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Eur. Burn J., Volume 4, Issue 2 (June 2023) – 12 articles

Cover Story (view full-size image): Post-burn scar contractures of the cervical region compromise the cosmetic appearance and airway security of recovering burn patients, imposing a significant impact on their psychological and functional quality of life. Free flap reconstruction of neck contractures in burn patients who developed moderate to severe neck contractures was performed using anterolateral thigh (ALT) flaps, radial forearm free flaps (RFFFs) and an ulnar forearm flap to release neck contractures. All flaps were completed successfully with significant improvement in the range of motion of the neck. Good aesthetic results were achieved with smooth contour and thin coverage which led to a high degree of patient satisfaction. Free tissue transfers can be considered an important and reliable method of reconstruction for neck contracture deformity following burn injuries. View this paper
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18 pages, 4617 KiB  
Review
Operative Management of Burns: Traditional Care
by David G. Greenhalgh
Eur. Burn J. 2023, 4(2), 262-279; https://doi.org/10.3390/ebj4020024 - 19 Jun 2023
Cited by 1 | Viewed by 3279
Abstract
Surgical treatment of burn wounds has had a tremendous impact on burn patients. The survival of patients with massive burns is now very common. Expeditious coverage of the wound has been a major contributor to improved survival, but survival is not enough. There [...] Read more.
Surgical treatment of burn wounds has had a tremendous impact on burn patients. The survival of patients with massive burns is now very common. Expeditious coverage of the wound has been a major contributor to improved survival, but survival is not enough. There is a need to improve the ultimate functional and cosmetic outcomes of the wound in order to facilitate a patient’s return to society. This paper reviews strategies, using fairly basic techniques, to optimize the outcomes of burn patients. While there are many new skin products available, the strategies presented here can apply to any surgeon treating burns throughout the entire world. Full article
(This article belongs to the Special Issue Surgical Treatment of Acute Burns)
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3 pages, 203 KiB  
Comment
Comment on Dinesen et al. Diphoterine for Chemical Burns of the Skin: A Systematic Review. Eur. Burn J. 2023, 4, 55–68
by Alan Hall, Amal Bouraoui, Karine Padois, Joel Blomet, Denise Jacquemin, François Burgher, Lucien Bodson, Jean-Luc Fortin and Howard Maibach
Eur. Burn J. 2023, 4(2), 259-261; https://doi.org/10.3390/ebj4020023 - 15 Jun 2023
Cited by 1 | Viewed by 681
Abstract
We read with interest the recent publication of Dinesen et al. [...] Full article
11 pages, 3257 KiB  
Communication
Free Tissue Transfer in the Reconstruction of Neck Contractures after Burn Injury: A Case Series
by Geneviève Ferland-Caron, Peter O. Kwan and Edward E. Tredget
Eur. Burn J. 2023, 4(2), 248-258; https://doi.org/10.3390/ebj4020022 - 09 Jun 2023
Viewed by 2684
Abstract
Background: Recent advances in burn care have significantly improved the survival rate of patients with extensive burn injuries, placing greater emphasis on reconstruction to improve the long-term outcomes of scar deformities. Anterior and lateral neck contractures are common after burn injuries; they [...] Read more.
Background: Recent advances in burn care have significantly improved the survival rate of patients with extensive burn injuries, placing greater emphasis on reconstruction to improve the long-term outcomes of scar deformities. Anterior and lateral neck contractures are common after burn injuries; they limit range of motion, complicate airway management and create significant cosmetic deformities. Traditional methods have been used to release contractures and improve function. However, they are subject to variable results, residual neck tightness, recurrence and suboptimal cosmetic appearance. Microvascular free tissue transfer is a more technically challenging and time-consuming method, but it offers the potential to overcome the long-term limitations of simpler options. In this paper, we present our experience with microvascular free flaps for the release of burn scar contractures of the neck as a potential high-quality permanent solution. Methods: Over a 10-year period, nine free flaps were performed on burn patients with total body surface area (TBSA) burns between 20 and 70%, who developed moderate to severe neck contractures. Four anterolateral thigh (ALT) flaps, four radial forearm free flaps (RFFFs) and one ulnar forearm flap were used to release neck contractures. Results: All nine flaps were completed successfully with significant improvement in the neck’s range of motion. Good aesthetic results were achieved with smooth contour and thin coverage. Overall, the patients were satisfied. However, five out of nine cases required at least one secondary procedure for flap defatting to reach optimal results. Conclusion: Post-burn scar contractures of the cervical region compromise the cosmetic appearance and airway security of recovering burn patients, imposing a significant impact on their psychological and functional quality of life. Consequently, cervical contractures can be prioritized when planning reconstruction for burn patients. Free flaps can be considered an important and reliable method of reconstruction for neck contracture deformity following burn injuries. Full article
(This article belongs to the Special Issue Reconstruction after Burn Injury: An Integrative Approach)
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14 pages, 1827 KiB  
Article
Evaluation of Outcomes following Reduction in Targeted Fluid Administration in Major Burns
by Maryum Merchant, Scott B. Hu, Stella Cohen, Peter H. Grossman, Kurt M. Richards and Malcolm I. Smith
Eur. Burn J. 2023, 4(2), 234-247; https://doi.org/10.3390/ebj4020021 - 29 May 2023
Viewed by 1067
Abstract
Adequate fluid resuscitation in adults with major burns is crucial to prevent or minimize burn shock, but needs to be balanced against the complications of over-resuscitation. A single-center, retrospective review of 95 ICU patients with severe burns from Jan 2014 to Aug 2021 [...] Read more.
Adequate fluid resuscitation in adults with major burns is crucial to prevent or minimize burn shock, but needs to be balanced against the complications of over-resuscitation. A single-center, retrospective review of 95 ICU patients with severe burns from Jan 2014 to Aug 2021 was performed. Some 52 patients were managed with a liberal targeted fluid goal of 4 mL/kg/%TBSA, and 43 patients were managed after we incorporated a restricted fluid goal of 2 mL/kg/%TBSA into our standard resuscitation strategy. Of the 95 patients included in this analysis, 76 patients (80%) survived admission. The median age was 41 years, and the median TBSA was 36%. All patients received Ringer’s lactate as the primary fluid for resuscitation, and 40 of the 95 patients (42%) received colloids as a rescue infusion within 24 h of injury. Some 44 of the 95 patients (46.3%) had a concurrent inhalational injury. The median length of hospital stay was 37 days, and the median ICU length of stay was 18 days. A total of 17 of the 95 patients developed ARDS (17.9%), 51 of the 95 (53.7%) patients developed pneumonia, and 34 of the 95 patients (35.8%) developed AKI within the first 7 days of admission. The median fluid administered during the first day of hospitalization from 2019 onwards remained close to 4 mL/kg/%TBSA, despite transitioning to a 2 mL/kg/%TBSA formula for a 24 h fluid goal (unless there was an electrical burn, in which case the 4 cc/kg formula was utilized). Further exploratory analyses also suggested that under-resuscitation and administration of albumin may be associated with increased mortality, though this did not reach statistical significance. ARDS development was associated with increased age and TBSA as well as increased fluid intake within the first 24 h. A change in the targeted fluid goal from liberal (4 mL/kg/%TBSA) to a restricted (2 mL/kg/%TBSA) formula did not change the actual fluids administered over 24 h when guided by clinical criteria. Our review did suggest that under-resuscitation contributed to mortality, but that excessive fluid resuscitation likely contributed to ARDS risks for large TBSA patients. Our data suggest that strategies to optimize fluid administration are important to improve patient outcomes, but should focus on clinical parameters rather than calculated fluid goals. Full article
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13 pages, 1208 KiB  
Article
Feasibility of Mindfulness for Burn Survivors and Parents of Children with Burns
by Eleni Papamikrouli, Marianne B. Kool, Carine van Schie and Nancy E. E. Van Loey
Eur. Burn J. 2023, 4(2), 221-233; https://doi.org/10.3390/ebj4020020 - 24 May 2023
Viewed by 849
Abstract
Burn survivors, spouses, and parents of children with burns may experience psychological distress for a prolonged period. Mindfulness-Based Stress Reduction (MBSR) is an intervention that can improve psychological well-being. This study aimed to examine the effectiveness of an MBSR group intervention in a [...] Read more.
Burn survivors, spouses, and parents of children with burns may experience psychological distress for a prolonged period. Mindfulness-Based Stress Reduction (MBSR) is an intervention that can improve psychological well-being. This study aimed to examine the effectiveness of an MBSR group intervention in a convenience sample. An MBSR group intervention was conducted for burn survivors (n = 8) and parents of children with burns (n = 9), each comprising eight sessions. The participants completed the Beck Depression Inventory-II-NL, PTSS Checklist DSM-5, Five Facet Mindfulness Questionnaire-Short Form, Self-Compassion Scale-Short form, and evaluation questions at baseline, immediately after, and three months post-intervention. All participants completed the intervention. The intervention was rated very useful (M = 8.8), and the participants were very satisfied (M = 8.8). The highest effect was observed in the parents’ group on mindfulness skills and self-compassion. For both groups, there was an increase in personal goal scores immediately after the intervention. Qualitative data show that the participants in both groups experienced more inner peace, more awareness of thoughts and emotions, and more self-compassion. This exploratory study suggests that a mindfulness intervention is feasible and can be effective in improving mindfulness skills and self-compassion, particularly in parents of children with burns. Full article
(This article belongs to the Special Issue Enhancing Psychosocial Burn Care)
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10 pages, 1064 KiB  
Article
Evaluating the Impact of a Paediatric Burn Club for Children and Families Using Group Concept Mapping
by Emma L. Hodgkinson, Alison McKenzie and Louise Johnson
Eur. Burn J. 2023, 4(2), 211-220; https://doi.org/10.3390/ebj4020019 - 10 May 2023
Viewed by 990
Abstract
Access to burn camps and clubs is cited as an essential element for children following a burn injury. In the Northern Regional Burns Service, this takes the form of a club run by a multidisciplinary team, offering residential camps and family day trips. [...] Read more.
Access to burn camps and clubs is cited as an essential element for children following a burn injury. In the Northern Regional Burns Service, this takes the form of a club run by a multidisciplinary team, offering residential camps and family day trips. In this service evaluation, Group Concept Mapping was used to evaluate the perception of the club by staff, children and families. Opportunistic sampling was used to seek responses to the following prompts: “The challenges for children and families after a burn injury are…” and “The role of The Grafters Club is…”. The results indicate that participants perceived the club to be effective at addressing body image and confidence issues for the children but highlighted an unmet parental expectation that the club would also facilitate the sharing of experiences, normalisation of emotional reactions, and processing of guilt and other psychological distress for parents. When taken concurrently with pre-existing evidence in the literature base, it is proposed that a club model of psychosocial support for children and families could provide an accessible and informal opportunity for parental support that may be less subject to barriers perceived with traditional formal psychological support. Full article
(This article belongs to the Special Issue Enhancing Psychosocial Burn Care)
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8 pages, 576 KiB  
Brief Report
Psychosocial Screening in Adult Burns Inpatients within a Scottish Burns Unit
by Dawn Lindsay, Kim Kirkwood and Rebecca Crawford
Eur. Burn J. 2023, 4(2), 203-210; https://doi.org/10.3390/ebj4020018 - 09 May 2023
Cited by 1 | Viewed by 1068
Abstract
National Burns Care Standards (NBCS) within the UK recommend psychological care throughout the burn pathway and psychosocial screening of inpatients admitted for over 24 h, at a time when this is clinically appropriate and prior to discharge. This brief report presents preliminary data [...] Read more.
National Burns Care Standards (NBCS) within the UK recommend psychological care throughout the burn pathway and psychosocial screening of inpatients admitted for over 24 h, at a time when this is clinically appropriate and prior to discharge. This brief report presents preliminary data from an audit of psychosocial screening in adult burns inpatients within a Scottish Burns Unit over a three-year period. Results are reported on the frequency and type of psychosocial screening completed. Differences between the groups of inpatients who were screened and those not screened are presented and discussed with a focus on plans for increasing the number of inpatients screened and improvements in how psychosocial screening data is collected. Full article
(This article belongs to the Special Issue Enhancing Psychosocial Burn Care)
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8 pages, 249 KiB  
Brief Report
Associations between Ethnicity and Referrals, Access and Engagement in a UK Adult Burns Clinical Psychology Service
by Laura Shepherd, Ishani Hari and Lauren Bamford
Eur. Burn J. 2023, 4(2), 195-202; https://doi.org/10.3390/ebj4020017 - 04 May 2023
Viewed by 999
Abstract
Ethnic inequalities exist across healthcare, including access to and experiences and outcomes of mental health services. Access to and engagement with burns clinical psychology services is essential for all patients. This study aimed to explore the ethnic diversity of adults referred to a [...] Read more.
Ethnic inequalities exist across healthcare, including access to and experiences and outcomes of mental health services. Access to and engagement with burns clinical psychology services is essential for all patients. This study aimed to explore the ethnic diversity of adults referred to a burns clinical psychology service compared to those admitted to the burns service. It also aimed to investigate associations between ethnicity and indicators of access and engagement (receiving, declining or not attending psychological assessments, receiving psychological therapy and the number of therapy sessions completed). Routinely collected data over eight years were analysed. Analysis revealed an association between ethnicity and referral to the burns clinical psychology service. Patients from White British and Other ethnic backgrounds were less likely to be referred, whereas patients from Black and Asian ethnic groups were more likely to be referred. There were no statistically significant associations between ethnicity and receiving, declining or not attending psychological assessments or receiving psychological therapy. Furthermore, there was no statistically significant difference in the number of psychological therapy sessions received between the ethnic groups. Therefore, patients from ethnic minority groups did not appear to have significant difficulties engaging with the service but further research is recommended. Full article
(This article belongs to the Special Issue Enhancing Psychosocial Burn Care)
11 pages, 528 KiB  
Review
Managing Thermal Injuries of the Penis and Scrotum: A Narrative Review
by Tannon Tople, Alexander Skokan, Russell Ettinger and Shane Morrison
Eur. Burn J. 2023, 4(2), 184-194; https://doi.org/10.3390/ebj4020016 - 26 Apr 2023
Viewed by 4505
Abstract
While thermal injuries to the external genitalia occur less often than burns to the trunk and extremities, such injuries can potentially leave patients with devastating lifelong sequelae. Though much is known about treating burns in commonly exposed areas of the body, there is [...] Read more.
While thermal injuries to the external genitalia occur less often than burns to the trunk and extremities, such injuries can potentially leave patients with devastating lifelong sequelae. Though much is known about treating burns in commonly exposed areas of the body, there is a lack of agreement concerning the management of genital thermal injuries. In this review, we seek to synthesize the past and existing literature into a clear analysis while reviewing current recommendations and new developments in the management of genital thermal injuries of the penis and scrotum. Specifically, recommendations for managing genital burns are discussed, including the role of urinary and fecal diversion, debridement, use of skin grafts, and flap coverage choice. Finally, less common thermal injuries, such as frostbite of the genitalia, are discussed. Full article
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11 pages, 282 KiB  
Article
Post-Burn Psychosocial Outcomes in Pediatric Minority Patients in the United States: An Observational Cohort Burn Model System Study
by Paul Won, Li Ding, Kara McMullen and Haig A. Yenikomshian
Eur. Burn J. 2023, 4(2), 173-183; https://doi.org/10.3390/ebj4020015 - 03 Apr 2023
Viewed by 1390
Abstract
Racial and ethnic minority burn patients face barriers to longitudinal psychosocial support after injury. Studies utilizing the Burn Model System (BMS) National Database report adult minority patients experience worse psychosocial outcomes in domains such as body image during burn recovery. No study to [...] Read more.
Racial and ethnic minority burn patients face barriers to longitudinal psychosocial support after injury. Studies utilizing the Burn Model System (BMS) National Database report adult minority patients experience worse psychosocial outcomes in domains such as body image during burn recovery. No study to date has investigated disparities in psychosocial outcomes by racial or ethnic category in the pediatric population using the BMS database. This observational cohort study addresses this gap and examines seven psychosocial outcomes (levels of anger, sadness, depression, anxiety, fatigue, peer relationships, and pain) in pediatric burn patients. The BMS database is a national collection of burn patient outcomes from four centers in the United States. BMS outcomes collected were analyzed using multi-level, linear mixed effects regression modeling to examine associations between race/ethnicity and outcomes at discharge after index hospitalization, and 6- and 12-months post-injury. A total of 275 pediatric patients were included, of which 199 (72.3%) were Hispanic. After burn injury, of which the total body surface area was significantly associated with racial/ethnicity category (p < 0.01), minority patients more often reported higher levels of sadness, fatigue, and pain interference and lower levels of peer relationships compared to Non-Hispanic, White patients, although no significant differences existed. Black patients reported significantly increased sadness at six months (β = 9.31, p = 0.02) compared to discharge. Following burn injury, adult minority patients report significantly worse psychosocial outcomes than non-minority patients. However, these differences are less profound in pediatric populations. Further investigation is needed to understand why this change happens as individuals become adults. Full article
10 pages, 2960 KiB  
Article
Review of Indications for Endotracheal Intubation in Burn Patients with Suspected Inhalational Injury
by Elizabeth Concannon, Lindsay Damkat Thomas, Lachlan Kerr, Ivo Damkat, Benjamin Reddi, John E. Greenwood, Nicholas S. Solanki and Marcus J. D. Wagstaff
Eur. Burn J. 2023, 4(2), 163-172; https://doi.org/10.3390/ebj4020014 - 29 Mar 2023
Viewed by 1886
Abstract
Inhalation injury is a major contributor to mortality following burn injury. Despite recognised clinical criteria to guide the intubation of burn patients, concerns remain regarding overutilisation of intubation. Complications can arise as a result of intubation, including ventilator-associated pneumonia (VAP). This study reviews [...] Read more.
Inhalation injury is a major contributor to mortality following burn injury. Despite recognised clinical criteria to guide the intubation of burn patients, concerns remain regarding overutilisation of intubation. Complications can arise as a result of intubation, including ventilator-associated pneumonia (VAP). This study reviews the indications for intubation against the internationally accepted criteria (American Burns Association (ABA) and Denver criteria) for burn patients treated at the Royal Adelaide Hospital (RAH) burns unit between 2017 and 2020. Burn patients who were intubated on arrival to the RAH or in a pre-hospital setting were identified using the BRANZ database. Indications for intubation were compared to the ABA and Denver criteria. A total of 61 patients were identified with a mean total body surface area of 17.8%. A total of 95% of patients met one of the ABA and Denver criteria. The most common ABA and Denver criteria for intubation was deep facial burns or singed facial hair, respectively. Most adult patients with burns admitted to the RAH are intubated per published criteria. Early nasoendoscopy/bronchoscopy may be useful in determining patients who can be safely extubated within 48 h. Full article
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21 pages, 10765 KiB  
Systematic Review
Laser, Intense Pulsed Light, and Radiofrequency for the Treatment of Burn Scarring: A Systematic Review and Meta-Analysis
by Yubing Bai, Yiqiu Zhang, Wei Ni and Min Yao
Eur. Burn J. 2023, 4(2), 142-162; https://doi.org/10.3390/ebj4020013 - 23 Mar 2023
Cited by 2 | Viewed by 1566
Abstract
Burns and scarring are considered some of the greatest problems in public health because of their frequent occurrence. Today, photo-electric technology shows promising results in the treatment of burn scars. Over the years, more clinical trials and more technologies for scarring have emerged. [...] Read more.
Burns and scarring are considered some of the greatest problems in public health because of their frequent occurrence. Today, photo-electric technology shows promising results in the treatment of burn scars. Over the years, more clinical trials and more technologies for scarring have emerged. The aim of this study was to determine better timing and methods of photo-electric therapy for burn scars. This study was registered in PROSPERO (CRD42023397244), following the PRISMA statement, and was carried out in concordance with the PRISMA checklist. In October 2022, we searched PubMed.gov, Embase, and the Cochrane library (1980–present) for published studies related to the photo-electric treatment of burn scars. Two review authors independently selected the studies, extracted the data, assessed the risk of bias among the studies included, and carried out NIH assessments to assess the certainty of the evidence. A third review author arbitrated any disagreements. Our research included 39 studies. We found evidence suggesting that photo-electric therapy between six months and one year offers significantly better outcomes than treatment of scarring after one year. The evidence also suggests the use of IPL for the treatment of early burn scarring. However, it is important to emphasize that the scientific evidence remains insufficient. We need more clinical trials of higher quality and with less heterogeneity to confirm our results. Full article
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