Preoperative Blood Loss Prediction Formulas in Burn Surgeries: A Review.

Extensive burn surgeries lead to a considerable amount of blood loss. Predicting preoperative blood loss is essential for blood ordering and cross-matching. Accurate amount of ordered blood units ensures patients' safety and minimizes cost. However, blood loss estimation is complicated due to a variety of factors influencing blood loss, including patient and operative-related variables. Currently, no standard method to predict blood loss exists prior to surgery. Our goal is to review factors influencing blood loss and formulas that can predict blood loss. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE databases for studies investigating blood loss in burn surgeries with a clear quantitative outcome. Fifteen studies were included, comprising 1613 subjects. All studies calculated blood loss and assessed possible related factors, and four studies proposed preoperative blood loss prediction formulas. Larger areas of tissue excised and grafted, younger age, and delayed surgery were correlated with increased blood loss. Varying decrease in blood loss was observed with tumescent usage and other bleeding control methods. Other variables produced inconsistent results. From four prediction formulas, only one formula, Dye's Formula, had been applied and proven effective in reducing unused blood units clinically by up to 40% of cross-matched blood. Various confounding factors and dissimilarities between studies make reliable prediction method construction challenging. With consideration of diverse patient characteristics, some study develops formulas to achieve optimal patient care and avoid unnecessary hospital expenditure. Further research with consistent variables should be done to construct a standardized blood loss estimation formula.

Amnion bilayer for dressing and graft replacement for delayed grafting of full-thickness burns; A study in a rat model.

Burn is a common case in developing countries, with over half of fire-related deaths reported in Southeast Asia and full-thickness burns as a high mortality risk. Human amnion has been used as a wound dressing for centuries. In this study, a decellularised amnion overlaid with fibrin, "amnion bilayer (AB)," was used as a dressing immediately after burn and as a graft to replace the scar in Sprague-Dawley rats subjected to full-thickness burn model. The aim was to observe whether amnion bilayer can reduce damages in third-grade burn when skin replacement is deemed impossible. The burn was induced using an electrical solder, heated for 5 mins, and contacted on the rat's bare skin for 20 s. AB was applied as a (i) dressing immediately after induction and graft after eschar removal. Two groups (n = 6) were compared: AB and Sofra-Tulle ®, the National Hospital of Indonesia (NHI) protocol. Sections were stained with hematoxylin and eosin and Masson trichrome stains. Immunohistochemistry labelling was used to indicate scars (α-smooth muscle actin [α-SMA] and collagen-1) and angiogenesis (von Willebrand factor). Also, the macrophages inflammatory protein-3α (MIP-3α) indicates an early inflammatory process. The post dressing of the AB group demonstrated hair follicle remains and adipose tissue development. The NHI group appeared with a denatured matrix. Complete healing was seen in the AB group after 28 days with skin appendages similar to normal, while the NHI group showed no appendages in the centre of the actively inflamed area. The α-SMA was found in both groups. Collagen-1 was highly expressed in the NHI group, which led to a scar. Angiogenesis was found more in the AB group. The AB group had shown the capacity to accelerate complete healing and recover skin appendages better than the current protocol.

A Review of Skin Banking Guidelines and Standards Worldwide: Towards the Harmonization of Guidelines for Skin Banking in Therapeutic Applications for the Regions under the Asia Pacific Burn Association (APBA).

Currently, there are no harmonized guidelines which govern skin banking in the Asia Pacific region. Therefore, skin banks are either unregulated or rely on their nation's legislation or international accreditation to uphold their quality standards. A new set of skin banking guidelines was developed through a comprehensive review and collation of best international practices for the Asia Pacific Burn Association (APBA) members, from donor screening and testing, to skin recovery, processing, storage and distribution, and quality assurance. National regulatory requirements reviewed include the European directives, Australia's Therapeutic Goods Administration and Singapore's tissue banking standards. Further technical and quality management recommendations are referenced from the American Association of Tissue Banks (AATB), the United States Food and Drug Administration standards and guidance documents, various relevant European guides, Japanese Society of Tissue Transplantation guidelines and the Asia Pacific Association of Surgical Tissue Banking. Adapted mainly from the AATB standards, the new Asia Pacific Burn Association Guidelines for Skin Banking in Therapeutic Applications offer a comprehensive manual, addressing: governance and contracts; staff responsibilities; quality management; facilities, equipment and supplies management; donor consent and testing; and recommendations of good practices pertaining to skin recovery, processing, storage and distribution. Besides complementing current generic regulations, they provide technical specifications of major aspects unaddressed in most legislations. This inaugural set of new regional skin banking guidelines would be a start for regional members of the APBA to adopt, and will hopefully culminate in a set of standards so that, in the long run, skin allografts from this region can be of similar quality, which can simplify import process and facilitate the exchange of allografts between members.