[Interdisciplinary extremity board in the treatment of complex injuries]. / Interdisziplinäres Extremitäten-Board in der Behandlung von Komplexverletzungen.

BACKGROUND: Interdisciplinary case conferences are well-established in the field of oncology in order to provide the best possible treatment for patients with complex disease patterns which overlap several disciplines. METHODS: After studying the available literature the aims, indications, frequency, patient enrolment and documentation modalities, disciplines necessary to create the reconstruction plan and evaluation parameters of the board, were agreed in an interdisciplinary discussion among colleagues. The utilization of the extremity board and demographic features of the cases presented in the extremity board within the first 6 months were subsequently descriptively analyzed. RESULTS: The agreed primary aim of an extremity board is the timely and transparent preparation of a high-quality holistic reconstruction plan for optimized treatment of a challenging patient collective with complex injuries of the extremities. Decisive interfaces of an extremity board are the participation of interdisciplinary disciplines, established enrolment and documentation modalities and a longitudinal analysis of parameters of the acute medical treatment, the long-term function and quality of life of those affected. The patient collective so far mostly includes men under 40 years old with traumatic soft tissue defects and combined injuries. On average, reconstruction plans for 1-2 patients were approved in an interdisciplinary team per session. CONCLUSION: The extremity board serves as a platform for coordinated planning of treatment for patients with complex injuries. The limited personnel and time resources represent the greatest challenge for the successful implementation. The extremity board enables a high degree of interdisciplinary networking. The digital registration and documentation modality within the internal hospital documentation system is of utmost relevance. The preparation of the reconstruction plan is of decisive importance for the qualitative success of treatment and the restoration of function. The longitudinal analysis of appropriate parameters is imperative to measure the quality of treatment.

[Reconstruction in polytraumatized burn patients]. / Rekonstruktion beim polytraumatisierten Brandverletzten.

BACKGROUND: Polytraumatized burn patients represent a rare patient collective and necessitate an individualized treatment concept due to the particular combination of injuries. OBJECTIVE: Against the background of this special injury pattern, especially with deep burns overlying the fracture zone, the question of a specific and interdisciplinary treatment algorithm arises. MATERIAL AND METHODS: This article is based on a PubMed database search and experiences of a trauma center for severely injured burn patients at a university hospital, with presentation of the special therapeutic requirements and goals exemplified by a case report. RESULTS: The evaluation of the literature search and own treatment results comes to the conclusion that the rate and extent of amputations and infections can be reduced by an early and interdisciplinary involvement of the plastic surgeon by early combined fracture stabilization, excision of necrotic tissue and immediate skin grafting. Furthermore, plastic reconstructive procedures enable a functional and esthetic reconstruction with optimized prosthesis fitting. CONCLUSION: Polytraumatized severely burned patients necessitate an interdisciplinary treatment approach, whereby preservation of length, functionality and esthetic appearance of the affected extremities and concurrent avoidance of bone and soft tissue infections have utmost priority.

German, European or American burn guidelines - Is one superior to another?

Adequate medical care of severe burn injuries requires special organizational infrastructure and high educational standards, with an appropriate number of health care professionals. Guidelines were written by the German Society for Burn Treatment (DGV), the European Burns Association (EBA) and the American Burn Association (ABA) to assist with the delivery of such care. Current DGV (2010), EBA (2013) and ABA (2001/2006/2008) guidelines are compared, focusing on similarities, differences, conciseness and completeness. This publication presents advantages and disadvantages of each of them. DGV guidelines outline understandable treatment recommendations for first aid measures, clinical procedures and wound care. Extensive rehabilitation guidelines with clearly defined indications and precise infrastructure requirements for a Burn Centre are stated. Negative aspects are the presence of multiple documents containing redundant and confusing information. EBA guidelines offer the most comprehensive treatment recommendations with multidisciplinary approaches. Overall, infrastructural requirements are weighted much higher than staff qualification demands - in contrast to ABA guidelines. However, lack of conciseness and complicated criteria regarding transfer of patients to a Burn Center - including imprecise indications for rehabilitation treatment - have to be mentioned as disadvantages. ABA guidelines have a clear focus on staff qualifications and easy-to-understand transfer criteria. Another focus is on detailed clinical procedures. However, these guidelines lack burn definition and precise treatment recommendations for rehabilitation. The reviewed guidelines provide standardized treatment recommendations for burn patients. Despite their usefulness, they all have weaknesses and discrepancies. Findings should be used to improve each of them.

La prise en charge correcte des brûlés graves nécessite une organisation spécifique, une expertise adaptée et un nombre adéquat de personnels entraînés. Des recommandations spécifiques ont été édictées par la « German Society for Burn Treatment ¼ (DGV), l'European Burns Association (EBA) et l'American Burn Association (ABA) afin d'aider à cette prise en charge. Nous les avons comparées, en nous focalisant sur les similarités, les différences, la concision et l'exhaustivité, chacune d'entre eux ayant ses points positifs et négatifs, que nous présentons ici. Les recommandations allemandes insistent sur la prise en charge initiale et le traitement local. La rééducation et les infrastructures nécessaires sont explicitées. Les documents sont cependant multiples et fréquemment redondants, obérant leur facilité d'utilisation. Les recommandations européennes sont plus exhaustives et s'attachent à l'approche multidisciplinaire. Les obligations infrastructurelles y ont un poids supérieur à l'expertise soignante, ce qui diffère des recommandations américaines. Cependant, une concision argumentable et des critères d'hospitalisation en CTB compliqués (ainsi que des critères de rééducation spécialisée flous) doivent être marqués défavorablement. Les recommandations américaines ont l'avantage de la clarté en ce qui concerne le niveau d'expertise des intervenants, les critères d'hospitalisation en CTB et le détail de la prise en charge. Elles pêchent cependant par le flou concernant la définition d'une brûlure et l'absence de préconisation concernant la rééducation. Globalement, ces recommandations ne présentent que des approches incomplètes de la prise en charge des brûlés et devraient toutes être optimisées.

[Pest control in your garden - a case series of severe hand injuries caused by privately used explosives and shot traps]. / Schädlingsbekämpfung im eigenen Garten - Fallserie schwerer Handverletzungen durch Spreng- und Schussfallen in privatem Gebrauch.

Booby traps and gun-like devices for vole control can lead to complex trauma requiring emergency medical care. We present a case series of patients who suffered severe hand and facial trauma through detonation of booby traps and paraphernalia (n = 9, Ø 60 years of age). All patients were admitted to the emergency department of Hannover Medical School for primary care. Between 2011 and 2015 we treated six patients with hand trauma due to gun-like devices, two patients with hand trauma due to booby traps, and one patient with injury to the face including eyes due to a gas cartridge explosion. All hand trauma patients (n = 8) showed injuries of the soft tissue. Six of these patients also presented fractures or lesions of capsular or tendon structures. Therapies included debridement as well as skin grafts or flaps for tissue defect coverage. We informed the Department for Commercial Safety (Gewerbeaufsicht Hannover) in 2014 because we believe that these traps pose a serious safety hazard.

Assessing burn depth in tattooed burn lesions with LASCA Imaging.

Tattoos are on the rise, and so are patients with tattooed burn lesions. A proper assessment with regard to burn depth is often impeded by the tattoo dye. Laser speckle contrast analysis (LASCA) is a technique that evaluates burn lesions via relative perfusion analysis. We assessed the effect of tattoo skin pigmentation on LASCA perfusion imaging in a multicolour tattooed patient. Depth of burn lesions in multi-coloured tattooed and untattooed skin was assessed using LASCA. Relative perfusion was measured in perfusion units (PU) and compared to various pigment colours, then correlated with the clinical evaluation of the lesion. Superficial partial thickness burn (SPTB) lesions showed significantly elevated perfusion units (PU) compared to normal skin; deep partial thickness burns showed decreased PU levels. PU of various tattoo pigments to normal skin showed either significantly lower values (blue, red, pink) or significantly increased values (black) whereas orange and yellow pigment showed values comparable to normal skin. In SPTB, black and blue pigment showed reduced perfusion; yellow pigment was similar to normal SPTB burn. Deep partial thickness burn (DPTB) lesions in tattoos did not show significant differences to normal DPTB lesions for black, green and red. Tattoo pigments alter the results of perfusion patterns assessed with LASCA both in normal and burned skin. Yellow pigments do not seem to interfere with LASCA assessment. However proper determination of burn depth both in SPTB and DPTB by LASCA is limited by the heterogenic alterations of the various pigment colours.

Les tatouages sont de plus en plus fréquents, et donc l'incidence des brûlures sur peau tatouée augmente. L'évaluation clinique correcte de la profondeur de la brûlure se heurte à la pigmentation du tatouage. Nous avons utilisé dans ce but l'imagerie laser, chez un patient porteur d'un tatouage multicolore, dans des zones le portant et ne le portant pas. La perfusion relative était mesurée en Unités de Perfusion (UP), comparée à des pigments colorés connus, et à l'aspect clinique. Les brûlures superficielles étaient plus perfusées que la peau normale, quand les brûlures profondes l'étaient moins. Les pigments bleus, rouges et rose entraînent une diminution des UP de la peau saine, les noirs une augmentation, l'effet artéfactuel des oranges et des jaunes étant non significatif. En cas de brûlure superficielle, les zones bleues et noires ont une perfusion diminuée, alors que le jaune ne change pas le résultat comparativement à une telle brûlure en zone non tatouée. L'aspect laser des brûlures profondes sur des tatouages noirs, rouges ou verts est semblable à celui observé avec les mêmes brûlures sur peau non tatouée. Les tatouages changent les résultats de l'évaluation laser de la perfusion cutanée, que la peau soit normale ou brûlée, sauf avec les pigments jaunes. En cas de tatouage multicolore, l'évaluation de la profondeur d'une brûlure par laser est prise en défaut.