The Evaluation of a Golden Period of Fasciotomy for High Voltage Electrical Burn Injury Patients With Compartment Syndrome.

Electrical burn injuries can cause various acute manifestations that require surgeons to make an early decision, such as fasciotomy for compartment syndromes. Early decompression can become a 'golden period'for limb salvation. This study evaluates the duration of burn to fasciotomy (B-F time) and amputation. A cross-sectional study was performed on medical records. Inclusion criteria were patients with high voltage electrical injuries and compartment syndrome. Exclusion criteria were patients whose extremities were already non-vital on admission and those lost to follow up. Demographic information, burn surface area and B-F time for patients amputated above the elbow (group A amputation), below the elbow (group B amputation), and no amputation (non-amputated) were investigated. More than 50% patients underwent amputation and 60% had less than 18 hours B-F time. Mean B-F time for non-amputated patients was 18 hours and for amputated patients 20.38 hours. Mean burn to amputation (B-A) time and fasciotomy to amputation (F-A) time in group B was about double compared to group A. The B-A time range of group Awas 4.2-7.3 days. Our study showed 18 hours maximum to be the golden period of burn to fasciotomy. The window period of muscle injury evaluation is maximum 7 days to permit limb salvation at the lowest level possible.

Les brûlures électriques peuvent entraîner des situations cliniques nécessitant une chirurgie urgente, en particulier une aponévrotomie pour syndrome de loge. Cette étude se penche sur l'évaluation de la corrélation entre le délai de réalisation d'une aponévrotomie après brûlure (délai B-A) et une amputation. Il s'agit d'une étude comparative rétrospective sur dossiers. Le critère d'inclusion était l'apparition d'un syndrome de loge après électrisation. Les critères d'exclusion étaient l'existence de nécrose distale d'emblée et les perdus de vue. Nous avons relevé les données démographiques, la surface brûlée, le délai B-A et comparé 3 groupes : amputation au bras (amp. A), amputation à l'avant- bras (amp. B) et sans amputation (amp. 0). Plus de la moitié des patients ont été amputés, et le délai B-A était de moins de 18 h pour 60% d'entre eux. Le délai B-F moyen de amp. 0 était de 18 h, et de 20,38 h pour les amputés. Les délais moyens entre brûlure et amputation (B-amp.) et entre aponévrotomie et amputation (A-Amp.) était presque le double chez amp. B que chez amp. A (de 4,2 à 7,3 jours dans ce groupe). Le délai maximal entre électrisation et aponévrotomie semble être de 18 h et le délai avant de décider du niveau d'amputation de 7 j.

Characteristics Of Liquefied Petroleum Gas (Lpg) Related Burn Injuries In Hasan Sadikin Bandung General Hospital.

The number of liquefied petroleum gas (LPG) related burn injuries has increased over recent years in Indonesia, since the conversion of kerosene to LPG in 2007 (government policy). Based on studies in India and China, LPG-related burn injuries have become a serious public health issue. A 5-year retrospective study was conducted from medical records of patients with LPG-related burn injuries. The data included age, gender, place, occupation, LPG tank size, mechanism, burn classification, burn site and concurrent injury. A total of 169 patients with LPG-related burn were admitted. The yearly incidence was in the range of 24-46% of all burn injury cases. They mostly occurred in males (66.2%) aged 36-55 years (43.1%). The most common place was the home (83.4%) and the most common occupation was merchant (32%). LPG leakage (94.7%) was the main cause of burn, followed by LPG explosion (5.3%). A 3-kilogram LPG tank (96.4%) was the most common cause. Patient burn classification was mostly major burns (62.1%), with the most common site being the head and neck (73%), and concurrent with inhalational injury (16%). Our study showed that the increasing number of LPG-related burn injuries is alarming. The majority of the patients were males in the productive age and they suffered major burns. Some of them suffered inhalation injury that increases the risk of mortality. Since LPG leakage was the main cause and the most common place was the home, there must be regulation with government related prevention strategies.

Le nombre de brûlures par GPL a augmenté ces dernières années en Indonésie, suivant la loi sur la conversion kérosène/GPL de 2007. Les études indiennes et chinoises en font un problème de santé publique. Nous avons revu les dossiers des 169 patients admis pour de telles brûlures pendant 5 ans. Les données étudiées comprenaient l'âge, le sexe, le lieu, l'activité, la taille du réservoir de GPL, le mécanisme, la surface, la profondeur, les zones brûlées et les lésions associées. Ces brûlures représentaient 22 à 46% de l'ensemble. Elles touchaient préférentiellement des hommes (66,2%) de 36 à 55 ans (43,1%). Bien que survenant le plus souvent au domicile (83,4%), elles étaient liées à des activités commerciales dans 32% des cas. La fuite de GPL était la cause très largement majoritaire (94,7%), les explosions ne représentant que 5,3% des mécanismes, la bonbonne de 3kg étant impliquée dans 96,4% des accidents. Les brûlures étaient considérées comme graves dans 62,1% des cas ; la zone cervico- faciale était atteinte 3 fois sur 4 (73%). Une inhalation était observée dans 16% des cas. Notre étude montre l'augmentation préoccupante des brûlures graves par GPL, survenant chez des hommes actifs, certains d'entre eux souffrant en plus d'une inhalation, qui accroît le risque létal. La fuite de GPL en étant l'origine prédominante, une législation de prévention primaire doit être mise en place.

The Profile Of Severe Burn Injury Patients With Sepsis In Hasan Sadikin Bandung General HospitaL.

Burn injury remains a major global health issue. An estimated 180,000 people die annually due to burn injury, and most cases occur in low- and middle-income countries, including Indonesia. Several complications of burns may lead to mortality, and sepsis is one of the major threats, with the risk of developing multi organ dysfunction syndrome. This study applied a descriptive-retrospective method on 3-year medical records of severe burn injury patients. The data were classified according to age, etiology, outcome, antibiotic resistance, and pathogens of sepsis. There were 100 medical records of severe burn injury, and 55% of them were accompanied by sepsis. The highest number of sepsis cases was found in the age category of 40-50 years old. Nearly 80% of the cases were fire-related burns. Blood and burn wound culture of recovered patients showed 55% contamination with gram-positive bacteria, and 50% of them with Staphylococcus hominis. Contamination of blood and burn wound culture of deceased patients with gram-negative bacteria was 100%, 60% of them with Pseudomonas Aeruginosa. There is a more than 50% chance of severe burn patients falling into septic conditions. More than half of the patients were infected with gram-negative bacteria. Pseudomonas aeruginosa remains the main culprit of septic burn-related death.

Les brûlures demeurent un problème de santé publique, responsable d'environ 180 000 morts chaque année, survenant préférentiellement dans les pays à IDH bas ou moyen- bas, dont l'Indonésie. Parmi les complications pouvant conduire au décès, le sepsis en est une majeure, avec le risque de développer une défaillance multiviscérale. Nous présentons une étude descriptive et rétrospective ayant étudié cent dossiers de patients sévèrement brûlés répartis sur 3 ans, dont 55% ont développé un sepsis. Nous avons répertorié l'âge, l'étiologie de la brûlure, la bactérie en cause et son phénotype ainsi que l'évolution. Environ 80% des brûlures étaient dues à une flamme. La majorité des sepsis était observée dans la classe 40- 50 ans. Les prélèvements sanguins et cutanés de ces patients retrouvaient une bactérie à Gram positif dans 55% des cas, identifiée Staphylococcus hominis 1 fois sur 2. Ces mêmes prélèvements étaient toujours positifs à Gram négatif chez les patients décédés ; il s'agissait de Pseudomonas æruginosa dans 60% des cas. Un patient sévèrement brûlés a plus d'un risque sur 2 de développer un sepsis, plus d'une fois sur 2 à Gram positif, mais le principal responsable de la mortalité d'origine septique reste Pseudomonas æruginosa.

Location and length of arteriovenous fistulas around axial-pattern skin-flap pedicles.

The importance of the location of a surgically-created arteriovenous fistula around the pedicle (both distal and proximal) on the viability of rat skin flaps was investigated. The animals were randomly divided into four groups. Group 1 included bilateral standard island groin flaps. The right side flap was used as a control. On the left side, after elevation of the flap, an X-type arteriovenous fistula greater than 1 mm (up to 2 mm) in length was created distal to the pedicle, and just before the bifurcation of the common femoral vessels. In Group 2, the flap was an axial-pattern medially-based peninsular flap, including the same vessels. In this group also, two flaps were elevated bilaterally, and the right side was used as a control; on the left side, an X-type arteriovenous fistula the same length as in Group 1 was also created distal to the pedicle. In both groups, all other branches of the common femoral vessels were kept intact. In a second part of the study, two other animal groups were used to clarify the importance of the length of the arteriovenous fistula on the viability of skin flaps. In Group 3, the model was the same as in Group 1, but the fistula was 1 mm in length. In Group 4, the length of the fistula was 1 mm, and its location was on the common femoral vessels proximal to the pedicle, using the same flap model. Flow values were measured repeatedly using a laser Doppler flowmeter. Histopathologic studies were also done. There are three important points arising from these studies. 1). The location of an X-type arteriovenous fistula around an island skin flap pedicle seems to be more important than diameter. An arteriovenous fistula proximal to the pedicle is more hazardous than an arteriovenous fistula distal to the pedicle, regarding island skin-flap viability. 2). However, the length of the fistula is also important, and an arteriovenous fistula distal to the pedicle, with a sufficiently long length, is not devoid of harmful effects. It is also clear that the larger the fistula, the greater the systemic effects. 3). An island skin flap with an arteriovenous fistula distal to its pedicle might be a useful model to study the relationship between skin-flap viability and edema formation.