Effect of burn sites (upper and lower body parts) and gender on extensive burns' mortality.

Our recent literature survey indicated a lack of clinical assessment of the influence of gender and site of burn injury on the outcome of patients with extensive burns. This report examines the effect of burn sites and gender on extensive burns' mortality. Data was gathered from 283 patients with burns larger than 65% of the total body surface area (TBSA) above the belt line or below the belt line; and without underlying diseases and inhalation burn injury. Patients were classified according to gender, site of injury (upper and lower body parts) and hospital stay period. Mortality rates of each category were then compared with each other. The hospital stay period in the female group was significantly higher compared with the male group (P<0.001) and the mortality rate among the female patients was higher compared with the male patients (P=0.004). Although the mortality rate in lower body part of the male group was significantly higher in comparison with the upper body part burn (P=0.001), there was no difference in mortality rate of upper versus lower body part in the female group. The mortality rate was generally higher among the female patients. Additionally, higher mortality rate was observed among male patients with lower body part burn compared with injuries of male patients with upper body part burn.

Metabolic effects of tourniquet application in burn patients.

BACKGROUND: Despite several studies investigating the pathophysiologic effects of tourniquet usage in extremity surgeries, there are not enough data about these effects in adhesion release surgeries of burn patients. In the light of numerous metabolic changes of burn tissues, we tried to determine whether there are any significant differences in metabolic responses of burn tissues to tourniquet ischemia in comparison to the findings of other studies in non burn tissue responses during tourniquet usage in extremity surgeries. METHODS: From March 2009 to April 2011, eighteen patients who were candidates for performing upper extremity adhesion release surgeries were enrolled. Patients with renal, hepatic, metabolic and any other underlying diseases were excluded from the study. Blood samples for determination of pH, pCO2 and HCO3 were obtained from the occluded hand (as the local response indicator of the body to ischemia) and the other hand too (as the systemic response indicator). The time for blood sampling was just before tourniquet inflation, 30 seconds, one minute, three minutes and five minutes after cuff inflation. RESULTS: Thirty seconds after tourniquet release, a rapid decrease was noticed in pH values (7.38±0.04-->7.21±0.08). This decrease was seen after 60s in the opposite hand (7.38±0.04-->7.27±0.01) and returned to the baseline values after 5 minutes in both hands. The blood PCO2 value in the occluded hand was found to be increased 30s after tourniquet release (34.93±3.96-->50.06±11.78), while this increase was seen after 180s in the opposite hand too (34.93±3.96-->38.98±9.21). HCO3 value increased after 30s (19.79±2.31-->20.62±2.37) in the occluded hand, but this increase was visible after 60s in the opposite hand. We found no significant difference in the response of burn patients to tourniquet ischemia in comparison to non-burn patients. CONCLUSION: There was no extra risk in the application of tourniquet in extremity surgeries of burn patients in comparison to non-burn patients. So current protocols of tourniquet application in non-burn patients can be used for adhesion release surgeries in burn patients without any extra caution.

Efficacy of debridement and wound cleansing with 2% hydrogen peroxide on graft take in the chronic-colonized burn wounds; a randomized controlled clinical trial.

BACKGROUND: Severe burns are associated with dramatic outcomes which are potentially detrimental. Nowadays the standard treatment for deep partial thickness and full-thickness burn is early excision and grafting, which is not always feasible this leads to chronicity and microbial colonization of burn wounds. Interesting properties of hydrogen peroxide 2% soaked gauze convinced us to use it in management of chronic burn wounds. METHODS: From January 2009 to September 2011, in a prospective clinical trial, 49 patients (98 limbs) with chronic-colonized burn wounds in both limbs were included in this study. Tissue cultures were taken from all the wounds. For the right, after debridement of granulation tissue and washing with hydrogen peroxide 2% soaked gauze for 5min followed by normal saline irrigation, grafting was done; debridement and skin grafting was performed in the conventional method in left limb wounds. The success rate of graft take was compared between two groups, after 21 days by the surgeon using the formula: Graft take surface area (cm2) x 100%/Total grafted area (cm2). RESULTS: The study group was composed of 98 limbs in 49 patients with mean age of 26.44±5.66 and burn in 28.3±7.23% TBSA. The most common causes of the burn wounds chronicity was delayed admission associated with poor compliance. (44.8%) Staphylococcus was the most frequent isolate bacterial wounds colonization in our patients. (59.2%) Mean graft take was 82.85% in right limbs, and 65.61% in left limbs; which was significantly different (P<0.05). CONCLUSIONS: Our study showed that, administration of hydrogen peroxide intraoperatively appears to be safe and significantly increases the mean success rate graft take in chronic-colonized wounds. Therefore, it can be recommended in management of chronic burn wounds management.

Surgical excision followed by low dose rate radiotherapy in the management of resistant keloids.

BACKGROUND: Depending on the cause, 40-90% of every deep dermis insult ends up in scar formation. Several modalities have been suggested as a treatment but a high rate of recurrence is reported in most of those interventions. High dose radiotherapy has been shown to be effective in reducing the recurrence rate. This study tried to determine the effectiveness of low dose rate radiotherapy following surgical excision in treating resistant keloids. METHODS: Between January 2008 and April 2011, seventeen patients (mostly burn patients) with 26 keloids went through surgical resection followed by radiotherapy. A total dose of 15 Gy in 5 fractions was administered to the areas of scar formation. RESULTS: All patients were followed for at least 11 months (mostly for 20 months). No recurrence occurred. There was no complication or adverse effect. CONCLUSION: Surgical excision followed by low dose postoperative radiotherapy was an efficient treatment for keloids that were resistant to many other modalities.