The effect of Extracorporeal Shock Wave Therapy in the treatment of burn scars: A prospective, randomized, controlled trial.

BACKGROUND: Current scientific evidence on the effect of Extracorporeal Shock Wave Therapy (ESWT) as adjunctive treatment for burn scars is scarce. However preliminary evidence, indicates it might prove a useful tool. MATERIALS AND METHODS: A prospective, randomized, controlled study was conducted from February 2017 to February 2019. Patients with burn scars were divided into two groups with twenty patients per group. The control group received the standard treatment for burn scars. The ESWT group received the standard treatment and treatment of burn scars with ESWT 512 impulses of 0.15mJ/mm2 in each session, twice per week for 4 weeks. We assessed the appearance of scar with the Vancouver Scar Scale (VSS), pruritus and pain with Visual Analog Scale (VAS) before the start of the treatment and at 2 weeks and 5 months after the treatment. RESULTS: Both groups showed improvements in all variables through the study. However, these improvements were only statistically significant for the VSS at the 6th month for the control group and VSS and VAS pain and pruritus for the ESWT group. Nonetheless the results failed to show statistically significant differences between the ESWT and the control group neither at two weeks after treatment nor at 5 months after treatment. CONCLUSION: Our study questions the relevance of ESWT as adjunctive treatment for burn scars as far as outward appearance, pain and pruritus as end-results are concern. Nonetheless, further studies are required to accurately assess the potential benefits of ESWT as an adjunctive treatment for burn scars.

Changes in the epidemiologic profile of burn patients during the lockdown in Catalonia (Spain): A warning call to strengthen prevention strategies in our community.

BACKGROUND: The worldwide coronavirus disease 2019 (COVID-19) epidemic, caused by the SARS-CoV-2 coronavirus, is the defining global health crisis of our time. Spain has had one of the highest burdens of COVID-19 worldwide. During this period, Vall d'Hebron University Hospital Burn Center (Barcelona) has faced a unique challenge: supporting the hospital response against COVID whilst continued offering an optimal care to the burn patient. OBJECTIVE: The aim of this study is to characterize the clinical and epidemiological characteristics of acute burn patients who received urgent health care or admission to the our Burn Center during the mandatory confinement period in Spain forced by the COVID-19 epidemic. METHODS: We analyzed the medical records of burn patients who received urgent care and/or admission to our Burn Center during the mandatory confinement period in Spain (Period 1: from March 14th to May 9th, 2020) and during the same period of the last year (Period 2: from March 14th to May 9th, 2019). Both groups were compared in order to find differences in the epidemiologic profile of burned patients. RESULTS: A total of 350 burns cases were analyzed. A 36% reduction in the number of emergency department visits was identified during Period 1. However, we found an increase in the rate of hospital admissions in Period 1 (20% of the burn cases) compared with Period 2 (13% of the burn cases). Seventy-six burn-related primary admissions were analyzed: 37 patients were admitted during Period 1 and 39 patients during Period 2. No differences were found between the two periods in the proportion of patients that underwent surgical treatment: 59.5% of patients admitted during Period 1 and 61.5% of patients admitted during Period 2. A statistically significant increase was noted in the rate of paediatric (aged 0-16 years old) admissions during Period 1 (40.54%, n = 15) compared to Period 2 (20.5%, n = 8). Among paediatric patients, an increase in the rate of surgical procedures was noted in Period 1 (47% of children), compared with Period 2 (37% of children). Proportion of patients that were admitted to the Intensive Care Unit was higher among burn children admitted during period 1 (46.7%, n = 7) than those admitted during Period 2 (25%, n = 2). Among the 37 patients admitted during the lockdown period, two positive COVID-19 patients were confirmed. CONCLUSIONS: This study gives an overview of the clinical and epidemiologic profile of burned patients during the stringent lockdown in Spain forced by the COVID-19 epidemic. Our data shows a stable trend in the number of burn-related admissions and burn related-surgeries during the confinement period. A significant increase in the rate of burn children admitted and an increase in the severity of injuries in this population is noted. These data must be taken in account in the development of strategies to ensure the maintenance of Burn Centers function in extremely situations such as the current epidemic. A lack of effective burn prevention campaigns in our environment has been noted and the development of focused prevention strategies is a priority.

Response of a single European burn center to Centelles mass casualty burn disaster: enzymatic debridement utility.

INTRODUCTION: Mass burn casualty disasters present with a big challenge due to the complex multidisciplinary management of severely burned patients and the limited capacity of the specialized centers. Literature is scarce, and so is the management of these disasters with enzymatic debridement (ED). METHODS: Retrospective observational analysis of nine patients admitted to the Vall d'Hebron University Hospital Burn Center (Barcelona, Spain), as a consequence of a bell tower explosion on December 30, 2019. The patients with intermediate-deep second-degree burns, either in circumferential or affecting highly functional areas as hands, feet or face, were included in the ED group. Continuous variables are expressed as mode and standard deviation and quantitative ones as percentages. RESULTS: Fourteen people were injured after the explosion of gunpowder-containing bags in a bell tower during a cultural celebration. Nine casualties (6 men and 3 women) suffered burn injuries that required assessment and admission in our Burn Center. The mean age was 44.33 years (range 19-61 years), with burns covering a mean total body surface area (TBSA) of 15% (range 5-48% TBSA). One patient required invasive mechanical ventilation and intensive care management. Seven patients required ED, with an average debrided TBSA of 6.1% (range 3-10% TBSA). Seven out of 9 patients required at least one surgery. The average hospital stay was 23.33 days (range 2-53 days). No escharotomy was required and no patient died. CONCLUSIONS: This experience brought out the weak and strong features of our center when facing a situation that implies an important care stress. It can be useful for other Burn Centers in similar situations in the future. We found that new tools, such as ED, can be advantageous in such situations.

Severely damaged lower limb salvage in a critically ill burned patient. Lessons learned.

Lower limb salvage in severely injured burned patients with bone or tendon exposure may be a reconstructive challenge. In this cases, local or regional flaps and other more conservative therapies such as dermal substitutes and negative-pressure wound therapy are usually not available or are not good enough to solve the problem. In such situations, microsurgical reconstruction with distant flaps seems to be the best option, even though the particularities of the severe burn patient may decrease free flaps' success rate. We report the case of a patient with severe electrical injuries affecting 70% of the total body surface area who had full-thickness burns to the lower extremity with wide bone exposure and extensively drug-resistant Pseudomonas aeruginosa infection. We achieved limb salvation using rectus femoris muscle free flap plus lateral and medial gastrocnemius muscle flaps and soleus muscle flap, after two failed microsurgical coverture attempts and a long not useful periplus with conservative therapies such us negative-pressure wound therapy and dermal substitutes. After 3 years of follow-up, the patient can walk without aid, and he has recovered his social and employment situation prior to the accident.

Implementation and evaluation of telemedicine in burn care: Study of clinical safety and technical feasibility in a single burn center.

OBJECTIVE: The objective of this study is to review our experience in the implementation of an innovative Telemedicine Platform (the Teleburns Project) for the acute care of burned patients. METHODS: We developed and implemented a Teleburns Platform by the creation of a new medical software and hardware for High Definition medical videoconference, in order to assist distant burned patients. After the establishment of the system and revision of technical requirements, an internal validation of the project was done: we managed 40 consecutive burned patients via telemedicine videoconference within our own Center. Following the internal validation, a pilot test with the Verge de la Cinta Hospital (VCH) - located in Tortosa, 180km away from Barcelona - was conducted. A prospective review of 43 burn patients participating in tele-encounters was performed. The data collected were: patient and injury demographics, need for transfer to our hospital, need for surgical treatment, complications, readmissions and technical problems. RESULTS: No discrepancies were found between remote and face-to-face diagnosis and treatment during internal validation, obtaining a 100% reliability. No technical errors were reported. Concerning the pilot test with the VCH, 43 patients were assessed via telemedicine during a 48-month period. Mean age of the participants was 36.7 (0-85 years). The mean total burn surface area was 3.1% (range 0.5-15%). The more frequently affected areas were head and neck (27 patients) and hands (16 patients). As a result of the 43 televisits, 8 patients (18.6%) were immediately transferred to our Burn Center in Barcelona and 12 patients (27.9%) were asked to come a few days later, to be visited in our Day Care Unit. Thus 23 patients (53.5%) could avoid being transferred to the Burn Center. 5 of them were followed via Teleburns without complications and 17 patients were discharged after the first tele-encounter. All patients discharged presented an uneventful evolution and did not receive further care from our Burn Unit. Technical problems were reported in eleven occasions during this phase, none of which prevented completion of the visits. CONCLUSIONS: The use of Telemedicine for burn assessment can improve the accuracy of burn patients triage, resulting in enhanced resource utilization, time and cost saving for the health system and increased quality of care.

Aplicación de la Microcirugía en el tratamiento del paciente quemado eléctrico / Application of Microsurgery in the treatment of the electric burned patient

INTRODUCCIÓN Y OBJETIVO: La Microcirugía como técnica dentro de la Cirugía Plástica no puede faltar en cualquier unidad de quemados para garantizar el tratamiento completo de sus pacientes. Sobre todo en los quemados eléctricos que presentan lesiones muy graves con exposición de tejidos nobles en los que es la primera opción reconstructiva. El objetivo de este artículo es mostrar la experiencia de la Unidad de Quemados del Hospital Universitario Vall d'Hebron de Barcelona, España, en los últimos 10 años en el uso de la Microcirugía en el paciente quemado agudo de etiología eléctrica. MATERIAL Y MÉTODO: Revisión retrospectiva de 19 colgajos realizados entre enero de 2010 y agosto de 2019 en 15 pacientes con quemaduras eléctricas, recogiendo datos de sexo, edad, localización del defecto, superficie corporal quemada (SCQ), colgajo empleado, días hasta la cobertura, tipo de anastomosis arterial, número de venas usadas, supervivencia de los colgajos y complicaciones. RESULTADOS: Destaca que los 15 pacientes fueron varones, con edad media de 36.5 años; SCQ media del 19.5%; el colgajo más usado fue el ántero-lateral de muslo con 9 casos (47.37%), seguido por el de dorsal ancho con 4 casos (21.05%), el colgajo inguinal y el de músculo recto femoral con 2 casos cada uno (10.53% en cada caso) y el de perforante tóraco-dorsal y de fascia temporal superficial con 1 caso cada uno (5.26% en cada caso). La localización más frecuente fue en extremidades inferiores con 12 casos (63.16%), seguida por las extremidades superiores con 5 casos (26.31%) y la cabeza con 2 casos (10.53%). La cirugía de cobertura con el colgajo libre se realizó de media a los 24 días. La anastomosis arterial fue término-terminal en 15 casos (79%). La anastomosis venosa fue término-terminal siempre, anastomosando 2 venas en 5 casos (26.31%) y solo 1 en el resto (73.69%). Dos colgajos fracasaron por congestión venosa (10.53%) y 2 colgajos se complicaron por infección (10.53%). CONCLUSIONES: La reconstrucción de defectos complejos tras quemadura eléctrica es un reto por el escaso número de casos que se presentan y por la propia idiosincrasia de la injuria eléctrica y del paciente quemado. El desbridamiento correcto, la selección del vaso receptor y decidir el momento óptimo para la reconstrucción son los puntos más importantes a tener en cuenta. Por estos motivos consideramos que esta patología debe ser abordada en unidades de quemados multidisciplinares con personal altamente entrenado

BACKGROUND AND OBJECTIVE: Microsurgery as a technique in Plastic Surgery cannot miss any burn ut for complete treatmeent of their patientes. Especially in electric burns that have very serious lesions with exposure of noble tissues where Microsurgery is the first reconstructive option. The objective of this paper is to show the experience of the Burn Unit of the Vall d'Hebron University Hospital in Barcelona, Spain, over the last 10 years in the application of Microsurgery in the burned patient of electrical etiology. METHODS: A total of 19 flaps performed between January 2010 and August 2019 in patients with electrical burn injury were reviewed retrospectively. The data collected were sex, age, location of the defect, total burned surface area (TBSA), flap used, days until coverage, type of arterial anastomosis, number of veins used, flap survival and complications. RESULTS: It is noteworthy that all the 15 patients treated were male, with an average age of 36.5 years; average TBSA was 19.5%; the most frequently flap used was the antero-lateral thigh in 9 cases (47.37%), followed by the latissimus dorsi muscle in 4 cases (21.05%), the inguinal and the rectus femoris muscle in 2 cases each (10.53% in each case) and the thoraco-dorsal artery perforator and the superficial temporal fascia on 1 occasion each of them (5.26% in each case). The most frequent location was in the lower extremities in 12 cases (63.16%), followed by the upper extremities in 5 cases (26.31%) and the head in 2 cases (10.53%). On average, coverage surgery with the free flap was performed at 24 days. Arterial anastomosis was performed end-to-end in 15 cases (79%). The venous anastomosis was always end-to-end anastomosing 2 veins in 5 cases (26.31%) and only 1 in the rest (76.69%). Two flaps failed due to venous congestion (10.53%) and 2 flaps were complicated with infection (10.53%). CONCLUSIONS: The reconstruction of complex defects associated with an electrical burn has been, is a challenge for plastic surgeons because of the small number of cases that occur and, because of the idiosyncrasy of the electrical injury and the burned patient. A correct debridement, the selection of the recipient vessel and deciding the optimal time for reconstruction are the most important points to consider. For these reasons we believe that this pathology should be addressed in multidisciplinary burn units with highly trained personnel