Journal of Burn Care & Research : Official Publication of the American Burn Association

Healthcare providers evaluating patients presenting with neurological, visceral, or cutaneous symptoms that are disproportionate to the expected severity may need to consider porphyria in the differential. Porphyria is an inherited condition in which toxic metabolites of the heme pathway are increased. Carriers of porphyrias are asymptomatic and will not present with classical symptoms, nor will levels be elevated, until the disease is induced by certain drugs, hormones, or idiopathic causes such as the stress of trauma...

Worldwide, thermal burn is the leading etiological type of burn injury accounting for 86% of burn injuries requiring admissions. Flame, Scald, and contact burn are the leading causes of thermal burn. Changes in the sociodemographic characteristics of societies has led to alterations in the epidemiology of burn. An understanding of such changes in the epidemiology of burn is essential in formulating and executing adequate burn prevention programs. We sought to establish the current trend in the etiology, gender distribution, age, occurrence of inhalation injury, burn surface area, burn depth, and mortality rate of thermal burns at Ibadan...

The devastating fire on January 9, 2022, led to the death of eight children and nine adults in New York City's Bronx borough. Previous reports have suggested that heating complaints in low socioeconomic Black/Latinx communities are frequently ignored. This trend suggests the existence of housing inequities and landlord negligence, which may lead to higher rates of residential fires in the Bronx and other low-income neighborhoods. However, this assertion has yet to be scientifically investigated. Two datasets (New York City Open Data Portal Fire Incident Dispatch and 311 Heat/Hot Water Complaints) were merged to determine the frequency of heating complaints and structural fires per month among community districts in New York City between 2017 and 2022...

Since 1970 surgeons have managed deep burns by surgical debridement and autografting. We tested the hypothesis that enzymatic debridement with NexoBrid®would remove the eschar reducing surgery and achieve comparable long-term outcomes as standard of care (SOC). In this Phase 3 trial, we randomly assigned adults with deep burns (covering 3-30% of total body surface area) to NexoBrid, surgical or non-surgical SOC, or placebo Gel Vehicle (GV) in a 3:3:1 ratio. The primary endpoint was complete eschar removal (ER) at the end of the debridement phase...

Skin grafting is the mainstay treatment in burn patients. However, in the scenario of soft tissue deficit along with exposure of critical structures, free flap is the only reconstructive option to provide adequate coverage. The aim of the study is to review indications and surgical outcomes of burn patients requiring free tissue transfer. A retrospective cohort study was conducted to review all patients who underwent free tissue transfer for burn-related injuries between March 2012 and June 2023. A total of 13 patients required a free flap for their reconstruction...

Physical, social, and psychological outcomes have been identified as relevant to the rehabilitation process of children with burn injuries. Existing legacy measures are limited in item content and only cover a few constructs. Condition-specific outcomes are highly relevant to gauge early growth and development. Computerized adaptive tests (CATs) leveraging advanced psychometric technologies minimize respondent burden. This project developed PS-LIBRE1-5 Profile CAT (Preschool Life Impact Burn Recovery Evaluation) to measure relevant post-burn outcomes in children aged one to five...

Patients with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have traditionally been treated in burn centers. Our burn center's approach differs by admitting these patients to a medicine service, with support from the burn team. The aim of this study was to determine whether SJS/TEN patients cared for with our system, with burn involvement but not burn admission, demonstrate equivalent outcomes. We conducted a retrospective review of all SJS/TEN patients admitted to the medicine service at a single academic medical center from 2009 to 2021...

Despite advancements in burn care, evidence estimates that pathological scarring occurs in 32% to 75% of cutaneous burns. Scar massage therapy is an under researched method of management for hypertrophic burn scars which has scope to be a low-cost treatment alternative. The aim of this systematic review was to determine the efficacy of scar massage techniques for common hypertrophic burn scar symptoms such as contraction, pruritus, pain and visibility. The keywords and corresponding MeSH terms were inputed into PubMed, EMBASE, Cochrane database of Systematic Reviews, University Library of Hull, York and Queen Mary, University of London...

Specialized burn centers are critical in minimizing burn-associated morbidity and mortality. However, American Burn Association (ABA)-verified burn centers are unequally distributed across the U.S., and fewer centers are available for pediatric patients relative to adults. The economic burden of transport to these centers contributes significantly to the high cost of burn care. This study quantifies inequitable burn care access in the contiguous U.S. due to age group and location as a function of physical proximity to a verified burn center and transportation cost...

Patients with augmented renal clearance (ARC) are a subset of critically ill patients including burn patients that exhibit increased renal elimination of medications beyond that of similarly injured patients. Currently approved maximum regimens of medications primarily eliminated by the kidney, such as cefepime (>90% unchanged in the urine), may be inadequate (e.g. compromising the bactericidal activity of cefepime) in patients with ARC. Due to recent resource limitations, centers have changed infusion practices of commonly prescribed medications to intravenous push (IVP), potentially exacerbating the problem of maintaining bactericidal cefepime concentrations...

The aim of the study is to assess the suitability of the herbal formulation for topical application as a skin burn dressing on the in vivo wound-closure of third-degree wound injuries. Rat wound models were used to prove the in vivo skin burn-healing process. Body weight gain, food and water intake, and behavior were investigated daily during treatment period. Cutaneous biopsies of the burned wound surfaces were monitored at days 4, 13, and 28. Formulation markedly (P < .05) increased wound repair rate and collagen production compared to untreated burnt skin...

Dermal substitutes have become fundamental tools for covering skin defects, most recently with biological subtypes such as glycerolized acellular dermal matrix (GADM). However, literature regarding this matter is scarce in Latin America and Colombia. In this descriptive observational study, we compared the use of partial skin autografts (PSA) combined with GADM and autografts without GADM. Patients were selected from the burn unit of a hospital in northeastern Colombia between 2021 and 2022. Two study groups were defined: one receiving GADM plus PSA, and the other control receiving only a partial split-thickness autograft...

The aim of this study is to investigate the contribution of concurrent physical therapy to the preservation of hand function in patients with hand burns. This retrospective cohort study included the records of adult patients who presented with hand burns between July 1, 2020, and December 1, 2021. A total of 67 out of 1578 burn patients who attended the clinic were included in this study. The patients' age, sex, total body surface area with burns, causative agent, depth of burn on the hand, right or left hand, location of the burned area on the hand, treatment applied, healing time of the burn on the hand, limitation of movement, , the joint restrictions, contractures and compliance with physical therapy were assessed and recorded...

Mothers closely follow the complex process due to the burning of their children. Caring for and supporting the child can pose various challenges for mothers. With the phenomenological method, this study was conducted to investigate mothers' experiences staying with their children in the pediatric burn intensive care unit. Twelve mothers participated in the study. The semi-structured face-to-face interviews obtained data. After each interview, the research team transcribed the interviews verbatim. Interpretive Phenomenological Analysis was used to analyze the data...

This project tested the hypothesis that burn survivors can perform mild/moderate-intensity exercise in temperate and hot environments without excessive elevations in core body temperature. Burn survivors with low (23±5%TBSA; N=11), moderate (40±5%TBSA; N=9), and high (60±8%TBSA; N=9) burn injuries performed 60 minutes of cycle ergometry exercise (72±15 watts) in a 25°C and 23% relative humidity environment (i.e., temperate) and in a 40°C and 21% relative humidity environment (i...

Due to its boiling point of -196°C, liquid nitrogen is a cryogenic substance which is commonly used in many industries for its cooling properties. However, this extreme cooling capability means it also has the potential to inflict severe full-thickness burns. Despite its widespread use in the workplace, very little has been described in the literature regarding complex reconstruction of liquid nitrogen burns. We present a case that is unique, not only in its unusual mechanism of injury, but also in that it is the first described case of free tissue reconstruction of cryogenic burns...

Patients with an extremely large, burnt surface area have a high mortality rate. The follow-up, treatment and intraoperative anesthesia practices of these patients in the ICU pose serious challenges. In this case, the experience of anesthesia and analgesia using cervical epidural anesthesia, which is not frequently used in anesthesia routine, applied to a patient with a 90% burnt surface area is shared. It was aimed to evaluate the contribution of effective non-opioid analgesia, early mobilization and nutrition applied to the patient's recovery...

The management of severe burns remains a complex challenge. Adenosine, lidocaine and magnesium (ALM) resuscitation therapy has been shown to protect against hemorrhagic shock and traumatic injury. The aim of the present study was to investigate the early protective effects of small-volume ALM fluid resuscitation in a rat model of 30% total body surface area (TBSA) thermal injury. Male Sprague-Dawley rats (320-340g; n=25) were randomly assigned to: 1) Sham (surgical instrumentation and saline infusion, without burn, n=5), 2) Saline resuscitation group (n=10), or 3) ALM resuscitation group (n=10)...

Burn injury accounts for a large proportion of surgically treatable disease. It is estimated that over 180,000 flame burn deaths occur annually across the globe, with roughly 95% occurring in low- or middle-income countries (LMIC). Within these countries children account for a disproportionately high number of burn injuries. As such, the WHO has identified burn prevention as a topic of interest, with an increased need in low- and middle-income countries. Here we describe the creation and implementation of a burn prevention program in Ukraine...

Sepsis is the main cause of death in major burns. In this retrospective study conducted in a reference hospital in Brazil, the main agents causing infection and the resistance profile to antibiotics were identified. Additionally, the epidemiological profile, length of hospital stay, type of burn and total body surface area (TBSA) in major burns were collected from medical records, comparing the years 2015/2016 and 2019/2020. In both time periods, there was a predominance of males with a mean age of 43 years...