Comparative Study of Frozen and Permanent Section for Diagnosis of Toxic Epidermal Necrolysis.

Toxic epidermal necrolysis (TEN) is a severe, life-threatening mucocutaneous reaction, causing widespread sloughing of skin and mucosal surfaces. Accurate and prompt diagnosis is essential for optimal management and subsequent outcome. In this study, frozen sections were used as a rapid examination for initial diagnosis of TEN, and the frozen section diagnoses were assessed compared with permanent sections. One hundred patients of suspected TEN were referred to our burn unit, and 67 had sufficient clinical findings for frozen and permanent biopsies. The accuracy of frozen section relative to permanent section was evaluated by calculating diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. And McNemar's tests were used to analyze the difference between the two methods. Fifty-two specimens were classified as TEN by frozen section, 51 of which were confirmed by permanent biopsy. The exception was diagnosed as bullous pemphigoid on permanent section. Fifteen specimens were read as negative for TEN on frozen slides but four were changed to positive by permanent biopsy. Overall, the diagnostic accuracy of frozen section was 92.5%, with sensitivity and specificity 92.7% and 91.7%, respectively. The positive predictive value, or coherence of positive diagnosis between the two methods, was as high as 98.1%, and the negative predictive value was 73.3%. The P value of McNemar's tests was .375, indicating there was no significant difference between the two biopsy methods. The data suggest that as a rapid histological assessment, frozen section is a reliable tool in the early diagnosis of TEN.

The Role of Practice Diversification in the Growth of a Burn Center Network.

Practices within the Burn and Reconstructive Centers of America network have been organized to provide immediate and secondary reconstructive plastic surgery to burn patients. These reconstructive surgery abilities have been further engaged to expand these practices with non-burn-related surgical cases.Seven Burn and Reconstructive Centers of America practices were analyzed to quantitate the effects of nonburn reconstructive cases on practice growth over a 4-year period (2015-2018).All surgical cases were performed during the study period and were analyzed to identify burn-related procedures and procedures not related to burn injuries. Fifty-two percent of the cases were burn-related, whereas 48% were not burn-related. Over the 4-year period, burn cases increased by 46%, whereas nonburn cases increased by 84%. The overall percentage of nonburn cases increased from 43% in 2015 to 50% and 49% in 2017 and 2018.Nonburn cases contributed effectively to practice growth over this period. This practice model successfully engages broad reconstructive surgery skill sets to expand practice volumes.

Practice Site Contributions to the Overall Growth of a Burn Care Network.

Beginning in 2009, The Joseph M. Still Burn Center in Augusta, Georgia began to develop additional practice sites. By 2018, 6 burn centers had been established and the practice network had been organized as the Burn and Reconstructive Centers of America.Between 2015 and 2017, the entire network had 2 consecutive years of increasing burn admissions of +21% and +20%. The proportion of burn admissions managed by the additional sites grew from 37% to 47% during the same period. All practice sites, including the Augusta center, demonstrated sustained net growth of burn admissions.These data show that this practice development plan has achieved substantial growth in burn admissions throughout the practice, with the newly developed sites contributing disproportionately to overall network practice growth. These findings also suggest that the development of new sites could affect burn center accessibility and utilization for burn patients in these areas.

Evolution of a Burn Care Network.

INTRODUCTION: A private burn center started in Augusta, GA, in 1978 has expanded into a burn care network of 7 comprehensive burn centers. We have analyzed 2 years of admissions to this network to assess growth and the network's level of participation in national burn care. MATERIALS AND METHODS: Total admissions to the network were quantified for years 2015 and 2016. Growth during that 2-year period was calculated, and the network's admissions were evaluated as a percentage of national burn admissions. RESULTS: Total admission for 2015 came from 4713 patients; 5683 patients were admitted in 2016. These totals demonstrated a 15% increase. The 2-year total of 10,217 admissions represented 21% of the 46,892 burn admissions in the United States for that period. CONCLUSIONS: This network has achieved a large capacity for burn admission and currently accounts for 21% of US burn admissions. The network has capacity for continued growth and the development of clinical innovations and research.

Burn-related peripheral neuropathy: A systematic review.

Peripheral neuropathy is the most frequent disabling neuromuscular complication of burns. However, the insidious and progressive onset of burn neuropathy makes it often undiagnosed or overlooked. In our study, we reviewed the current studies on the burn-related peripheral neuropathy to summarize the morbidity, mechanism, detecting method and management of peripheral neuropathy in burn patients. Of the 1533 burn patients included in our study, 98 cases (6.39%) were presented with peripheral neuropathy. Thermal and electrical burns were the most common etiologies. Surgical procedures, especially nerve decompression, showed good effect on functional recovery of both acute and delayed peripheral neuropathy in burn patients. It is noteworthy that, for early detection and prevention of peripheral neuropathy, electrodiagnostic examinations should be performed on burn patients independent of symptoms. Still, the underlying mechanisms of burn-related peripheral neuropathy remain to be clarified.

Surgical Decompression in the Treatment of Diabetic Peripheral Neuropathy: A Systematic Review and Meta-analysis.

Background Over the last decade, surgical decompression procedures have been commonly used in the treatment of diabetic peripheral neuropathy. However, the effectiveness of them remains to be proved. Methods A comprehensive literature search of databases including PubMed-Medline, Ovid-EMBASE, and Cochrane Library was performed to collect the related literatures. The Medical Subject Headings used were "diabetic neuropathy," "surgical decompression," and "outcomes." The methodological index for nonrandomized studies was adopted for assessing the studies included in this review. Analyses were performed with Review Manager (Version 5.3, Copenhagen: The Nordic Cochrane Centre, the Cochrane Collaboration, 2014). Results A total of 12 literatures (including 8 prospective and 4 retrospective) encompassing 1,825 patients with DPN were included in the final analysis. Only one literature was identified as a randomized controlled trial. The remaining 11 literatures were observational studies; 7 of them were classified as upper-extremity nerve decompression group and 4 of them were classified as lower-extremity nerve decompression group. Meta-analysis shows that Boston questionnaire symptom severity and functional status of upper extremities, and distal motor latency and sensory conduction velocity of median nerve of DPN patients are significantly improved after carpal tunnel release. Besides, visual analog scale and two-point discrimination are considered clinically and statistically significant in lower extremities after operation. Conclusions The findings from our review have shown the efficacy of surgical decompression procedures in relieving the neurologic symptoms and restoring the sensory deficits in DPN patients. As there are few high-quality randomized controlled trials or well-designed prospective studies, more data are needed to elucidate the role of surgical procedures for DPN treatment in the future.

Thromboembolic complications in burn patients and associated risk factors.

Early mobilization and deep venous thrombosis (DVT) prophylaxis have been shown to reduce the incidence of DVT and pulmonary embolism among hospitalized patients, yet thromboembolic complications remain a great concern, especially to those who remain immobilized for an extended period of time. There are many risk factors associated with the development of thromboembolism, especially DVT. The main objective of this retrospective study is to estimate the occurrence of DVT in burn patients and to investigate some burn-related risk factors. A retrospective examination of DVT cases was conducted among the acute burn patients admitted to our Regional Burn Center during 2008. The analysis included the demographic factors, preexisting medical conditions, ventilator support, number of surgeries and blood transfusions, and use of central line. There was a total of 97 diagnosed patients with DVT and among them 86 were adult acute burn patients. There were 113 diagnosed with DVTs in 86 burn patients, including 22 patients diagnosed with DVT at multiple sites either in one screening or in subsequent screenings. Incidence of DVT at the center was 5.92 per 100 adult acute burn admissions. Men had more DVT than women (6.87 vs. 3.34%, relative risk 2.05, P < .05). The average percentage of %TBSA was smaller in the patients who were more than 50 years of age compared with the patients who were 49 years or younger (21.97 vs. 34.77%, P < .05). Among the patients with DVT, 80 (93%) had a central venous catheter before DVT developed and the other six never had a central venous catheter. The most common site for DVT development was common femoral vein site 89%. The average number of procedures before DVT was 7.84 ± 8.36, and blood transfusions were 39.55 ± 108.37 units. Six patients (7%) died in the hospital within these study cohorts and there was no indication that pulmonary embolism was the cause of the deaths. The study showed that the incidence of DVT in the burn center was comparable with the incidences reported in the literature. Being of male sex, a smoker, an alcoholic, high-age group, high %TBSA, use of central line, increased number of surgeries, and increased number of blood transfusions are identified as possible predisposing factors for DVTs. Further meaningful evaluation to determine the incidence of DVT in burn patients and its associated risk factors will require large multicenter, well-controlled, prospective designed study.

An open, parallel, randomized, comparative, multicenter study to evaluate the cost-effectiveness, performance, tolerance, and safety of a silver-containing soft silicone foam dressing (intervention) vs silver sulfadiazine cream.

An open, parallel, randomized, comparative, multicenter study was implemented to evaluate the cost-effectiveness, performance, tolerance, and safety of a silver-containing soft silicone foam dressing (Mepilex Ag) vs silver sulfadiazine cream (control) in the treatment of partial-thickness thermal burns. Individuals aged 5 years and older with partial-thickness thermal burns (2.5-20% BSA) were randomized into two groups and treated with the trial products for 21 days or until healed, whichever occurred first. Data were obtained and analyzed on cost (direct and indirect), healing rates, pain, comfort, ease of product use, and adverse events. A total of 101 subjects were recruited. There were no significant differences in burn area profiles within the groups. The cost of dressing-related analgesia was lower in the intervention group (P = .03) as was the cost of background analgesia (P = .07). The mean total cost of treatment was $309 vs $513 in the control (P < .001). The average cost-effectiveness per treatment regime was $381 lower in the intervention product, producing an incremental cost-effectiveness ratio of $1688 in favor of the soft silicone foam dressing. Mean healing rates were 71.7 vs 60.8% at final visit, and the number of dressing changes were 2.2 vs 12.4 in the treatment and control groups, respectively. Subjects reported significantly less pain at application (P = .02) and during wear (P = .048) of the Mepilex Ag dressing in the acute stages of wound healing. Clinicians reported the intervention dressing was significantly easier to use (P = .03) and flexible (P = .04). Both treatments were well tolerated; however, the total incidence of adverse events was higher in the control group. The silver-containing soft silicone foam dressing was as effective in the treatment of patients as the standard care (silver sulfadiazine). In addition, the group of patients treated with the soft silicone foam dressing demonstrated decreased pain and lower costs associated with treatment.