Severe case of staphylococcal scalded skin syndrome in a 5-year-old child - case report.

Benign impetigo can progress into a potential fatal staphylococcal scalded skin syndrome (SSSS) if prompt diagnosis and correct therapy is not established rapidly. Local and systematic antibiotics as well as Lactulose are crucial in order to stop SSSS from progressing. Burns units should be involved when skin lesions are extensive.

[Estimation of burn injuries].

Estimation of acute burn injuries is known to be difficult, but a thorough and precise evaluation is essential in order to initiate relevant treatment. The initial estimation relates to the size, depth and localisation of the injury as well as a number of concomitant factors. This article reviews the literature concerning the initial evaluation of burns and highlights the areas, which most often cause difficulties. The initial treatment and the types of burn injuries needing referral to specialist care are summarized.

[Burn wounds caused by a hair-dryer].

Burn wounds (ambustio) in children are frequent and occur in about 5% of all children and in about half of these before the age of three. The majority of the burn wounds in children occur at home, most frequently in the kitchen or the bathroom. This case describes an accidental ambustio caused by a hair dryer in a 3-month-old baby. Hair-dryers have become widely used in drying soar baby buttoms. Therefore, professionals as well as parents should be better informed about the potential risks of using hair-dryers for this purpose.

Optimization of burn referrals.

INTRODUCTION: Correct estimation of the severity of burns is important to obtain the right treatment of the patient and to avoid over- and undertriage. In this study we aimed to assess how often the guidelines for referral of burn injured patients are met at the national burn centre (NBC), Denmark. METHODS: We included burn patients referred to the NBC in a three-months period. Patient records were systematically analyzed and compared with the national guidelines for referral of burn injured patients. RESULTS: A total of 97 burn injured patients were transferred for treatment at the NBC and the most common reason for referral was partial thickness burn exceeding 3% estimated area of burn (55% of the patients) while facial burns (32%) and inhalational injury (25%) were other common reasons. We found that 29 (30%) of the referrals were considered potentially unnecessary according to the guidelines. The overtriage was highest among patients suffering of burns due to scalding and these were mostly children below 2 years of age. CONCLUSION: An overtriage of referred burn injured patient was found and 30% of the referred patients were treated as outpatients. A telemedicine solution may be useful in the evaluation of burn injured patients before transfer.

[Correct treatment of frostbite]. / Korrekt behandling af forfrysninger.

Frostbite is rare in Denmark and is often associated with psychiatric conditions or drug- and alcohol abuse. It is seen regularly in countries with an arctic climate and tradition for outdoor activities such as skiing and climbing. The past winter in Denmark was long and cold, so we may see this phenomenon more frequently in the future. We report two cases from the winter 2009/2010 and summarize the pathophysiology and briefly present the treatment strategy.

Crusted scabies in the burned patient.

The objectives of this study were 1) to describe a case of crusted scabies (CS) in a burned patient, which was primarily undiagnosed and led to a nosocomial outbreak in the burn unit; 2) to analyze and discuss the difficulties in diagnosing and treating this subset of patients with burn injury; and 3) to design a treatment strategy for future patients. Case analysis and literature review were performed. The index patient had undiagnosed crusted scabies (sive Scabies norvegica) with the ensuing mite hyperinfestation when admitted to the department with minor acute dermal burns. Conservative healing and autograft healing were impaired because of the condition. Successful treatment of the burns was only accomplished secondarily to scabicide treatment. An outbreak of scabies among staff members indirectly led to diagnosis. CS is ubiquitous, and diagnosis may be difficult. This is the first report of a burned patient with CS in the English language literature. CS is also highly contagious and may lead to a nosocomial outbreak. Furthermore, CS seems to have a detrimental impact on the burned patient's course of treatment. A scabicide treatment is necessary to guarantee successful treatment of the burns.

Fractional nonablative 1540 nm laser resurfacing for thermal burn scars: a randomized controlled trial.

BACKGROUND AND OBJECTIVE: Burn scars cause permanent and disfiguring problems for many patients and limited treatments are available. Nonablative fractional lasers induce a wound healing response, which may lead to remodeling of burn scar texture. This randomized trial evaluates efficacy and adverse effects of 1540 nm fractional laser versus untreated control for burn scars. MATERIALS AND METHODS: Seventeen adult patients with burn scars of 1 year or older and Fitzpatrick skin types I-III were included in the study. Side-by-side test areas were randomized to (i) three monthly 1540 nm fractional laser treatments and (ii) no treatment. Blinded on-site response evaluations were performed 4 and 12 weeks after final treatment. Primary endpoints were change in skin texture (0-10 categorical scale), pain and adverse effects. Secondary endpoints were change in skin color and patient satisfaction (0-10 categorical scales). RESULTS: Preoperative skin texture was similar and moderately uneven in treated and untreated sites (6 (5.5-8), P = 1). Postoperative laser-treated skin appeared significantly more even and smooth compared to adjacent untreated control sides (4 weeks: 4 (2.5-6), P = 0.0015; 12 weeks: 4 (2-5), P = 0.0007). Patients were satisfied with treatments (week 12: 7 (4-8.5)) and 8/17 patients evaluated burn scars to be moderately or significantly improved. Skin redness increased transiently from laser treatments. No significant differences were found in skin pigmentation. Patients experienced moderate pain (5 (3.5-6)), erythema (17/17/16 patients, after first/second/third treatments), edema (9/9/8), bullae (3/0/3), and crusts (4/0/4). One patient had minor scarring. No adverse effects were seen in untreated control areas. CONCLUSIONS: Nonablative 1540 nm fractional laser improves burn scar texture, which raises a new potential for future burn scar treatment.

Recombinant FVIIa decreases perioperative blood transfusion requirement in burn patients undergoing excision and skin grafting--results of a single centre pilot study.

BACKGROUND: Excision of burn wounds is frequently associated with a large volume of blood loss requiring allogeneic blood transfusion. We conducted a pilot study to investigate the effect of activated recombinant coagulation factor VII (rFVIIa) on the reduction of blood transfusion requirements in burn patients undergoing excision and skin grafting. METHODS: Eighteen consecutive patients scheduled for the surgery were randomised to receive either placebo or 40 microg/kg rFVIIa administered at first skin incision, and a second dose (40 microg/kg) at 90 min later. Blood transfusion requirements during, and up to 24h post-surgery per patient and percentage full thickness wound excised were compared. In addition, postoperative complications commonly seen in patients with burns as well as adverse events related to rFVIIa were monitored. RESULTS: rFVIIa significantly decreased the total number of units of blood components transfused per patient and percentage full thickness burn wound excised compared with placebo (0.9 versus 2.2, p=0.0013) including significant fewer red blood cell units (0.5 versus 1.1, p=0.004). We further observed a trend towards improved graft survival (p=0.1) and a reduction in multiple organ failures (p=0.08) in the rFVIIa-treated group. There were no adverse events, in particular thromboembolic events. CONCLUSION: rFVIIa might be useful in decreasing blood transfusion requirements in burn patients undergoing excision and skin grafting.

Guidelines for the management of partial-thickness burns in a general hospital or community setting--recommendations of a European working party.

Most partial-thickness burns in Europe and the United States are managed by non-burns specialists who do not treat burns on a regular basis. To achieve better patient outcomes, partial-thickness burns should be properly managed in non-specialist centres and referred to burn units when appropriate. Although some guidelines have been published to assist non-specialists, few have attempted to provide a comprehensive step-by-step guidance emphasising wound-healing principles. A working party of European burn specialists devised a new treatment algorithm to provide clear and current guidance on the management of partial-thickness burns in the general hospital and community setting. Four areas were identified for improvement: diagnosis and referral, wound preparation, wound covering and post-wound care. The guidelines take into account the role of wound dressings, infection and general patient well-being, bearing in mind the different working environments that occur across Europe. They are aimed at improving the overall outcome for community-treated patients within the expanding European Union and reducing the number of preventable late referrals to specialists.

[Intraoperative burns. An unforeseen danger?]. / Intraoperative forbraendinger. En overset fare?

Two patients were admitted to the department of burns in Copenhagen. Both had suffered burns following uncontrolled ignition of chlorhexidine-alcohol during surgery. The aim of this article is to highlight this potentially detrimental risk, which exists in almost all operating rooms, unless simple precautions are taken.