Sauna contact burns in adults in the Helsinki Burn Centre during 2006-2018.

INTRODUCTION: Within Finish culture is a strong tradition of sauna bathing. This special environment predisposes the persons refreshing in the sauna to different kind of burns with varying etiologies. Despite the high prevalence of sauna related burns in Finland, there is paucity on the sauna related burns literature. METHODS: In this 13-year retrospective study, all sauna-related contact burns in the adult population treated at the Helsinki Burn Centre were analyzed. Altogether 216 patients were included in this study. RESULTS: The incidence of sauna-related contact burns was significantly higher in males; they accounted for 71.8% of patients. In addition to male gender, another risk factor was high age, with the elderly also being more prone to have a longer length of stay in hospital and more often receiving operative treatment. Despite most burns being relatively small, they were deep and more than one-third (36.6%) of patients underwent surgery. A strong seasonal variation in the injuries was recorded; over 40% of the burns took place during the summer months. CONCLUSION: Sauna contact burns are common, and despite their small size, they frequently cause deep injuries indicating operative treatment. There is a clear male predominance in the patient population. Most probably the cultural aspects of sauna bathing at summer cottages explain the strong seasonal variation in the incidence of these burns. The long latency between initial injury and presentation at the Helsinki Burn Centre should be highlighted to health care centres and central hospitals.

Experiences of frostbite injury from recreational use of nitrous oxide canisters in a UK burns center: Not a laughing matter.

Nitrous oxide is used as a recreational drug. Contact frostbite injury from compressed gas canisters has previously been described in the literature, but an increased number of such cases has been noted in our busy regional burns center in the UK. A single-center prospective case series of all patients referred and treated for frostbite injury secondary to misuse of nitrous oxide compressed gas canisters between January and December 2022 is presented. Data collection was performed through a referral database and patient case notes. Sixteen patients, of which 7 were male and 9 were female, satisfied the inclusion criteria. Mean patient age was 22.5 years. The median TBSA was 1%. In total, 50% of patients in the cohort had a delayed initial presentation to A&E of greater than 5 days. Eleven patients were reviewed at our burns center for further assessment and management. In total, 11 patients had bilateral inner thigh frostbite injuries, of which 8 had necrotic full-thickness injury, including subcutaneous fat. Seven patients were reviewed at our burns center and offered excision and split-thickness skin graft. Four patients presented with contact frostbite injury to the hand and one patient to the lower lip. This subgroup was managed successfully with conservative management alone. The reproducible pattern of frostbite injury secondary to the abuse of nitrous oxide compressed gas canisters is demonstrated in our case series. The distinct pattern of injury, patient cohort, and anatomical area affected presents an opportunity for targeted public health intervention in this group.

An automated high-throughput platform for experimental study of burn injuries - in vitro and ex vivo.

The use of in-vitro and ex-vivo models for the study of burn wound injuries is encouraged to reduce the animal burden in experimental burn research. However, few existing platforms enable the production of reproducible, locally confined thermal injuries at short durations in a high-throughput manner for both in-vitro and ex-vivo models. To address this gap, we established an automated high-throughput burn platform (HTBP) that provided accurate control over burn temperature, exposure time, and pressure application. This platform was built by fabricating an aluminum heat block with 96 pins and positioning a high-resolution actuator below the block. By activating the actuator, 96-well cell culture plates and skin samples were pressed against the heat block's pins. We demonstrated the applicability of the HTBP for studying in-vitro burn injuries by investigating the effects of burn temperature and contact duration on cell viability and migration in human umbilical vein endothelial cells and NIH-3T3 fibroblasts. We showed that higher temperatures and a longer contact duration decreased cellular viability and increased the area of the burn. Moreover, we found that even a short exposure time of 200 msec caused a severe burn wound at 75 °C in a cell monolayer. In addition, we used the HTBP to generate burn injuries at different burn durations in ex-vivo porcine skin and showed that dermis discoloration was present in histologic sections after exposure to 100 °C for a short duration of 500 msec. Our work demonstrates that the HTBP can constitute an important tool for both in-vitro and ex-vivo research of mild and severe burn injuries in a tightly controlled setting and high-throughput manner.

Epidemiology And Outcomes Of Radiator Burns At A High Throughput Burns Centre.

Indoor radiator burns can cause significant morbidity and mortality, especially in vulnerable patients. However, the epidemiology and clinical outcomes are poorly characterized. A retrospective study of all radiator burns referred to a tertiary regional burns centre between 2013-2019 was conducted. Four hundred and forty-seven patients (median age 25.6 years, male:female ratio 1.4:1) were referred; 109 (24%) admitted, 201 (45%) managed in outpatients and 137 (31%) managed locally. The incidence of burns leading to referral was 0.65/100,000/year, but increased annually. Contact burns consisted of 99.6%. Age distribution was bimodal: <5 years (43%), >65 years (27%), although all ages were affected. Median TBSA was 0.75% (0.1-11.5%), but 79% had injuries <2%. Childhood burns were predominantly superficial dermal grab injuries, usually manageable as outpatients. Elderly patients had larger burns usually secondary to falls or impaired sensorium, and were more likely to die (p<0.05). Burns due to impaired sensorium were deeper and more likely to require surgery (p<0.05). Sixty-three (14%) patients required surgery. Thirty-day mortality was 1.1%. Age was the only significant predictor of mortality. This study quantifies the epidemiology and outcomes of a growing problem. It identifies at risk populations (extremes of age), and important features of the clinical assessment.

Les brûlures en milieu clos liées à un radiateur peuvent être responsables de morbidités et de mortalité non négligeables, particulièrement chez les patients fragiles. Toutefois, l'épidémiologie et l'évolution en sont mal connues. Nous avons étudié rétrospectivement les 447 brûlures (âge médian des patients 25,6 ans ; 1,4 hommes pour 1 femme) liées à ces appareils adressées dans un CTB de référence entre 2013 et 2019. Parmi celles- ci, 109 (24%) ont été hospitalisées, 201 suivies par nous en externe et 137 (31%) pris en charge dans une structure non spécialisée. L'incidence annuelle est de 0,65/100 000/an, en augmentation régulière. Quasiment toutes (99,6%) sont dues à un contact. Bien que tous les âges puissent être affectés, on observe 2 pics d'incidence, avant 5 ans (43% des patients) et après 65 ans (27%). La surface atteinte s'étendait de 0,1 à 11,5% (médiane 0,75%), 79% des brûlures touchant moins de 2% SCT. Les enfants souffraient le plus souvent de brûlures superficielles, suivies en externe, après avoir empoigné le matériel. Chez les sujets âgés, les brûlures, consécutives à une chute ou à contact prolongé en raison de troubles sensoriels (ces dernières plus souvent profondes et nécessitant un traitement chirurgical ­ p< 0,05), sont plus étendues et plus souvent mortelles (p< 0,05). Soixante- trois (14%) patients ont eu besoin de chirurgie, la mortalité à 30 jours était de 1,1% ; l'âge étant le seul facteur prédictif de mortalité. Cette étude précise l'épidémiologie et l'évolution d'un problème émergeant, la population à risque (âges extrêmes) et met en avant certaines particularités cliniques.

Modeling early thermal injury using an ex vivo human skin model of contact burns.

BACKGROUND: Early mechanisms underlying the progressive tissue death and the regenerative capability of burn wounds are understudied in human skin. A clinically relevant, reproducible model for human burn wound healing is needed to elucidate the early changes in the human burn wound environment. This study reports a reproducible contact burn model on human skin that explores the extent of tissue injury and healing over time, and defines the inter-individual variability in human skin to enable use in mechanistic studies on burn wound progression and healing. METHODS: Using a customized burn device, contact burns of various depths were created on human skin by two operators and were evaluated for histologic depth by three raters to determine reproducibility. Early burn wound progression and wound healing were also evaluated histologically after the thermally injured human skin was cultured ex vivo for up to 14 days. RESULTS: Burn depths were reproducibly generated on human skin in a temperature- or time-dependent manner. No significant difference in operator-created or rater-determined depth was observed within each patient sample. However, significant inter-individual variation was identified in burn depth in ten patient samples. Burn-injured ex vivo human skin placed into culture demonstrated differential progression of cell death and collagen denaturation for high and low temperature contact burns, while re-epithelialization was observed in superficial burn wounds over a period of 14 days. CONCLUSION: This model represents an invaluable tool to evaluate the inter-individual variability in early burn wound progression and wound healing to complement current animal models and enhance the translation of preclinical research to improvements in patient care.

Beauty is pain: pediatric burns resulting from hair curling and flat irons.

Ceramic and metal hair straightening and curling irons are common household items which reach up to 450°F in as little as five seconds. Of particular concern is the threat these devices pose to children. Our objective is to characterize and bring attention to this preventable injury in the pediatric population. Retrospective records from a high-volume level I trauma center and regional burn center from 2011-2015 were analyzed. Inclusion criteria were defined as patients <11 years of age, as those presenting with burns above this age were more likely to be utilizing the tools for hair styling. A total of 59 patients were identified with an average age of 2.4 years. The average burn size was 0.30%, with an average 0.24% 2nd degree TBSA. The etiology of the burns included touching a hair iron that was within reach (61%), pulling a hair iron's power cord (15%), stepping/rolling/jumping onto a hair iron left on the ground (17%), and hair irons falling (7%). The majority of households were comprised of unemployed (64%), single (60%) parents. CPS consult was required for 20% of patients. Grafting and excision was necessary for 20% of patients The pediatric population is at risk for accidental burns with household hair irons. These burns typically have a small TBSA, but may require excision and grafting and extended follow-up.

Les lisseurs et fers à friser, en céramique ou en métal, sont des objets courants au domicile. Leur température peut monter à plus de 230°C en quelques secondes. Le risque qu'encourent les enfants est préoccupant. Nous avons explorés ces brûlures afin de déterminer des stratégies de prévention. Nous avons analysé rétrospectivement les données d'un CTB régional, recueillies entre 2011 et 2015. Nous n'avons retenu que les brûlures atteignant les enfants de 11 ans au maximum (59 cas, âge moyen 2,4 ans), les enfants plus âgés étant susceptibles d'utiliser ces instruments à leur propre bénéfice. La surface brûlée était de 0,3 % dont 0,24 % de 2ème degré. La brûlure était consécutive au toucher d'un ustensile atteignable (61%), à la traction sur le cordon d'alimentation (15%), à la marche dessus (17%), à la chute de l'objet (7%). Les familles concernées étaient en majorité monoparentales (60%) sans emploi (64%). Les services de protection de l'enfance ont été sollicités dans 20% des cas. Les enfants sont particulièrement à risque de brûlures lors d'accidents domestiques, pouvant impliquer des fers à friser et des lisseurs. Ces brûlures sont typiquement peu étendues mais peuvent être profondes, nécessiter une greffe et un suivi prolongé.

Burn on the buttocks caused by gel wheelchair cushion left on driver's seat of hand control car.

Context: Nowadays, people with paraplegia and quadriplegia have greater opportunities to venture into the general public. However, there is also an increased risk of associated hazards.Findings: This report describes a 42-year-old man with paraplegia, who was insensate below the T7 level and sustained burns from sitting on a gel wheelchair cushion that had been left on the driver-side seat of a hand control car on a sunny day. Physical examination revealed deep partial-thickness burns on both his buttocks. He underwent surgical debridement and received an autologous split-thickness skin graft, and healed well.Conclusion In modern times, the lives of people with paralysis are no longer restricted to the bed and wheelchair. Active people with spinal cord injuries inevitably diversify the use of wheelchair cushions in many ways; therefore, there is a greater possibility for the occurrence of associated hazards. This is a preventable issue, so both the user and manufacturers should recognize this potential hazard of gel wheelchair cushions.

Exhaust system-related burns affecting children: a UK perspective and literature review.

Burns caused by exhaust systems in children may be associated with considerable morbidity. Current epidemiological data varies, but no data are available for the UK population. We aim to identify the pattern of exhaust-related burns affecting children who presented to a regional centre for paediatric burn care in the UK. Patients who sustained burns related to exhaust mechanisms between May 2005 and August 2012 were identified via the departmental database. Data collected included patient demographics, burn injury information, management and outcomes. Thirty-nine patients sustained 43 burns from contact with exhaust mechanisms, and the majority were less than 5 years of age. 77% of the patients were male. Burns affected critical areas such as the hands and feet in 26% of cases. Most burns involved a total body surface area of ≤1% and were partial thickness in depth. Thirty-three percent of patients required operative intervention. Time to heal was less than 3 weeks in 69% of cases and 3 patients healed with hypertrophic scarring. The majority of burns were small in size and partial thickness in depth. Most were treated conservatively and healed with low complication rates. More than 1 in 5 injuries involved critical burn areas, highlighting the potential for considerable morbidity. The age profile in our study contrasted with other results worldwide. Our study highlights the need for vigilant supervision of children around motorcycles. We recommend the wearing of protective long trousers when riding motorcycles and the fitting of external shields to motorcycle exhaust pipes.

Les brûlures par pot d'échappement chez l'enfant peuvent être responsables d'une morbidité importante. Les données épidémiologiques actuelles sont variables, mais il n'y en a pas au Royaume Uni. Nous avons analysé les circonstances de survenue des brûlures par pot d'échappement touchant les enfants vus dans un CTB régional du Royaume Uni, entre mai 2005 et août 2012, retrouvés via la banque de données régionale. Les variables analysées étaient les données démographiques, le mécanisme précis de la brûlure, la prise en charge et le devenir. Trente neuf patients ont subi 43 brûlures par ce mécanisme, la majorité ayant moins de 5 ans, 77% d'entre eux étant des garçons. Les brûlures atteignaient des régions sensibles (mains, pieds) dans 26% des cas, touchaient moins de 1% de SCT dans la plupart des cas et étaient fréquemment intermédiaires. Trente neuf pour cent des patients on nécessité une intervention chirurgicale. Dans 69% des cas, la cicatrisation était obtenue en moins de 3 semaines, 3 patients ont développé une cicatrice hypertrophique. La majorité des brûlures touchent une petite surface et sont peu profondes, cicatrisant sans chirurgie ni séquelles. Plus d'une brûlure sur 5 touche des zones fonctionnelles, avec un potentiel morbide élevé. La classe d'âge touchée contraste avec les données retrouvées ailleurs et nécessite une vigilance accrue au profit des enfants lorsqu'ils sont autour de 2 roues à moteur. Nous recommandons de porter des pantalons longs et la mise en place de protections autour des pots d'échappement.

A novel device to create consistent deep dermal burns in a porcine model.

We conducted this study to evaluate a novel device to create a consistent and reproducible deep partial thickness burn in a porcine model. A thermostatically controlled, heated aluminium disc device was fashioned by the Biomedical Department of our institution. Contact burns were made on the flank of two Great White pigs by applying the device heated to 92°C at intervals of 5, 10, 15 and 20 seconds to four separate test areas area of skin. Biopsies for histological analysis of burn depth were taken on day 0 at 10 minutes post burn and on day 8. Biopsies taken at day 0 revealed superficial to mid-dermal burns, with minimal dermal edema and necrosis. Those from day 8 showed mid to deep dermal edema and necrosis in all four test areas following a 20 second contact duration burn. The new contact burn device was able to create a consistent deep dermal burn after 20 seconds of contact. We anticipate that this new device could be used to investigate the development of hypertrophic scarring in a porcine model.

Factors affecting the depth of burns occurring in medical institutions.

INTRODUCTION: Most cases of burns occurring in medical institutions are associated with activities involving heat. It is very difficult to detect these burns. To date, there are few reports on burns occurring in medical institutions. The purpose of this paper was to analyze the etiology of burns occurring in medical institutions and to elucidate the factors affecting burn depth. METHODS: We conducted a retrospective analysis of the medical records of patients who visited our center from April 2008 to February 2013. This study enrolled all patients with burns occurring in the medical institution during or related to treatment. We excluded burn patients whose burns were not related to treatment (for example, we excluded patients with scalding burns that occurred in the hospital cafeteria and pediatric patients with hot water burns from the water purifier). However, patients with burns that occurred in the recovery room after general anesthesia were included. RESULTS: A total of 115 patients were enrolled in this study. The average patient age was 41.5 years, with more women than men (M:F=31:84). There were 29 cases (25.3%) of superficial burns (first-degree and superficial second-degree) and 86 cases (74.7%) of deep burns (deep second-degree and third-degree). Hot packs were the most common cause of burns (27 cases, 23.5%), followed by laser therapy, heating pads, and grounding pads, accounting for 15 cases each. There were 89 cases (77.4%) of contact burns and 26 cases (22.6%) of non-contact burns. The most common site of burns was the lower extremities (41 cases, 35.7%). The burn site and contact burns were both factors affecting burn depth. The rate of deep burns was higher in patients with contact burns than in those with non-contact burns (odds ratio 4.26) and was associated with lower body burns (odds ratio 2.85). CONCLUSION: In burns occurring in medical institutions, there is a high probability of a deep burn if it is a contact burn or occurs in the lower body. Therefore, safety guidelines are needed for the use of hot packs, heating pads, and grounding pads to prevent such incidents.

Severe Case of Low Temperature Contact Burn with Rhabdomyolysis

Although low temperature contact burn doesn't have clear definition, it is used to describe the burn occurred by long time exposure under 50℃ temperature. 4(th) degree burn can be occurred by low temperature contact burn because of low pain, especially in patients who are insensitive to stimulation by various reasons. The under-floor heating system such as Ondol or electronic heating pad is popular in Korea because of the cultural influence. Although the upper limit surface temperature of electronic heating pad is 50℃, severe burn injury can happen by long time exposure. So we report a low temperature contact burn case of 4(th) degree involving gluteus maximus muscle of the buttock caused by electric heating pad, which led to Rhabdomyolysis.

Contacts Burns Caused by Electric Pad

PURPOSE: The use of the Ondol, which is a traditional Korean floor heating system, has made the electric heating pad popular in Korea. Although the surface temperature of electric pads is around 45 degrees, rarely they can cause severe contact burns. Because an electric pad is usually used while sleeping, the skin could be exposed to heat and pressure for a prolonged period. The purpose of this study was to investigate the epidemiology and clinical features of these types of burns and to advise caution in the use of electric heating pads. METHODS: We performed a retrospective analysis of 58 cases identified from March 2007 to March 2012 at the Hangang Sacred Heart Hospital plastic surgery department. Collected data included sex, age, seasonal variation, distribution and extent of the burn, underlying disease, related factors, and treatment. RESULTS: Patients (23 females and 10 males) were predominantly in their twenties, with an average age of 40.7 years (range, 14~83). The majority of the burns occurred during winter (51.5%). According to the patients' histories, sleeping in a drunken state was the most common associated factor, with taking hypnotics and lying under spinal anesthesia being the second and third factors, respectively. Eight patients had diabetes mellitus and four patients had hypoesthesia after spinal cord injury and cerebral stroke. The lower extremity was the most commonly involved site (42.4%), followed by the buttocks (33%). The extent burn areas accounted for less than 2% of the total body surface area. But deep second degree and third degree burns were sustained that required surgical intervention. CONCLUSION: Unconsciousness and hypoesthesia were the primary factors that provoked contact burns related to the use of electrical pads. Although the percentage of body surface area burns is often small, the burns caused by electric pads can cause deep thermal injuries, necessitating the use of skin grafts and local flaps. These injuries could be prevented by taking precautions when using electric pads and by educating the public.

The Change of Burn Depth within 24 Hours after Burn in the Standardized Burn Mode

PURPOSE: In full thickness burn, the depth of burn is known to increase until around 1-3 days after the burn. However, no study on how the depth increase during the first 24 hours has been conducted. Therefore, the authors investigated how the depth of burn changes within the first 24 hours after the burn by using the standardized burn model. METHODS: A total of four experiments on pigs were carried out for this study. Experiment 1 was performed to examine how temperature affects the depth of burn. The digitally controlled aluminum thermal block was set at different temperatures-80, 90 and 100 degrees in Celsius, respectively. Then the pig was exposed to the block for 15 seconds each time. The time exposed to heat was set as a variable for the Experiment 2. The temperature was maintained at 80 degrees Celsius, and the pig was contacted with the thermal block for 5, 10 and 20 seconds, respectively. The biopsy of the tissues were performed in one hour, 6 hours, 24 hours, and 7 days after the burn. After hematoxylin and eosin staining a percentage of the depth from a basement membrane of epidermis to the deepest tissue damaged by the burn against total dermal thickness was measured. RESULTS: In Experiment 1, the depth of burn increased considerably as time passed by. At all three temperatures, differences in depths measured in 6 and 24 hours, and in 1 hour and 7 days were both significant. In addition, the depth deepened as the temperature went higher. In the case of Experiment 2, the depth of burn also increased significantly as time passed by. At all three times, differences in depth measured in 6 and 24 hours, and in 1 hour and 7 days were also significant. Moreover, the depth extended with longer contact time when it was compared according to the time. CONCLUSION: Full thickness burn progressed rapidly from 6 to 24 hours after the burn and the depth of burn was almost decided within the first 24 hours after the burn. On the other hand, partial thickness burn also advanced from 6 to 24 hours after the burn but the depth deepened at slower level.