Thermal injury patterns associated with electronic cigarettes.

E-cigarettes are typically lithium-ion battery-operated devices that simulate smoking by heating a nicotine-solution into a vapor that the user inhales. E-cigarette use is becoming rapidly popular as an alternative to traditional cigarette smoking. This report describes an emerging problem associated with e-cigarettes, consisting of 10 thermally injured patients seen at a single burn center over a 2-year period from 2014 to 2016. Our cohort was comprised mainly of young adults who sustained mixed partial and full thickness burns as a result of e-cigarette-related explosions. In many documented scenarios, a malfunctioning or over-heated battery is the cause. Our data support the need for increased awareness among healthcare providers and the general public of the potential harms of e-cigarette use, modification, storage, and charging.

Silver-coated nylon dressing plus active DC microcurrent for healing of autogenous skin donor sites.

INTRODUCTION: Burn wounds are a significant cause of morbidity and mortality, and improved outcomes are demonstrated with early closure of both primary burn wounds and skin donor sites. Thus, technology that decreases the healing time of burns and donor sites would be potentially lifesaving. We present the results of a single-center, prospective, double-blinded, randomized controlled trial to evaluate the efficacy of silver-coated dressing with active microcurrent in comparison to silver-coated dressing with sham microcurrent on wound-closure time for autogenous skin donor sites. METHODS: Four hundred five patients were screened for treatment of their donor sites using a silver-coated nylon dressing with either sham or active microcurrent stimulation. Thirty patients were enrolled in the study and then randomized. Of these, 5 patients were removed from analysis due to protocol deviations. Differences in time-to-closure were analyzed using Kaplan-Meier analysis and the proportional hazard regression model. Subjective verbal pain rating scores (0-10; 0, no pain; 10, worst pain) were also recorded. All devices were blinded and programmed at an outside facility, so that every patient had either an active or sham device. The study was unblinded only after the final patient's donor site had healed. All patients achieved donor-site healing before postoperative day 20. The 14 patients in the active microcurrent group [mean, 10.8 (2.9) days; range, 7-15 days] experienced no difference in time to wound healing as compared to the remaining patients in the sham microcurrent group [mean, 11.1 (2.0) days; range, 8-14 days; P = 0.75]. There were no differences in pain from one group compared to the other. None of the donor sites exhibited clinical signs of infection. CONCLUSIONS: In a sample size of 25 burn patients, the addition of direct microcurrent to silver-nylon dressings did not decrease time to wound closure of skin donor sites, and it did not show a difference in reported pain levels.

Negative-pressure wound therapy: a hemostatic adjunct for control of coagulopathic hemorrhage in large soft tissue wounds.

BACKGROUND: Negative-pressure wound therapy has been commonly used for treating chronic wounds and recently applied for treatment of traumatic wounds. We investigated the potential hemostatic benefit of negative-pressure wound therapy for control of refractory hemorrhage in a soft tissue wound model in swine. METHODS: Coagulopathy was induced in pigs (n = 38, 36 kg) by hemodilution and hypothermia. Next, a large soft tissue wound (diameter, approximately 20 cm) was created by slicing the gluteus maximus muscle. Free bleeding was allowed for 1 minute, and wounds were then randomly dressed with either laparotomy gauze (G) alone or TraumaPad (TP, a kaolin-coated dressing) alone or in combination with negative pressure (NP, approximately -500 mm Hg). All wounds were sealed with adhesive drapes. Fluid resuscitation was administered and targeted to mean arterial pressure of 60 mm Hg. Pigs were observed for 150 minutes or until death after which tissues were sampled for histologic examination. RESULTS: Induced coagulopathy as measured by increases in prothrombin time (12%) and activated partial thromboplastin time (22%) and decreases in fibrinogen (48%) were similar in all groups. There were no differences in initial bleeding rates (4.5 mL/kg/min). Dressing the wounds with G or TP produced hemostasis only in one pig (1 of 18 pigs). Addition of NP to these dressings secured hemostasis in 70% (G) and 90% (TP) of animals with average hemostasis time of 34 minutes and 25 minutes, respectively. Blood losses and fluid resuscitation requirements were significantly less, and survival times were significantly longer in NP adjunct groups than in the other groups. Survival rates were 80% (G+NP) and 90% (TP+NP) versus 0% (G) and 10% (TP) in the respective groups. Histologic examination showed similar superficial myofibril damages in all groups. CONCLUSION: To our knowledge, the present data provide the first evidence that NP serves as an effective hemostatic adjunct and when combined with standard hemostatic dressing it is able to stop lethal coagulopathic bleeding in large soft tissue wounds.