Abordaje de la mano con quemaduras en una unidad de grandes quemados / Management of burned hand in a critical care burn unit

Introducción y Objetivo. Las quemaduras en las manos suponen un volumen total muy importante en la atención sanitaria. Prácticamente la totalidad de la población ha sufrido o sufrirá a lo largo de su vida una quemadura en sus manos. Afortunadamente, la inmensa mayoría no requerirá una atención especializada por parte de un cirujano plástico. Aun así, el impacto de los que sí precisan dicha atención es importante y debemos tener siempre planificado cómo actuar en cada situación. La función final que se obtenga de una mano quemada será de vital importancia, tanto si es la única zona del cuerpo afectada, como si entra en el contexto del gran quemado, y más en estos casos puesto que tendrá una gran repercusión positiva en su calidad de vida si se logra un resultado óptimo y/o funcional. El objetivo de este artículo es revisar nuestra experiencia como Unidad de Quemados en el tratamiento de la mano quemada y mostrar una serie de ejemplos de abordaje de las secuelas de quemaduras en manos que permita al paciente reincorporarse de forma completa a su actividad habitual. Material y Método. Revisamos los pacientes atendidos en nuestra Unidad entre 2012 y 2014, la afectación en manos, su epidemiología, distribución por variables, y revisamos varios casos de secuelas, algunos típicos y otros menos frecuentes. Resultados. Atendimos a un total de 307 pacientes, de los cuales 68 sufrieron quemaduras en 1 mano y 113 en las 2, requiriendo finalmente cirugía 155 manos. Del total, 39 pacientes provenían del ámbito laboral, de los cuales sufrieron quemaduras en manos 20, siendo en estos casos más frecuente la afectación de ambas manos que en los pacientes que no sufrieron accidentes laborales (4 afectados en una sola mano y 20 en ambas manos). Conclusiones. Nuestros pilares básicos se centran en: un diagnóstico preciso y precoz de profundidad, extensión y repercusiones; un tratamiento quirúrgico temprano y adecuado; un manejo rehabilitador continuo; y un seguimiento detallado de las posibles secuelas para poder tratarlas con la mejor indicación y en el momento preciso (AU)

Background and Objective. Hand burns have a very important total volume in healthcare. Virtually all of the population has suffered or will suffer throughout the life a burn on hands. Fortunately, the vast majority do not require a specialized attention by a plastic surgeon. Still, the impact of those who need such specialist attention is important and we must always plan what to do in every situation. The final function that is obtained from a burned hand will be vital whether it is the only area affected as if within the context of a critical burn patient, and more so in these cases as it will have a positive impact on their quality of life if results achieved are optimal and/or functional. The aim of this study is to present our experience as Burns Unit in the treatment of burned hands, and to review some examples of management of burns sequels in hands in order to get a complete reintegration of patients to their usual activities. Methods. We reviewed patients at our Unit involvement in hands, epidemiology, distribution in variables, and reviewed several cases, some typical and others less frequent. Results. We attended a total of 307 patients, 68 of them with burns in 1 hand, and 113 in both hands, finally needing surgery 155 hands. From the total, 39 patients came from the laboral ambient, 20 with hand burns, being both hands burns more frequent in those cases than in those who didn't suffered laboral accidents (4 burns in only 1 hand and 20 in both hands). Conclusions. Our cornerstones are: an accurate and early diagnosis of depth, extent and impact; an early and appropriate surgical treatment; continuous rehabilitation management; and a close follow up of the possible sequelae to treat them with the best indication and at the right time (AU)

EHTIC study: Evaluation of a new hemostatic agent based on tissue factor in skin grafting procedures.

BACKGROUND: Excessive bleeding is a major concern in scar debridement and grafting procedures. TT-173 is a new topical hemostatic agent based on recombinant human tissue factor that has shown promising results in patients who underwent tooth extraction. EHTIC study sought to evaluate the efficacy and safety of TT-173 to reduce the bleeding in donor sites of skin grafting procedures. METHODS: EHTIC study was a phase II, randomized, parallel, double blind, placebo controlled trial. Patients received TT-173 (n=38) or placebo (n=33) sprayed over donor site after graft harvest. Time to hemostasis and incidence of adverse events were recorded. Systemic absorption of the product and its immunogenicity were also measured during the follow up of the subjects. RESULTS: Treatment with TT-173 significantly reduced the bleeding time from 7 to 3min (Log-Rank p<0.0001). Moreover, bleeding stopped within the 10min of evaluation period in all the patients that received TT-173. In contrast, 24.24% of patients from placebo group required additional measures to arrest hemorrhage (Fisher p=0.0013). Product related adverse events, systemic absorption into blood stream, interferences with the healing of the donor site or immunogenic reaction against TT-173 were not observed. CONCLUSION: The new hemostatic agent TT-173 has proven efficacious and safe to reduce the bleeding from donor site. This study paves the way for further investigation of the product as topical hemostatic treatment in plastic surgery and other surgical indications.