The Clinical Investigation of Necrotizing Fasciitis in Burn Center

The Clinical Investigation Study of Pancreatitis Developed in Burn Patients

PURPOSE: To find progression and prognosis of pancreatitis developed in massive burn patients through retrospective analysis. METHODS: A retrospective study was conducted on 32 patients with abnormal increase of serum lipase level among 2523 acute burn patients admitted to our burn center from January 1, 2017 to June 30, 2018. Pancreatitis in this study was defined as a serum lipase concentration level that is higher than 180 IU/L which is three times more than the normal level (less than 60 IU/L). In this study, a retrospective analysis was performed on patients with serum lipase level higher than 300 IU/L to better understand causality of burns and pancreatitis. RESULTS: 32 patients (1.27%) had serum lipase level higher than 180 IU/L among 2523 acute burn subjects. And 13 patients (0.52%) of these 32 patients had serum lipase level elevated more than 300 IU/L. The study indicated serum lipase level was increased around 7 days after the injury. It returned to normal level early as after 1 to 2 weeks and late as after 4 to 6 weeks of injury. The serum amylase level was increased as similar modality as to the serum lipase level increase. The serum bilirubin, AST, ALT, LD, and GGT were also observed to be elevated when serum lipase was more than 1000 IU/L. CONCLUSION: The pancreatitis developed in burn patients are mostly as mild symptom. It could due to the ischemic injury and can easily be treated by a temporary fasting, TPN, and Gabexate intravenous injection.

Survival Time Analysis of Severly Burned Patients

PURPOSE: The authors analyzed the survival time of severely burned patients who died and reviewed the time of the death after the burn injury. We aimed to determine any relation to the survival time with most important prognostic factors of the surface area burned and the age. METHODS: Statistical analysis was performed on 275 severely burned victims who died at our burn center of Hangang Sacred Heart Hospital from January 1, 2010 to December 31, 2015 for 6 years. RESULTS: 1. The mean age was 50.12±18.2 years and the average burn size was 61.0±27.1% of total body surface area. 2. Most of the patients (90%) died within 45 days, and 80% died within 30 days. 40% of the patients died within 10 days after burn injury, 20% of the patients died between 10 to 20 days after burn injury, 20% of the patients died between 20 to 30 days after burn injury and the rapid decrease in the number of death was observed after 30 days of burn injury time. 3. The shorter survival time (x-axis) time was observed in the patients with larger area of the burned size (y-axis) and the longer survival time was observed with smaller area of the burned size. The negative correlation was shown as figure 1. 4. There was no correlation shown between the age and the survival time of burn victims after burn injury. CONCLUSION: The mortality rate was significantly decreased at 30 to 40 days after burn injury. Therefore, the burn surgeons need more carefully and diversely plan and perform for the initial treatments since the initial surgical procedures determine the survival of severely burned patients.

Clinical Effectiveness of a Newly Developed Collagen Substitute (InsureGraf®)

PURPOSE: Aim of this study was to assess effects of InsureGraf® (SK-Bioland Co., Korea), an artificial dermis developed by using tissue engineering technology in severe burn patients. METHODS: To examine the clinical effectiveness of InsureGraf®, we transplanted them in patients with severe burns. A total of 14 joint regions in 8 patients received InsureGraf® graft selectively from July to December, 2014. The graft results were determined after confirming the take rate of the transplanted skin graft on top of the InsureGraf®. Take rates were examined twice, at 7 and 14 days after grafting. Photographs of the skin grafts were evaluated individually by two burn surgeon specialists, and the mean values were recorded. RESULTS: The take rate was 99% after day 7 and 100% after day 14 respectively. CONCLUSION: InsureGraf® can be used successfully as an artificial dermis that allows one-stage operation in severe burn patients, exhibiting a successful early-stage graft take rate that is close to 100%.

Usefulness of Negative Pressure Wound Therapy (NPWT) in Burn Center

PURPOSE: Negative pressure wound therapy (NPWT) is an adjunct therapy using negative pressure to remove fluid from open wounds through a sealed dressing and a specialized tubing that is connected to a collection container. NPWT is suitable for acute and chronic wound condition because it was designed to accelerate granulation formation on deep wound. Therefore, we performed this study to assess the effectiveness of NPWT for various wound condition in burn center. METHODS: We enrolled 17 patients who were treated with NPWT from January 2014 to April 2016. We analyzed the characteristics and outcomes of the patients through retrospectively. RESULTS: Among 17 patients, there were 13 patients for contact burn, 2 patients for electrical injury, 1 patient for diabetic foot ulcer and 1 patient for Flame burn. Most of the contact burn victims were injured by the exposure of relatively low temperature for a long time and some of them were injured under the condition of sensory deterioration including spinal cord injury, diabetes or sedatives. Wound coverage was accomplished by split thickness skin graft (STSG) in 12 patients. Local flap was done in 1 patient. STSG with local flap was done in 3 patients. And there were 1 patient who got a conservative management. The duration of NPWT application was from 8 days to 101 days (average 36.2 days). CONCLUSION: NPWT showed good clinical outcomes under various wound condition. Therefore, we think that it can be a new treatment paradigm for difficult wound management in burn center.

Surgical Treatment of Acute Arterial Occlusion after Applying the Vascular Closure Device for Hemostasis of Femoral Arteriotomy in Vascular Intervention

Vascular intervention via the femoral artery can cause vascular access complications and complications from closure of the arteriotomic incision site such as bleeding, thrombotic complications and vascular trauma. These types of complications occur in about 2% to 10% of the cases. After removal of the catheter, hemostasis is traditionally achieved by manual compression as a standard method. Many vascular closure devices have been developed in an attempt to improve the patient's comfort and to decrease the time to ambulation. Yet the safety and effectiveness of these vascular closure devices as compared to that of manual compression remains unclear. Herein we report on a case of femoral arterial occlusion due to vascular closure devices and the operative management.

Clinical Significance of Serum Prealbumin (Transthyretin) Level of Nutritional Assessment Index in Massive Burn Patients

PURPOSE: Hangang Sacred Heart Hospital Burn Center has operated the Nutritional Support Team (as known as NST) since 2003. From our experiences of active participation of NST, our authors believed the serum prealbumin level of Nutritional Assessment Index can be a useful testing index for assessing burn patients clinical condition. Therefore, we would like to verify the correlation of the prealbumin level with the patients prognosis. METHODS: The subjects are limited to those who has made at least a single visit to NST during their hospital stay from January 1, 2005 to December 31, 2008 at Hangang Sacred Heart Hospital Burn Center. The total number of NST patients were 129 patients in 2005, 124 patients in 2006, 131 patients in 2007, and 127 patients in 2008. It includes those patients who deceased due to the burn shock within a few days of first admission. Basically it includes any patients regardless of chance of survival rate who has seen the NST at least once during the study period. We obtained the lowest serum prealbumin level of NST patients from 2005 to 2008 and made comparison analysis within the subjects. RESULTS: The mortality rate of NST patients decreased in the study period from 2005 to 2008 as time passed by (47%-37%-24%-22%). However, the lowest serum prealbumin level of mean value was increased notably. The mean values of lowest prealbumin level were 6.07 in 2005, 6.73 in 2006, 9.53 in 2007 and 7.31 in 2008. The mean total body surface burned areas were 50.3% in 2005, 44.6% in 2006, 43.1% in 2007 and 47.2% in 2008. The lowest prealbumin level in the survived group is 2 to 3 gm/dl higher than the deceased group. The lowest prealbumin level in deceased group was shown mostly below 7 mg/dl and mortality rate was extremely increased to 35% to the group below 5 mg/dl. CONCLUSION: Our study suggests it is necessary to pay special attention if prealbumin level drops below 7 mg/dl in massive burn patients. If the level drops below 5 mg/dl or 6 mg/dl, it can be considered as nutritional condition of the patient is poor and need to make extra observations on several criteria such as nutritional supply, high in catabolism and progression of septicemia to assess proper needed care for burn patients.