Evaluation of who oral rehydration solution (ORS) and salt tablets in resuscitating adult patients with burns covering more than 15% of total body surface area (TBSA).

Intra-venous (IV) burn resuscitation is effective; nevertheless it has its disadvantages. WHO Oral Rehydration Solution (ORS) has shown high effectiveness in treating dehydration. WHO-ORS, with salt supplement, seems to be suitable for burn resuscitation, where IV resuscitation is not available, feasible or possible. The objective of the study was to evaluate acute phase efficacy and safety, as well as limitations and complications of burn resuscitation using WHO-ORS and salt tablets. This randomized controlled clinical trial was conducted in the Burn Unit, Suez Canal University Hospital, Ismailia, Egypt. The study group was given WHO-ORS (15% of body weight/day) with one salt tablet (5gm) per liter according to Sørensen's formula. The control group was given IV fluids according to the Parkland formula. Patients' vital signs and urine output were monitored for 72 hours after starting resuscitation. Both groups were comparable regarding age, sex, and percentage, etiology and degree of burns. For all assessed parameters, there were no major significant differences between the study group (10 cases) and control group (20 cases). Even where there was a significant difference, apart from blood pressure in the first hour of the first day, the study group never crossed safe limits for pulse, systolic blood pressure, urine output, respiratory rate and conscious level. WHO-ORS with 5gm salt tablets, given according to Sørenson's formula, is a safe and efficient alternative for IV resuscitation. It could even be a substitute, particularly in low resource settings and fire disasters.

La réanimation hydro-électrolytique IV initiale des brûlés est efficace mais connaît des effets indésirables. La SRO de l'OMS a montré son efficacité dans le traitement des déshydratations. Cette solution, supplémentée en sel, semble être utilisable pour la réanimation initiale des brûlés lorsque la voie IV n'est pas utilisable. Une étude randomisée prospective a été réalisée dans le CTB du CHU Canal de Suez d'Ismaïlia. Elle avait pour but d'analyser l'efficacité, l'innocuité, les limites et les complications de l'utilisation de la SRO supplémentée en sel dans la réanimation initiale des brûlés. Le groupe à l'étude (10 patients) recevait 15% de son poids de SRO par jour, additionné de 5 g de sel par litre (formule de Sørensen) quand le groupe contrôle (20 patients) était réanimé par voie IV selon la formule de Parkland. Les patients étaient monitorés (paramètres vitaux, diurèse) pendant 72 h. Les groupes étaient comparables en termes de l'âge, du sexe, de la surface, de la profondeur et de la cause de la brûlure. Il n'y avait pas de différence majeure entre les 2 groupes, exceptée une PA plus basse durant la première heure dans le groupe SRO. Il n'a pas été observé, dans ce groupe, d'anomalie dangereuse le la fréquence cardiaque, le la pression artérielle systolique, de la diurèse, de la fréquence respiratoire ni de l'état de conscience. La solution SRO de l'OMS additionnée de 5 g de sel, délivrée selon la formule de Sørensen, est une alternative efficace et sûre à la réanimation IV initiale des brûlés, qu'elle pourrait remplacer dans les pays à IDH bas et en cas de catastrophe.

Scald management protocols - outcome differences in two different time periods using different treatment strategies.

Over the years the treatment of scalds in our centre has changed, moving more towards the use of biological dressings (xenografts). Management of scalds with mid dermal or deep dermal injuries differs among centers using different types of dressings, and recently biological membrane dressings were recommended for this type of injury. Here we describe differences in treatment outcome in different periods of time. All patients with scalds who presented to the Linkoping Burn Centre during two periods, early (1997-98) and later (2010-12) were included. Data were collected in the unit database and analyzed retrospectively. A lower proportion of autograft operations was found in the later period, falling from 32% to 19%. Hospital stay was shorter in the later period (3.5 days shorter, p=0.01) and adjusted duration of hospital stay/TBSA% was shorter (1.2 to 0.7, p=0.07). The two study groups were similar in most of the studied variables: we could not report any significant differences regarding outcome except for unadjusted duration of hospital stay. Further studies are required to investigate functional and aesthetic outcome differences between the treatment modalities.

Le traitement des brûlures par liquides chauds a changé avec le temps, évoluant de plus en plus vers l'usage des pansements biologiques (xénogreffes). La prise en charge de ce type de brûlures (de profondeur moyenne ou profonde) diffère suivant les centres qui utilisent différents types de pansements et plus récemment, les membranes biologiques ont été recommandées pour ce type de traumatisme. Dans cette étude, nous décrivons les résultats thérapeutiques obtenus au cours de différentes périodes. Tous les patients avec des brûlures par liquides chauds admis au Centre de brûlés Linkoping pendant deux périodes d'abord de 1997-1998 et plus tard de 2010 à 2012 ont été inclus. Les résultats de notre banque de données ont été recueillis et analysés de façon rétrospective. Une proportion basse de greffes cutanées a été retrouvée dans la dernière période passant de 32% à 19%. Le séjour à l'hôpital a été également raccourci dans cette période (3,5 jours en moins, p= 0,01) et la durée d'hospitalisation en rapport avec l'étendue a diminué (1,2 à 0,7, p=0,07). Les résultats dans les deux groupes étaient semblables dans la plupart des variables étudiées: nous ne trouvons pas de différence significative sur le plan des résultats, excepté pour la durée d'hospitalisation. De nouvelles études sont nécessaires pour évaluer les divers résultats fonctionnels et esthétiques en fonction des modalités thérapeutiques.

Temporary coverage of burns with a xenograft and sequential excision, compared with total early excision and autograft.

During the 80s and 90s, early and total excision of full thickness burns followed by immediate autograft was the most common treatment, with repeated excision and grafting, mostly for failed grafts. It was hypothesized, therefore, that delayed coverage with an autograft preceded by a temporary xenograft after early and sequential smaller excisions would lead to a better wound bed with fewer failed grafts, a smaller donor site, and possibly also a shorter duration of stay in hospital. We carried out a case control study with retrospective analysis from our National Burn Centre registry for the period 1997-2011. Patients who had been managed with early total excision and autograft were compared with those who had had sequential smaller excisions covered with temporary xenografts until the burn was ready for the final autograft. The sequential excision and xenograft group (n=42) required one-third fewer autografts than patients in the total excision and autograft group (n=45), who needed more than one operation (p<0.001). We could not detect any differences in duration of stay in hospital / total body surface area burned% (duration of stay/TBSA%) (2.0 and 1.8) (p=0.83). The two groups showed no major differences in terms of adjusted duration of stay, but our findings suggest that doing early, smaller, sequential excisions using a xenograft for temporary cover can result in shorter operating times, saving us the trouble of making big excisions. However, costs tended to be higher when the burns were > 25% TBSA.

Pendant ces dernières décades, l'excision précoce et totale des brûlures profondes, suivie immédiatement d'autogreffe a constitué le traitement le plus habituel avec souvent, en cas d'échec, des excisions répétées et de nouvelles greffes. Nous avons pensé, cependant, que la couverture par autogreffe retardée, précédée par une couverture temporaire par xénogreffe après des excisions itératives et moins larges permettait d'obtenir un meilleur lit receveur avec moins d'échecs, des sites donneurs plus petits et une durée d'hospitalisation moindre. Nous avons ainsi mené une étude analytique rétrospective dans notre Centre National de Brûlés pendant la période 1997-2011. Les patients qui avaient été traités par une excision précoce totale suivie d'autogreffe ont été comparés à ceux qui avaient eu des petites excisions séquentielles, couvertes de façon temporaire par des xénogreffes jusqu'à ce que la brûlure soit prête pour une autogreffe finale. Le groupe excision séquentielle et xénogreffe (n=42) a nécessité un tiers de moins d'autogreffes que les patients qui avaient une excision totale suivie d'autogreffe (n=45) et plus d'une seule opération (p<0001). Nous n'avons pas remarqué de différence dans la durée d'hospitalisation en fonction de l'étendue de la surface brûlée (durée du séjour TBSA%) (2,0 et 1,8) (p=0,83). Les deux groupes n'ont pas montré de différence majeure en terme de durée d'hospitalisation, mais l'excision précoce, limitée et séquentielle avec une xénogreffe temporaire, permet de réduire le temps opératoire et évite les excisions trop généreuses. Cependant les coûts ont tendance à être plus élevés avec les brûlures de 25% ou plus de TBSA.

The clinical and cost effectiveness of bee honey dressing in the treatment of diabetic foot ulcers.

Honey is known, since antiquity, as an effective wound dressing. Emergence of resistant strains and the financial burden of modern dressings, have revived honey as cost-effective dressing particularly in developing countries. Its suitability for all stages of wound healing suggests its clinical effectiveness in diabetic foot wound infections. Thirty infected diabetic foot wounds were randomly selected from patients presenting to Surgery Department, Suez Canal University Hospital, Ismailia, Egypt. Honey dressing was applied to wounds for 3 months till healing, grafting or failure of treatment. Changes in grade and stage of wounds, using University of Texas Diabetic Wound Classification, as well as surface area were recorded weekly. Bacterial load was determined before and after honey dressing. Complete healing was significantly achieved in 43.3% of ulcers. Decrease in size and healthy granulation was significantly observed in another 43.3% of patients. Bacterial load of all ulcers was significantly reduced after the first week of honey dressing. Failure of treatment was observed in 6.7% of ulcers. This study proves that commercial clover honey is a clinical and cost-effective dressing for diabetic wound in developing countries. It is omnipresence and concordance with cultural beliefs makes it a typical environmentally based method for treating these conditions.

Assessment of the relation between prealbumin serum level and healing of skin-grafted burn wounds.

Nutritional status is an important factor in graft healing. Prealbumin (transthyretin) is a better nutritional marker than the widely used albumin serum level. Prealbumin serum levels were estimated in an endeavour to correlate them to graft healing and to serve as a predictor of graft healing in burn wounds. Fifty burned patients undergoing graft in the Suez Canal University Hospital Burn Unit were subjected to this cross-sectional study. Prealbumin levels were assessed on preoperative day and on the fourth postoperative day. Graft healing was considered complete when the take was 90% or more of the grafted area. The most significantly correlated factor to graft healing was serum prealbumin. Serum albumin levels were not in significant correlation with graft healing or prealbumin levels. In addition, serum prealbumin levels were significantly higher in the younger age group and significantly lower in patients with chronic diseases. Serum prealbumin level is a sensitive tool in predicting graft take in burned patients when all local conditions are favourable and optimised. Nevertheless, it seems less sensitive in the prediction of graft healing in small raw areas less than 5% of total body surface area (TBSA).

Assessment of amniotic and polyurethane membrane dressings in the treatment of burns.

As allograft and xenografts are not available in Islamic countries, amniotic membrane seems to be an effective alternative in the management of deep burns. Its proven bioactivities and modest price suggest that it might be superior to synthetic dressings. Forty-six patients were enrolled in this randomized, controlled clinical trial conducted in the Burn Unit at Suez Canal University Hospital, Ismailia, Egypt. All age groups and both gender were included in the study. Only patients with less than 50% total body surface area burned were included, thus minimizing the dropouts in both groups. All were either second or third degree. These patients were randomly assigned either to group I: amniotic membrane (Biomembrane) dressing, or group II: polyurethane membrane (Tegaderm) dressing. Those in group I demonstrated a significantly lower rate of infection and required less frequent dressing changes than those in group II. They also sustained less electrolyte and albumin loss. The rate of healing in the amniotic membrane group was significantly faster than in the polyurethane group. Furthermore, pain was significantly less when Biomembrane was used. Based on these findings, we recommend the use of lyophilized gamma-irradiated amniotic membrane as an effective alternative for allograft and xenografts in Islamic countries and the Jewish population.