Pediatric burn injuries from day-old campfires: a highly morbid and preventable problem.

The purpose of this study was to review the authors' experience with pediatric burns from day-old campfires. The authors sought to characterize the operative courses, hospitalizations, and complications arising from burn injuries in this patient population. After Institutional Review Board approval, charts were retrospectively reviewed of pediatric patients seeking care for burn injuries at a regional burn center over 6 years. From June 2002 to September 2008, 30 pediatric patients sought care for burn injuries sustained in campfires; 25 (83.3%) of these occurred in fire pits with previously extinguished fires; 68% were male, with median age of 2.0 years (range, 14 months to 17 years). The median TBSA burned was 2% (range, 1-40%). The most common burn locations were hand (68%), forearm (28%), and foot (24%). Additional locations included back, arm, abdomen, and thigh. Eighteen patients (72%) required hospital admission; among these patients, mean number of hospitalizations was 1.3 (range, 1-2) and mean length of stay was 5 days (range, 1-22 days). This group accounted for 23 admissions, 96 hospital days, 3 intensive care unit days, 16 operations under general anesthesia, and 30 procedural sedations/dressing changes under anesthesia. Operative procedures included 9 full-thickness skin grafts, 13 split-thickness skin grafts, 2 escharotomies, and 1 amputation. Complications included one death (4%), one graft loss (4%), two cellulitis (8%), and four scar hypertrophies (16%). Day-old campfires may cause significant burns in the pediatric population, resulting in considerable short- and long-term morbidities and utilization of health care resources. Our experience with this patient population lends justification for campaigns aimed to prevent such injuries.

Cold injury.

The pathophysiology of true frostbite reveals that the direct injury produced during the initial freeze process has a minor contribution to the global tissue damage. However, rapid rewarming to reverse the tissue crystallization has essentially been the lone frostbite intervention for almost half a century. The major pathologic process is the progressive microvascular thrombosis following reperfusion of the ischemic limb, with the cold-damaged endothelial cells playing a central role in the outcome of these frozen tissues. Newer interventions offer the opportunity to combat this process, and this article offers a scientific approach to frostbite injuries of the upper extremities.