Effect of shaped polyurethane foam dressing on healing of scalp donor sites in the patients with extensive burn / 上海交通大学学报（医学版）

Objective • To evaluate shaped polyurethane foam dressing applied on scalp donor sites in the patients with extensive burn. Methods • The extensively burned adult patients without chronic diseases before injury, who were hospitalized in the Department of Burns and Plastic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from October, 2017 to October, 2018 were selected. Their scalps as skin donor sites during all past grafting surgeries were divided into two groups by different treatments, i.e. control group and research group. The scalps in control group were covered by gauze clipped by the skulls. Those in research group were covered by shaped polyurethane foam dressing. Afterwards, the wound healing time for the scalps, the intervals between the two adjacent grafting operations, the post-operation pain assessed by visual analogue scale (VAS), and the workload of medical staffs were analyzed and compared between the two groups. Results • The mean time of wound healing for scalp donor sites in research group was (6.77±0.10) d, whereas it was (9.73±0.17) d in control group. For the intervals between the two contiguous operations, they were (9.33±0.16) d in research group and (11.90±0.22) d in control group, respectively. The differences in these two indexes between the two groups were statistically significant (P=0.000). Also, the VAS scores were significantly lower in research group compared with those in control group at all the points after operations (P=0.000). The application of shaped polyurethane foam dressing evidently reduced the treatment time for turning bed and had no need of lamp-aid treatment, so it reduced the workload for medical staffs. Conclusion • The application of shaped polyurethane foam dressing on extensively burned patients' scalp may significantly accelerate its wound healing, shorten the intervals between two grafting operations, which will be beneficial in closing the wounds of these patients earlier eventually. Meanwhile, its application may also alleviate pains of the patients and reduce the burdens of post-operation nursing.

Early application of artificial dermis scaffold in repairing deep wounds on hands and feet after extensive burn / 第二军医大学学报

Objective To investigate the clinical efficacy of artificial dermis scaffold combined with autologous split-thickness skin graft in repairing deep wounds on hands and feet after extensive burn by comparing with the traditional ways. Methods The patients with deep wounds on hands and feet, who were treated in Department of Burn Surgery, Changhai Hospital, Second Military Medical University from March 2012 to March 2015, were selected as participants. A total of 28 patients meeting the inclusion criteria were allocated into two groups according to the operations. The observation group (14 cases) received artificial dermis scaffold after crust resectional therapy at 4-7 days after burns, and they also received autologous split-thickness skin graft following crust resectional therapy at 21-28 days after burns. The control group (14 cases) received changing medicine to maintain the scab following crust resectional therapy at 4-7 days after burns, and they also received autologous split-thickness skin graft following crust resectional therapy at 28-35 days after burns. The following data were recorded: the operation time, survival rate of skin graft, the cause of the flap necrosis, healing time of donor site and whether it could donor more flap or not, and the hyperplastic scars on hands and feet. Results The observation group needed similar operation time when compared with the control group for the first operation ([4.50±0.76] h vs[4.14±0.86] h,P>0.05), while the second operation time of the observation group was significantly shorter than that of the control group ([2.11±0.35] h vs [3.39±0.49] h, P<0.001). When changing the medicine at the 8th day after skin grafting, the survival rate of skin graft in the observation group was 97.37%(37/38) and the infection rate was 2.63%(1/38); the survival rate of the whole skin graft in control group was 73.68%(28/38), and that of partial skin graft was 23.68%(9/38), with an infection rate of 2.63%(1/38). The healing time of donor site in the observation group was significantly shorter than that of the control group([6.07±0.83] d vs [14.64±0.93] d, P<0.001). And it was estimated that 78.57%(11/14) of the patients in the observation group and 14.29%(2/14) of patients in the control group could donor more graft(P<0.05). One year follow-up showed that hyperplastic scars on hands and feet in the observation group was significantly better than those in the control group according to the Vancouver Scar Scale (VSS, [5.07±1.21] vs [8.07±1.14], P<0.001). Conclusion Artificial dermis scaffold can be used at early time in repairing deep wounds on hands and feet after extensive burn, with no need for additional operation time; and both the survival rate of skin graft and long-term function are good, with less damage to the donor site.

Acute Lung Injury after Extensive BurnMerging Smoke Inhalation:Treatment in 32 Cases of Early Stage / 中国医科大学学报

Objective To summarize the treatment experience of extensive burn merging smoke inhalation acute lung injury(SIALI)in 32 early stage cases,and to provide a reference for the further improvement of success rate in early stage. Methods A total of 32 cases of extensive burn merging SIALI resulting from mine explosion that received clinical treatment and triage from November to December in 2014 were enrolled for the study. In addition,the experience of triage and prognosis(after injured in a month)to guide therapy was analyzed. Results Two of the 32 patients died from respiratory failure in shock period,after shock period(3 days after injured),19 bad sufferers were cured in the local hospital,and the oth?er 11 cases in stable condition were triaged to the nearby hospital. 1 month follow?up results showed that:patients who received therapy in local hospi?tal,one died from MODS in 3 weeks,one died from kidney failure in 4 weeks. The other 28 patients were alive. Conclusion For these patients who suffering from extensive burn merging SIALI received therapy in early stage,we should not only schedule positive anti?shock,tracheotomy,antibiot?ics,escharectomy and nutritional support or other treatments,but also face to the challenge of lacking medical resources from too more patients. Thus,we suggest to triage the wounded to nearby hospital after anti?shock treatment,so as to improve the success rate in early stage.

Change trend and antimicrobial resistance of pathogens causing infection in extensive burn patients / 中国感染控制杂志

Objective To explore the change trend and antimicrobial resistance of pathogens causing infection in extensive burn patients,and provide reference for clinical prevention and treatment.Methods Specimens from 9 extensive burn patients who were admitted to a hospital at the same time were performed pathogenic culture and an-timicrobial susceptibility testing, change trend and antimicrobial susceptibility of pathogens were observed. Results The main specimen was wound secretion,accounting for 93.81 %.The major pathogens causing infection were Acinetobacter baumannii (44.85%),Staphylococcus aureus (32.47%),Pseudomonas aeruginosa (12.37%), and Klebsiella pneumoniae (5.15%).With the prolongation of hospital stay,pathogens changed from one kind to multiple strains, and from susceptibility to resistance,multidrug resistance,and extensive drug resistance. Conclusion Itis difficult to avoid infection in burn patients,timely realizing the changes of pathogens causing infec-tion and antimicrobial resistance play an important role in the control of infection.

Hematogenous Septic Arthritis of the Hip in Extensive Burn

In the patient with extensive burn injury, the occult site of infection such as septic arthritis is easy to be overlooked because a painful hip joint may be confused for painful burn wounds around pelvic area. We describe a extensive burned young adult who experienced a septic hip joint with methicillin resistant Staphylococcus aureus bacteremia A 22 year old male who had full thickness burns of whole body (90%) presented with fever, groin pain, and immobility of right hip joint about 3 months after injury. The physical findings, radiographic findings and bone scan were diagnostic for a septic arthritis. Septic arthritis in the extensive burns may be misdiagnosed for painful burn wounds. Hematogenous septic hip arthritis by sustained bacteremia is rare, but clinical examination combined with appropriate laboratory and radiographic studies can lead to prompt diagnosis and treatment.

Early treatment of multiple patients with extensive burns combined with burst injury of the lung / 中华急诊医学杂志

Objective To explore effective treatment methods and experience of management and organization in the early period of multiple patients with extensive burns combined with blast injury of the lungs. Methods To summary and analyze the climical date of 16 patients with extensive burns the combined with blast injury and experience of management and organization. Results One patient died of severe blast injury of lung 5 days after,one died of multi-organ dysfunction syndrome, the others recovered well and the burn, healed well. Organization and the course of resuscitating patients were effective, logistic support was strong and all patients were transported and transferred successfully. Conclusion Individualization fluid infusion based on exact clinical observations and increaseing the ratio of colloid fluid would help to prevent shock accompany burst injury of lung. Early and suitable mechanical ventilation mode to improve ventilation/gas exchange function were important measures to manage inhalation injuries. To plan directive salvage schemes for emergency and powerful logistic support,and transporting and transferring patients in time would help to increase treatment efficiency of multiple patients.

Application of permanent needle of deep venipuncture to first aid of extensive burn / 医疗卫生装备

Objective:To explore the clinical application of permanent needle of deep venipuncture in early management of extensive burn.Methods:88 patients with extensively burn are analyzed.Results:The success rate of venipuncture was 96%.The effect was satisfactory,while the complication was less.Conclusion:The permanent needle of deep venipuncture shows an important role in early management of extensive burn.