The Use of an Autologous Cell Harvesting and Processing Device to Decrease Surgical Procedures and Expedite Healing in Two Pediatric Burn Patients.

INTRODUCTION: Autologous cell harvesting and processing devices are designed to facilitate the harvesting of cells using enzymatic and physical disruption techniques to immediately apply non-cultured autologous cell suspension (ACS) to the wound area. OBJECTIVE: This case report evaluates clinical outcomes following application of cellular suspension with split-thickness skin grafts (STSGs) as an adjunct for definitive closure of burn injuries and donor sites in 2 pediatric patients. MATERIALS AND METHODS: The cases were performed under a humanitarian use protocol following institutional review board approval at St. Christopher's Hospital for Children (Philadelphia, PA). RESULTS: The first patient was a 4-year-old girl with partial- and full-thickness (32% total body surface area) burn injuries of her head, trunk, flank, arms, thighs, and feet. The patient was discharged 19 days following ACS treatment. The second patient was an 18-month-old girl with partial- and full-thickness (21% total body surface area) burns involving the bilateral lower extremities. She was discharged 22 days after ACS treatment with widely meshed autograft. Neither patient required additional surgical interventions. All treatment and donor areas for both patients remained uninfected and neither patient experienced any unexpected treatment-related adverse events. CONCLUSIONS: These cases are the first of their kind reported in the pediatric population and suggest ACS in conjunction with STSGs can help decrease surgical procedures and expedite healing in pediatric patients with large surface burns.

Usefulness of Pelvic Radiographs in the Initial Trauma Evaluation with Concurrent CT: Is Additional Radiation Exposure Necessary?

Trauma patients in a Level I Pediatric Trauma Center may undergo CT of the abdomen and pelvis with concurrent radiograph during initial evaluation in an attempt to diagnose injury. To determine if plain digital radiograph of the pelvis adds additional information in the initial trauma evaluation when CT of the abdomen and pelvis is also performed, trauma patients who presented to an urban Level I Pediatric Trauma Center between 1 January 2010 and 7 February 2017 in whom pelvic radiograph and CT of the abdomen and pelvis were performed within 24 hours of each other were analyzed. A total of 172 trauma patients had pelvic radiograph and CT exams performed within 24 hours of each other. There were 12 cases in which the radiograph missed pelvic fractures seen on CT and 2 cases in which the radiograph suspected a fracture that was not present on subsequent CT. Furthermore, fractures in the pelvis were missed on pelvic radiographs in 12 of 35 cases identified on CT. Sensitivity of pelvic radiograph in detecting fractures seen on CT was 65.7% with a 95% confidence interval of 47.79-80.87%. Results suggest that there is no added diagnostic information gained from a pelvic radiograph when concurrent CT is also obtained, a practice which exposes the pediatric trauma patient to unnecessary radiation.

Flame time of a cigarette lighter to achieve temperature capable of inflicting a burn.

OBJECTIVE: Cigarette lighters are frequent vectors in intentional contact burns. Time and temperature needed to cause thermal injury are considered to differentiate accidental from inflicted burns. This study examines the minimum time needed to heat a cigarette lighter's top to temperatures capable of inflicting any clinically visible skin burn. This information could be useful in child abuse and other forensic cases. METHODS: A literature search was performed to establish the time and temperature at which partial/full thickness skin burns are acquired, regardless of vector. Using a thermocouple, the temperature of the top of two common lighters was measured at ten second intervals while sustaining maximal flame held both upright and sideways and during cooling once the flame was extinguished. RESULTS: In the literature, the lowest temperatures documented to cause burns in one second were 69°C-70°C for transepidermal or partial thickness burns. From an ambient temperature prior to flame ignition, it took over 50s for the lighter tops to reach 60°C when held upright. After 180s, the lighters were shut off. It then took less than 60s for the lighters to cool to less than 60°C. The BIC lighter held to the side heated to 60°C in about 15s and needed over 100s to cool to under 60°C. CONCLUSIONS: Cigarette lighter burns are often blamed on non-intentional occurrences. At least 50s of sustained flame is needed to heat typical cigarette lighter tops to temperatures capable of inflicting clinically visible skin burns. This time is longer than the time required to light a cigarette. Therefore, for a cigarette lighter to inflict a contact burn injury, there needs to be intent and preparation, making accidental cigarette lighter burns unlikely.