Microbiology and risk factors associated with war-related wound infections in the Middle East.

The Middle East region is plagued with repeated armed conflicts that affect both civilians and soldiers. Injuries sustained during war are common and frequently associated with multiple life-threatening complications. Wound infections are major consequences of these war injuries. The microbiology of war-related wound infections is variable with predominance of Gram-negative bacteria in later stages. The emergence of antimicrobial resistance among isolates affecting war-related wound injuries is a serious problem with major regional and global implications. Factors responsible for the increase in multidrug-resistant pathogens include timing and type of surgical management, wide use of antimicrobial drugs, and the presence of metallic or organic fragments in the wound. Nosocomial transmission is the most important factor in the spread of multidrug-resistant pathogens. Wound management of war-related injuries merits a multidisciplinary approach. This review aims to describe the microbiology of war-related wound infections and factors affecting their incidence from conflict areas in Iraq, Syria, Israel, and Lebanon.

Management of burns in the elderly.

Burns are one of the most devastating forms of trauma worldwide. While geriatric burns are uncommon in the developing world - accounting for less than 5% of burns in South Asian and Middle Eastern countries - they account for almost 20% of burns in economically developed countries such as the USA. The elderly population in general is at higher risk for burn injury, moreover mortality rate, as well as severity of complications, is more pronounced in this group of patients. A review of the literature was conducted to evaluate risk factors as well as pathophysiological and immunological conditions that affect response to burn injury in the elderly population. Surgical and medical interventions used for the management of geriatric burns remain a field of controversy and ongoing debate. Improvement of burn management with reduction in mortality in this age group warrants addressing survivors' quality of life, with a special focus on rehabilitation and support.

Les brûlures représentent les traumatismes les plus dévastateurs au monde. Alors les patients âgés ne représentent que moins de 5% des brûlés des pays en développement (Asie du sud et moyen orient), ils atteignent presque 20% des patients des pays à IDH élevé. Les sujets âgés représentent une population à risque élevé de brûlure, celle-ci étant grevée d'une morbi-mortalité plus élevée. Nous avons réalisé une revue de la littérature pour étudier les facteurs de risque et les modifications physiologiques comme immunologiques interférant avec la réponse à la brûlure du sujet âgé. La prise en charge médico-chirurgicale de ce groupe de patients reste sujette à débats. L'amélioration de cette prise en charge doit être couplée à une vie de qualité, nécessitant une rééducation optimisée.

Treatment of a paediatric patient with a distal lower extremity traumatic wound using a dermal regeneration template and NPWT.

Degloving injuries are common in trauma and represent a spectrum of complex wounds, the management of which may be highly challenging especially in the paediatric population. In severe injuries leading to wounds reaching tendon and bone, vascularity is compromised precluding traditional wound management, and sometimes necessitating amputation. This report highlights the use of a dermal regeneration template combined with vacuum-assisted closure (VAC) in the treatment of complex traumatic degloving wounds. Here, we present a case of a five-year-old boy who sustained a high-energy shear injury to his lower extremity that resulted in an extensive degloving wound involving the distal third of his leg and the dorsum of his foot. After debridement, the patient underwent VAC combined with a dermal skin substitute placement, followed by split-thickness skin grafting. The extremity healed with no complications and without the need for amputation or flap reconstruction, achieving satisfactory recovery of range of motion and favourable cosmetic results.

Reverse tissue expansion by liposuction deflation adopted for harvest of large sheet of full-thickness skin graft.

Full-thickness skingraft is a valid option to release burn scar contractures with the main purpose of correcting the induced limitation in function and improve the disfiguring appearance of the scar. The main pitfall remains the limited availability of these grafts, especially when large sheets are needed. We present an application of a previously described technique known as reverse tissue expansion, which permits the harvesting of a large sheet of full thickness skin graft when needed. This method was adopted to release a burn scar contracture in a 32-yr-old man who sustained a 65% TBSA burn secondary to a gasoline tank explosion at the age of 7 yr followed by multiple reconstructive procedures. The patient presented with a disfiguring anterior neck contracture coupled to limited range of motion. Improvement of neck extension was contemplated using full-thickness skin graft harvested following reverse tissue expansion achieved by deflation liposuction of the donor site.

Cardiovascular dysfunction in burns: review of the literature.

Major burn injury produces substantial hemodynamic and cardiodynamic derangements, which contribute to the development of sepsis, multiple organ failure, and death. Cardiac stress is the hallmark of the acute phase response and its severity determines postburn outcomes, with poorer outcomes associated with cardiac dysfunction. With available evidence from the literature, the present is a comprehensive review of cardiac dysfunction in burns as well as the different monitoring modalities.

Thermal injury to the hand: review of the literature.

This paper is a comprehensive review of hand burn injuries. The different classifications of thermal burns, out- and inpatient care, indications for escharotomies as well as surgical management, skin substitutes, and paediatric hand burns are thoroughly reviewed.