BACKGROUND: An increasing number of high voltage electric burn injuries in a typically younger patient collective of train surfers and climbers at our level I center for burns was recognized. The purpose of this study was a retrospective data evaluation and as a consequence the implementation of an awareness program against train surfing.
METHODS: In a retrospective analysis of prospectively collected data, 17 patients with high voltage injuries, who had been treated at our unit between January 2022 and January 2023, were identified. Of these patients seven were treated for injuries due to train surfing or climbing and therefore included in this study. The patients were assessed clinically for total burn surface area (TBSA), degree of burn, associated Injuries, hospital length of stay, number and type of surgeries (fasciotomy, minor/major amputations, defect coverage split skin graft or flaps).
RESULTS: A total of seven males formed the basis of this report with an average age of 17.7 years (range 14-21 years). The highest ABSI (Abbreviated Burn Severity Index) score was 12, leading to the death of the 21-year-old patient who had 80% TBSA as well as multiple comorbidities including severe brain damage. The mean duration of stay at the intensive care unit (ICU) was 24.8 days and the mortality rate was 14.29%.
CONCLUSIONS: This study highlighted the severity of injuries, with a mean TBSA of 41.42% and a mortality rate of 14.29% among the study population. Train climbing and surfing patients presented with severe injuries and fatal long-term consequences. A pilot project involving several stakeholders was initiated in order to raise awareness of the dangers of electric arcs and the risk involved.

Background: Burn care has long been an integral part of the scope of plastic surgery, but the time allocated to exposure for plastic surgery residents is under threat due to the range of sub-specialities competing for their time. As part of the Competence by Design approach to plastic surgical training, residents are provided with a list of 52 \"Entrustable professional activities\' (EPA\'s) to ensure that core skills and knowledge are acquired. Methods: This survey, distributed via email using a link to Survey MonkeyTM, sought to determine which EPA\'s were available for completion by plastic surgeons in training during the burn rotation at a major academic burn centre in Canada. Via investigator consensus, 26 of the 52 EPA\'s were included for assessment; the remaining 26 were not regarded as relevant to the burn centre rotation and therefore better acquired elsewhere. Results: Thirty two residents who underwent a burn rotation between 1 January 2015 and 31 December 2021 completed the anonymous survey. Seventeen of the 26 EPA\'s evaluated were judged by more than 75% of respondents as being readily amenable to completion during the burn rotation. Most of these EPA\'s relate to the comprehensive care of patients with acute burn injuries, the management of an in-patient plastic surgery service, and associated quality improvement processes. Residents who completed rotations less than three months in duration had less opportunity to complete a further 8 EPA\'s in comparison to those who had longer rotations, especially with respect to the care of patients undergoing complex wound care and burn reconstruction. Conclusions: In addition to threatening seamless service delivery at burn centres, reduced resident exposure to the burn rotation may compromise the delivery of burn care in the community. The results of this survey refute any argument that the burn service is a \"low yield\" rotation from an EPA acquisition perspective.
Historique: Les soins aux grands brûlés font partie intégrante de la chirurgie plastique depuis longtemps, mais le temps alloué à y exposer les résidents en chirurgie plastique est menacé en raison de l’éventail de surspécialités. Dans le cadre de l’approche de compétence par conception à la formation en chirurgie plastique, les résultats reçoivent une liste de 52 « activités professionnelles confiables » (APC) pour assurer qu’ils acquièrent les compétences et le savoir de base. Méthodologie : Ce sondage, distribué par courriel grâce à un lien vers la plateforme Survey MonkeyMD, visait à déterminer quelles APC étaient offertes aux chirurgiens plastiques en formation pendant leur rotation dans un grand centre universitaire pour grands brûlés du Canada. Par consensus des chercheurs, 26 des 52 APC ont été incluses dans l’évaluation. Les 26 autres n’ont pas été considérées comme pertinentes pour la rotation au centre pour grands brûlés, mais mieux à même d’être acquises ailleurs. Résultats:  Au total, 32 résidents qui ont participé à une rotation auprès des grands brûlés entre le 1er janvier 2015 et le 31 décembre 2021 ont rempli le sondage anonyme. Selon plus de 75% d’entre eux, 17 des 26 APC évaluées peuvent facilement être effectuées pendant la rotation auprès des grands brûlés. La plupart de ces APC portent sur les soins complets aux patients atteints de brûlures aiguës, la gestion d’un service de chirurgie plastique aux patients hospitalisés et les processus d’amélioration de la qualité qui s’y associent. Les résidents qui ont effectué leur rotation en moins de trois mois avaient moins l’occasion d’effectuer huit APC de plus par rapport à ceux qui avaient vécu des rotations plus longues, particulièrement à l’égard des soins des plaies complexes aux patients et de la reconstruction après leurs brûlures. Conclusions : En plus de menacer la prestation harmonieuse des services dans les centres pour grands brûlés, la moins grande exposition des résidents à la rotation des grands brûlés peut compromettre la prestation des soins aux grands brûlés dans la communauté. Les résultats de ce sondage réfutent toute prétention selon laquelle les services aux grands brûlés est une rotation « à faible rendement » selon le point de vue de l’acquisition des APC.

Finding a perfect epidermal transplant remains a holy grail of burn surgery. The epidermis is a site of stem cells that allows for the epithelial regeneration. The use of CEA for the treatment of major burns was first reported in 1981. CEA requires specialized skills; thus, reports from different burn-centers have shown mixed results. Comparing our modern data with past data shows how this field has advanced while maintaining institutional control. We performed a retrospective analysis of all patients admitted between 01/01/1988-12/31/2021 for massive burns that were managed with CEA. Patients were divided into pre-defined groups: G1(early-era)=1988-1999, G2(pre-modern-era)=2000-2010, and G3(modern-era)=2011-2021. We compared demographics, %TBSA, presence of inhalation-injury, LOS, complications, and mortality. We treated 52 patients with CEA during the study period. In the modern-era, we found 11 patients; in the pre-modern-era, 10; and in the early-era, 31. Injury characteristics, including %TBSA and the presence of inhalation-injury, were not significantly different between the groups. We observed lower mortality rates in G1 and G3 (G1:20% vs. G2:42% vs. G3:27%, p<0.05), although the predicted mortality was not significantly different between the groups (G1:50% vs. G2:47% vs. G3:49%, NS). Patients in G1 also had a shorter hospital LOS, in days, (G1:90 vs. G2:127 vs. G3:205, p<0.05). Finally, the surface-area grafted per patient was the highest in G2 (G1:2,000cm2 vs. G2:4,187cm2 vs. G3:4,090cm2, p<0.01). CEA has not gained popularity despite proven positive outcomes. Our retrospective analysis showed that CEA should be considered as a treatment option for patients with large burns, given proper training and infrastructure.

Seasonal acclimatization is known to result in adaptations that can improve heat tolerance. Staff who operate on burn injuries are exposed to thermally stressful conditions and seasonal acclimatization may improve their thermoeffector responses during surgery. Therefore, the aim of this study was to assess the physiological and perceptual responses of staff who operate on burn injuries during summer and winter, to determine whether they become acclimatized to the heated operating theater. Eight staff members had physiological and perceptual responses compared during burn surgeries conducted in thermoneutral (CON: 24.1 ± 1.2°C, 45 ± 7% relative humidity [RH]) and heated (HOT: 31.3 ± 1.6°C, 44 ± 7% RH) operating theaters, in summer and winter. Physiological parameters that were assessed included core temperature, heart rate, total sweat loss, sweat rate, and urinary specific gravity. Perceptual responses included ratings of thermal sensation and comfort. In summer, CON compared to winter CON, baseline (85 ± 15 bpm VS 94 ± 18 bpm), mean (84 ± 16 bpm VS 93 ± 18 bpm), and peak HR (94 ± 17 bpm VS 105 ± 19 bpm) were lower (p < 0.05), whereas core temperature was not different between seasons in either condition (p > 0.05). In HOT, ratings of discomfort were higher in summer (15 ± 3) than winter (13 ± 3; p > 0.05), but ratings of thermal sensation and sweat rate were similar between seasons (p > 0.05). The surgical team in burns in Western Australia can obtain some of the physiological adaptations that result from seasonal acclimatization, but not all. That is most likely due to a lower than required amount of outdoor heat exposure in summer, to induce all physiological and perceptual adaptations.

暂无摘要。

Regenerative therapies such as fat grafting and Platelet Rich Plasma (PRP) have emerged as new options to tackle burn-related injuries and their long-term sequelae. Fat grafting is able to promote wound healing by regulating the inflammatory response, stimulating angiogenesis, favoring the remodeling of the extracellular matrix, and enhancing scar appearance. PRP can enhance wound healing by accelerating stages including hemostasis and re-epithelization. It can improve scar quality and complement fat grafting procedures. Their cost-effectiveness, minimal invasiveness, and promising results observed in the literature have made these tools as therapeutic candidates. The current evidence on fat grafting and PRP in acute and reconstructive burns is described and discussed in this study.

In recent decades, advances in surgical anatomy, burn pathophysiology, surgical techniques, and laser therapy have led to a paradigm shift in how we approach burn scars and contractures. Scar excision and replacement with uninjured tissue, which predominated burn scar treatment for much of the 20th century, is no longer appropriate in many patients. A scar\'s intrinsic ability to remodel can be induced by reducing tension on the scar using various techniques for local tissue rearrangement. Often in combination with laser therapy, local flaps can optimally camouflage a burn scar with adjacent normal tissue and restore a patient more closely to their preinjury condition.

Fellowship program websites pertaining to various subspecialties have been evaluated according to the amount and type of content they communicate to prospective applicants. This study aimed to evaluate what information specifically burn fellowship programs communicate through their websites and to what extent, if at all. Ten of the 30 unique burn fellowship programs, American Burn Association (ABA)-verified or otherwise, identified through the ABA website did not have official websites which could be readily located at time of data collection. Thus, twenty burn fellowship program websites were included in analysis. Burn fellowship program websites were assessed according to 23 criteria relating to recruitment, education, and social life. On average, each website contained an average of 8.5 ± 2.6 criteria (range, 2 - 13), with all of them listing a program contact email/phone, and 95% containing a program description. Only 35% of programs listed the faculty, and a single program advertised alumni job placement. Neither total number of fellows, total number of clinical faculty, nor Accreditation Council for Graduate Medical Education accreditation status were significantly associated with amount or type of content. Geographic region was associated with a significant difference in amount of education-related content. Fellowship program websites are important to prospective applicants when comparing programs and deciding where to apply. These results show where burn fellowship programs can increase the amount of publicly-available information that applicants tend to find helpful in order to hopefully both diversify and tailor their applicant pool to those whose goals align with the programs\'.

BACKGROUND: Contact layer dressing (CLD) is standard after autologous skin cell suspension (ASCS); however, the authors wondered whether a poly-lactic acid dressing (PLAD) results in superior outcomes and cost savings.
METHODS: Retrospective cohort study including greater than 10% total body surface area (TBSA) burns treated with ASCS and either PLAD or CLD. Primary outcomes were infection and length of stay (LOS).
RESULTS: 71 patients (76% male, 24% pediatric, mean age 37 years) were included. Twenty-eight patients (39%) received CLD and 43 (61%) received PLAD. Wound infections were decreased in PLAD (7 vs 32%, p = 0.009). When controlling for area grafted (cm2) and TBSA, logistic regression revealed odds of post-operative infection was 8.1 times higher in CLD (p = 0.015). PLAD required antibiotics for fewer days (mean 0.47 vs 4.39, p = 0.0074) and shorter LOS (mean 17 vs 29 days, p < 0.001). Mean adjusted charges per %TBSA was $18,459 in PLAD vs. $25,397 in CLD (p = 0.0621).
CONCLUSIONS: In the first analysis of its kind, this study showed polylactic acid dressing combined with autologous skin cell suspension led to a decrease in postoperative infections, length of hospital stay, and total patient charges.

This study aims to establish the significance of social determinants of health and prevalent co-morbidities on multiple indicators for quality of care in patients admitted to the Burn and Surgical Intensive Care Unit (ICU).
We performed a retrospective analysis of population group data for patients admitted at the Burn and Surgical ICU from January 1, 2016, to November 18, 2019. The primary outcomes were length of hospital stay (LOS), mortality, 30-day readmission, and hospital charges. Pearson\'s chi-square test for categorical variables and t-test for continuous variables were used to compare population health groups.
We analyzed a total of 487 burn and 510 surgical patients. When comparing ICU patients, we observed significantly higher mean hospital charges and length of stay (LOS) in BICU v. SICU patients with a history of mental health ($93,259.40 v. $50,503.36, p = 0.013 and 16.28 v. 9.16 days, p = 0.0085), end-stage-renal-disease (ESRD) ($653,871.05 v. $75,746.35, p = 0.0047 and 96.15 v. 17.53 days, p = 0.0104), sepsis ($267,979.60 v. $99,154.41, p = <0.001 and 39.1 v. 18.42 days, p = 0.0043), and venous thromboembolism (VTE) ($757,740.50 v. $117,816.40, p = <0.001 and 93.11 v. 20.21 days, p = 0.002). Also, higher mortality was observed in burn patients with ESRD, ST-Elevation Myocardial Infarction (STEMI), sepsis, VTE, and diabetes mellitus. 30-day-readmissions were greater among burn patients with a history of mental health, drug dependence, heart failure, and diabetes mellitus.
Our study provides new insights into the variability of outcomes between burn patients treated in different critical care settings, underlining the influence of comorbidities on these outcomes. By comparing burn patients in the BICU with those in the SICU, we aim to highlight how differences in patient backgrounds, including the quality of care received, contribute to these outcomes. This comparison underscores the need for tailored healthcare strategies that consider the unique challenges faced by each patient group, aiming to mitigate disparities in health outcomes and healthcare spending. Further research to develop relevant and timely interventions that can improve these outcomes.