Logistics Department and Nanjing Military Command, a treatment team was set up including a special medical unit and a special care unit, with Chai Jiake from the First Affiliated Hospital of PLA General Hospital as the team leader, Zheng Qingyi from the 175th Hospital of PLA (the Affiliated Dongnan Hospital of Xiamen University) as the deputy leader, the 100th Hospital of PLA as the treatment base, and burn care, respiratory, nephrology, nursing specialists from the First Affiliated Hospital of PLA General Hospital, and the burn care experts and nursing staff from the 180th Hospital of PLA, 118th Hospital of PLA, 98th Hospital of PLA, and 175th Hospital of PLA, and nurses from the 85th Hospital of PLA, 455th Hospital of PLA, 101th Hospital of PLA, 113th Hospital of PLA as team members. Treatment strategies were adopted as unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns. With exception of one patient who received deep vein catheterization before admission, the other 7 patients were treated with deep vein catheterization 0.5 to 3.0 hours after admission to correct hypovolemic shock as soon as possible. Eight patients received tracheotomy, and 7 patients were treated with mechanical ventilation by ventilator in protective ventilation strategy with low tide volume and low volume pressure to assist breathing. Fiberoptic bronchoscopy was done one to three times for all the 8 patients to confirm airway injuries and healing status. Escharectomy and Meek dermatoplasty in the extremities of all the 8 patients were performed 3 to 6 days after injury for the first time. Escharectomy, microskin grafting, and covering of large pieces of allogeneic skin on the trunks of 4 patients were performed 11 to 16 days after injury for the second time. The broad-spectrum antibiotics were uniformly used at first time of anti-infective therapy, and then the antibiotics species were adjusted in time. The balance of internal environment was maintained and the visceral functions were protected. One special care unit was on responsibility of only one patient. Psychological intervention was performed on admission. The rehabilitative treatment was started at early stage and in company with the whole treatment.@*Results@#Acute renal injury occurred in 5 patients within 36 hours after injury and their renal function was restored to normal 4 days after injury due to active adjustment of fluid resuscitation program. No pulmonary complications, such as severe pulmonary infection and ventilator-associated pneumonia, occurred in the survived patients. One of the 8 patients died, and the other 7 patients were cured successfully. The wounds were basically healed in 2 patients in 26 or 27 days by 2 or 3 times of operation, and in 5 patients by 4 or 5 times of operation. The basic wound healing time was 26-64 (48±15) days for all the 7 patients.@*Conclusions@#Treatment strategies of unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns are the bases to successful treatment. Correcting shock as soon as possible is the prerequisite and closing wound as soon as possible is the key to successful treatment. Comprehensive treatment measures, such as maintaining and regulating the function of viscera, improving the body immunity, and preventing and treating the complications, are the important components to successful treatment. It is emphasized that in the treatment of mass extremely severe burn patients, specialist burn treatment should always be in the dominant position, and other related disciplines may play a part in auxiliary function.

2.
Chinese Journal of Burns ; (6): 105-106, 2002.
Article in Chinese | WPRIM | ID: wpr-289177

ABSTRACT

<p><b>OBJECTIVE</b>To summarize the experience of repairing of severely burned hand and wrist with abdominal thin skin flaps in insertion pattern.</p><p><b>METHODS</b>Twelve burn patients with the dorsum of the hands and wrist being severely injured were enrolled in this report. The donor sites of the flaps were selected on the upper abdomen in 4 cases and on the lower abdomen in 8 cases. The division of the flap pedicles was done on the 10th - 13th postoperative days.</p><p><b>RESULTS</b>All the flaps survived except that there were two necrotic areas sized 2 cm x 2 cm and 1 cm x 1 cm, respectively, on the distal ends of the flaps in two cases. The hand function and contour recovered satisfactorily after the operation.</p><p><b>CONCLUSION</b>It could be an ideal choice for the repair of severely burned hand and wrist with abdominal thin skin flaps.</p>


Subject(s)
Abdomen , Adult , Burns , General Surgery , Female , Hand Injuries , General Surgery , Humans , Male , Skin Transplantation , Methods , Time Factors , Wound Healing , Wrist Injuries , General Surgery
3.
Article in Chinese | WPRIM | ID: wpr-596808

ABSTRACT

OBJECTIVE To know the pathogens distribution and resistance situation in the burn wards.METHODS A retrospective analysis was conducted to 627 pathogen isolates and sensitivity results,which submitted by burn department from May 2005 to May 2008.RESULTS Gram-negative(G-) bacilli occupied for 33.8%,Gram-positive(G+) cocci occupied for 48.8% and fungi occupied for 17.4%.Acinetobacter baumannii occupied for 8.6%,Pseudomonas aeruginosa occupied for 6.0%,Staphylococcus aureus occupied for 77.5%,in which the isolation rate of meticillin-resistant S.aureus(MRSA) was 94.9%.The drug sensitivity tests showed that various detectable bacteria possessed multi-drug resistance;G+ bacteria were sensitive to vancomycin,G-were sensitive to imipenem,but only A.baumannii was sensitive to cefoperazone/sulbactam.CONCLUSIONS The bacterial infection in the burn department in our hospital mainly is due to G+ cocci,then is G-bacilli,from which the A.baumannii detection rate is increasing.Clinicians should enhence to detect the sensitivity of bacteria and use antibiotics reasonably.

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