A Review of Burn Patients Requiring Extracorporeal Membrane Oxygenation at a Burns Facility

Respiratory compromise is a recognised sequelae of major burn injuries, and in rare instances requires extracorporeal membrane oxygenation (ECMO). Over a ten-year period, our hospital trust, an ECMO centre and burns facility, had five major burn patients requiring ECMO, whose burn injuries would normally be managed at trusts with higher levels of burn care. Three patients (60%) survived to hospital discharge, one (20%) died at our trust, and one patient died after repatriation. All patients required regular, time-intensive dressing changes from our specialist nursing team, beyond their regular duties. This review presents these patients, as well as a review of the literature on the use of ECMO in burn injury patients. A formal review of the overlap between the networks that cater to ECMO and burn patients is recommended.

Comparative Analysis of Hydrogen Fluoride Exposed Patients Based on Major Burn Criteria After the 2012 Gumi City Chemical Leak Disaster

This study conducted to analyze and compare the epidemiological and clinical characteristics of hydrogen fluoride exposed patients based on major burn criteria for the appropriate emergency department (ED) response to a mass casualty chemical spill. This retrospective cross-sectional study included the records of patients (n = 199) who visited the ED of Gumi City University Hospital from September 27, 2012, to October 20, 2012. Subjects were included in the major burn group (MBG) if they presented with wounds that required referral to a burn center according to the American Burn Association guidelines or in the non-major burn group (NMBG) if not. Males were predominant in both the MBG (n = 55, 48 males) and NMBG (n = 144, 84 males; p < 0.05). The most prevalent timeline for visiting the ED was the phase which included 9-32 hours post-leak of HF, including 45 patients (81.8%) in the MBG and 122 patients (84.7%) in the NMBG (p < 0.001). The respiratory tract was the site of greatest damage in patients in both the MBG and NMBG (n=47, 85.5% versus n=142, 98.6%, p < 0.001). Regarding dispositions, all patients in the NMBG were discharged (n=144, 100%); however, 8 patients (14.5%) in the MBG underwent other dispositions (discharge againt medical advice, 5 patients; admission, 1; death, 2, p < 0.05). Patient outcomes after major chemical contamination events should be characterized in future studies to maximize the quality of patient care.

A case of burn evisceration with full-thickness injury to abdominal wall, bowel, bladder, and three extremities

Background Severe electrical burns are a rare cause of admission to major burn centers. Incidence of electrical injury causing full-thickness injury to viscera is an increasingly scarce, but severe presentation requiring rapid intervention. We report one of few cases of a patient with full-thickness electrical injury to the abdominal wall, bowel, and bladder. Case report The patient, a 22-year-old male, was transferred to our institution from his local hospital after sustaining a suspected electrical burn. On arrival the patient was noted to have severe burn injuries to the lower abdominal wall with evisceration of multiple loops of burned small bowel as well as burns to the groin, left upper, and bilateral lower extremities. In the trauma bay, primary and secondary surveys were completed, and the patient was taken for CT imaging and then emergently to the operating room. On exploration, the patient had massive full-thickness burns to the lower abdominal wall, five full-thickness burns to small bowel, and intraperitoneal bladder rupture secondary to full-thickness burn. The patient underwent damage-control laparotomy including enterectomies, debridement of bladder coagulative necrosis, and layered closure of bladder injury followed by temporary abdominal closure with vacuum dressing. The patient also underwent right leg escharotomy and partial right foot fasciotomies. The patient was subsequently transferred to the nearest burn center for continued resuscitation and comprehensive burn care. Conclusion Severe electrical burns can be associated with devastating visceral injuries in rare cases. Though uncommon, these injuries are associated with very high mortality rates. The authors assert that rapid evaluation and initial stabilization following ATLS guidelines, damage-control laparotomy, and goal-directed resuscitation in concert with transfer to a major burn center are essential in effecting a successful outcome in these challenging cases.

Postburn Hand Deformities: Principles of Management and Approach

The hand is one of the top 3 locations for burn scar contracture deformity. The functionality of the hands is one of the primary determinants of burns survivors’ quality of life. Although most burn abnormalities are preventable, they do arise when adequate treatment is not delivered in an emergency or when they are part of a major burn. Reconstructive surgeries can significantly improve hand function. For a burn’s survivor, the right methods and timing of surgery, followed by supervised physiotherapy, can be a game changer.

Major Burn Injury Successfully Treated with Cultured Epithelial Autografts, a Case Series Presentation: Establishing Standard Clinical Practices

Cultured epithelial autografts have been an option for coverage of large surface area burns for over two decades. However, there remains extreme variability in clinical practice in wound bed preparation, application of cultured epithelial autografts, and post-operative wound care and rehabilitation practices, demonstrating the need for a standardized and multidisciplinary approach in the treatment of critically injured patients treated with cultured epithelial autografts. The purpose of this case series was to share the development of a clinical practice guideline and competency checklist in our institution where cultured epithelial autograft case volume is low. In this case series, we examined the medical records of three patients treated with cultured epithelial autografts at a single burn center over a period from 2015-2018. Operating room times and fluid resuscitation volumes were examined on days when cultured epithelial autograft grafting was performed. In order to facilitate meticulous post-operative wound care in a facility where only 1-2 cultured epithelial autograft applications are performed per year, a clinical practice guideline and competency checklist were generated and trialed on a series of nurses and rehabilitation therapists for the three applications of cultured epithelial autografts. Amongst the patients treated with cultured epithelial autografts, the average TBSA burned was 71.6%. Less intra-operative crystalloid administration and faster operative case times were associated with improved cultured epithelial autograft success. The inclusion of the clinical practice guideline and checklist into our practice led to reported improved confidence in patient care, along with the successful outcomes of these cultured epithelial autograft applications.