ABSTRACT
In harvesting skin to cover the defect caused by a burn, a second wound is created, the donor site wound. We propose an alternative method to manage the donor site: taking a split-thickness skin graft (STSG) from a donor site adjacent to the burn wound to be treated, and meshing at a 3:1 ratio to cover both sites at once. The main objective of this study is to evaluate the effectiveness of covering both burn wound and adjacent donor site with the same STSG in elderly and bedridden patients. We retrospectively reviewed the medical records of 6 patients over 60 years old or/and bedridden presenting with a small burn wound who underwent STSG of both burn wound and adjacent donor site between April 2016 and November 2016 in the Department of Plastic Surgery and Burn Treatment at Percy Military Hospital (France). Their data were compared with data of five patients who had undergone the usual STSG procedure during the same period. There was a statistically significant difference between patients who underwent adjacent STSG procedure and those who underwent usual STSG procedure in healing time (days) mean (SD) (7,33 ± 1,03 vs. 16,2 ± 0,83; p = 0,007) and Numeric Rating Scale pain mean (SD) at day 2 (0,33 ± 0,33 vs. 2,4 ± 1,35; p = 0,04). Grafting both acute burn wound and adjacent donor site with the same graft seems to be an easy method to improve healing and minimize pain in the STSG donor site in elderly and bedridden patients.
Lors du prélèvement de peau mince pour couvrir une plaie causée par une brûlure, une seconde plaie est créée, le site donneur. Voici une méthode alternative pour la gestion du site donneur: prélever une greffe de peau mince GPM à partir d'un site donneur adjacent à la brûlure, l'expandre avec un ratio de 3:1 pour couvrir les deux sites à la fois. Ici l'objectif principal est d'évaluer l'efficacité de la couverture simultanée d'une petite brûlure et du site donneur adjacent avec la même GPM chez les patients âgés et alités. Nous avons étudié rétrospectivement les dossiers de 6 patients traités par couverture simultanée de la brûlure et du site donneur adjacent avec la même GPM entre avril 2016 et novembre 2016 dans le Service de Chirurgie Plastique de l'hôpital militaire Percy (France). Les données ont été comparées à un groupe similaire de patients qui ont subi une procédure habituelle durant la même période. Il y avait une différence statistiquement significative entre les patients qui ont subi une procédure de GPM du site donneur adjacent et ceux qui ont subi une procédure habituelle sur la durée (jours) moyenne (écart-type, SD) de cicatrisation (7,33 ± 1,03 vs 16,2 ± 0,83; p = 0,007) et de la douleur sur l'échelle numérique au jour 2 (0,33 ± 0,33 vs 2,4 ± 1,35; p = 0,04). Greffer la plaie liée à la brûlure aiguë et le site donneur adjacent avec une même GPM semble être une méthode simple pour améliorer la guérison et minimiser la douleur du site donneur.
ABSTRACT
Accidental burns in the operating room are hopefully rare events, but it could happen during any surgical procedure. To reduce the nosocomial infection, the use of alcohol-base products is recommended by all the recent guidelines. Yet these inflammables products represent a potential danger if they are not carefully employed, and the surgeon's responsibility can be involved. We therefore thought it would be interesting to show the benefit provided by such products in terms of wound infection and skin preparation. However, two recent cases of severe accidental burn illustrate the importance of precautions when using such products.
Subject(s)
Anti-Infective Agents , Burns/etiology , Burns/prevention & control , Intraoperative Complications/etiology , Intraoperative Complications/prevention & control , Povidone-Iodine , Cross Infection/prevention & control , Female , Humans , Iatrogenic Disease , Middle Aged , Operating Rooms , Practice Guidelines as Topic , Risk Factors , Young AdultSubject(s)
Burns/therapy , Skin, Artificial , Transplantation, Heterologous , Culture Techniques , Humans , Skin TransplantationSubject(s)
Burns/therapy , Patient Care Team , Acute Disease , Adolescent , Adult , Aged , Ambulatory Care , Burns/classification , Burns/etiology , Child , Child, Preschool , Humans , Infant , Middle AgedABSTRACT
OBJECTIVE: We report recent five-year experience in a large, single center series of severely burned and otherwise traumatized patients given cultured epithelial autografts (CEA) from a single commercial laboratory. SUMMARY BACKGROUND DATA: Initial optimism over CEA application has been tempered by subsequent reports asserting that this modality is unreliable and expensive. Discussion continues over its clinical role. METHODS: From 1991 to 1996, CEA were applied to a mean 37+/-17% of total body surface area (TBSA) of 30 patients. These patients had 78+/-10% average burn size, 65+/-16% average third-degree burn size, 90% prevalence of endoscopically confirmed inhalation injury and 37% prevalence of other serious conditions. RESULTS: CEA achieved permanent coverage of a mean 26+/-15% of TBSA, an area greater than that covered by conventional autografts (a mean 25+/-10% of TBSA). Survival was 90% in these severely burned and otherwise traumatized patients. Final CEA take was a mean 69+/-23%. In subset analyses, only younger age was significantly associated with better CEA take (p = 0.0001 in univariate analysis, p<0.04 in multivariate analysis, Student's t-test). CONCLUSIONS: Epicel CEA successfully provided extensive, permanent burn coverage in severely traumatized patients, proving an important adjunct to achievement of a high survival rate in a patient population whose prognosis previously had been poor. In our experience CEA appear to have a very high beneficial value in the management of bur ns >60% TBSA. In some cases studied it is very likely that CEA was a life-saving treatment.
