Oﬃcial Congress of Asia Paciﬁc Burn Association

The 13th Asia Pacific Burn CongressOfficial Congress of Asia Pacific Burn Association

The 13th Asia Pacific Burn CongressOfficial Congress of Asia Pacific Burn Association

APBC2021APBC2021

Live SessionsOn-Demand

Thursday, October 21 - Sunday, October 24Thursday, October 21 - Sunday, November 7

THE NEXT DYNAMIC CHANGE IN BURN CARE - Coping with Infection, Infection prevention and control -

Program & Abstract

Congress PresidentHajime MATSUMURA, MD, DMSc, FACS Department of Plastic and Reconstructive Surgery,

Tokyo Medical University

Virtual Meeting

3

APBC & JSBI 2021 LIVESTREAM SCHEDULE E：Session in English

Thursday, October 21 Friday, October 22 Saturday, October 23 Sunday, October 24

9:00

9:20-10:20

Report of the Academic Committee of the

Japanese Burn Association

9:20-10:00Invited Lecture 3

The Need for a Surviving Sepsis After Burn Campaign

Speaker : David GREENHALGHModerator : Hiroshi TANAKA

309:30-10:00

JSBI General Assembly10:00


COVID-19 and Burn Systems: What we should learn for future health security policy.

Speaker : Mark FISHERModerator : Hajime MATSUMURA

10:10-10:45Presidential Speech

The Importance of Prevention and Treatment of Infections in Burn Care

Speaker : Hajime MATSUMURAModerator : Si Jack CHONG ｜ Junichi SASAKI

10:10-10:50

Sponsored Seminar 8MIMEDX Group, Inc.

3010:30-11:40

JSBI Panel DiscussionPost ABLS; How to Standardize Burn

Care in Japan?

Moderator : Yoshinori MURAO Minoru NAKANO

11:00 11:00-11:40JSBI Educational Lecture 2Burn Rehabilitation; Focus on the

Viewpoint of TherapistsSpeaker : Masahiko KIMURA

Moderator : Ichiro HASHIMOTO

11:00-11:50

APBC Symposium 1Burn Care During the COVID-19

PandemicModerator : Niann-Tzyy DAI ｜ Hiroto IKEDA

11:00-12:20

APBC Symposium 4Burn Treatment Guideline

Moderator : David GREENHALGHAsako MATSUSHIMA

30

11:50-12:30Sponsored Seminar 1

ALCARE Co., Ltd / Olympus Terumo Biomaterials Corp.

（The official language Japanese）


Japan Tissue Engineering Co., Ltd.（The official language Japanese）

12:0012:00-12:30

APBA General Assembly30

Promotion Live Promotion Live12:30-13:10

Sponsored Seminar 9Mölnlycke

12:40-13:15Plenary Speech

Historical Perspectives and the next ten years of APBA Speaker : Rajeev AHUJA

Moderator : Aditya WARDHANA ｜ Nyoman Putu RIASA

13:0013:00-14:20

JSBI Symposium 1Environment of Burn Care to

Prevent Infection～ Especially in Initial Treatment

Moderator : Kiyoshi MATSUDA Kiyotsugu TAKUMA

13:00-14:20

JSBI Symposium 3Surgical Treatment of Burn Scars/

Scar Contracture

Moderator : Hiroshi YASUDA Kenichi SHIMADA

13:20-14:50

APBC Symposium 5Scar Management and Surgery, Post-Burn Scar Contracture and

Keloids

Moderator : Rei OGAWA Dong Chul KIM

30 13:25-14:45

APBC Symposium 2Management of Burn Wound

Infection

Moderator : Jun WU Hiroyuki SAKURAI

14:00

3014:30-15:10

Sponsored Seminar 2ConvaTec Japan KK

GUNZE LIMITED（The official language Japanese）

14:30-15:10

Sponsored Seminar 5COSMOTEC Co., Ltd.15:00

15:00-15:40

Sponsored Seminar 7Smith + Nephew PLC

15:00-15:40

Sponsored Seminar 10Syneron Candela K.K.15:20-16:40

JSBI Symposium 2How to Control Local Infection in

Artificial Dermis / Cultured Epidermis Cases?

What Are the Specific Methods?

Moderator : Hiroto IKEDA Hiromi MIYAZAKI

15:20-16:30

JSBI Symposium 4Japanese Burn Association Registry,What have we learned in 10 years?

What do we do next?

Moderator : Katsumi TANAKA Yoshiaki INOUE

30


Current Diagnosis of Inhalation InjurySpeaker : Folke SJÖBERG

Moderator : Daizoh SAITOH

15:50-17:35

APBC Symposium 6Laser/Aesthetic Treatment in Burn

Care

Moderator : Jui-Yung YANG Taro KONO

16:00

30


Century Medical, Inc.（The official language Japanese）

16:40-18:00

APBC Symposium 3Infection Control in Burn ICU/Burn

Unit

Moderator : Folke SJÖBERG Jun ODA


KAKEN PHARMACEUTICAL CO.,LTD.（The official language Japanese）

17:00

3017:30-18:10

Special LectureFuture Management of Burn Sepsis

Speaker : Naiem MOIEMENModerator : Junichi SASAKI

17:40-18:20JSBI Educational Lecture 1

Current Status of COVID-19 and Adequate Clinical Practice - Including

Care of Burn PatientsSpeaker : Tetsuya MATSUMOTO

Moderator : Jun ODA

18:00

30

19:00

30

20:00

E

E

E

E

E

E

E

E

E

E

E

E

E

E

E

E

E

E

17:35-17:40Closing Remarks

9:05-9:10Opening Remarks

The 47th JSBI & The 13th APBC

Program

Program

Special Lecture Live-streaming

Friday, October 22　　17：30 - 18：10

Moderator：Junichi SASAKIEmergency and Critical Care MedicineKeio University School of MedicineJAPAN

Future Management of Burn SepsisNaiems S MOIEMENBurn and Plastic Surgery, University of Birmingham School of Medicine UK

Invited Lecture 1 Live-streaming

Friday, October 22　　10：10 - 10：50

Moderator：Hajime MATSUMURADepartment of Plastic and Reconstructive SurgeryTokyo Medical UniversityJAPAN


Mark FISHERPlastic and Reconstructive Surgery, University of Iowa Hospitals & Clinics USA


Saturday, October 23　　15：50 - 16：30

Moderator：Daizoh SAITOHDivision of Traumatology, Research InstituteNational Defense Medical CollegeJAPAN

Current Diagnosis of Inhalation InjuryFolke SJÖBERGThe Burn Center, Linköping University Hospital / Department of Biomedical and Clinical Scienses (BKV), Linköping University SWEDEN

5

ProgramThe 47th JSBI & The 13th APBC


Sunday, October 24　　9：20 - 10：00

Moderator：Hiroshi TANAKADepartment Emergency and Disaster MedicineJuntendo University Urayasu HospitalJAPAN

The Need for a Surviving Sepsis After Burn CampaignDavid G. GREENHALGHShriners Hospitals for Children Northern California and Department of Surgery, University of California USA

Plenary Speech Live-streaming


Moderator：Nyoman Putu RIASAPlastic Surgery DivisionUdayana University Sanglah General Hospital DenpasarINDONESIA

Aditya WARDHANAPlastic, Reconstructive, and Aesthetic Surgery DivisionRSCM-FKUIINDONESIA

Historical Perspectives and the next ten years of APBARajeev AHUJAPlastic & Cosmetic Surgery, Sir Ganga Ram HospitalINDIA

6


Presidential Speech Live-streaming


Moderator：Si Jack CHONGPlastic, Reconstructive & Aesthetic SurgerySingapore General HospitalSINGAPORE

Junichi SASAKIEmergency and Critical Care MedicineKeio University School of MedicineJAPAN

The Importance of Prevention and Treatment of Infections in Burn CareHajime MATSUMURADepartment of Plastic and Reconstructive Surgery, Tokyo Medical UniversityJAPAN

7


APBC Symposium 1 Live-streaming


Burn Care During the COVID-19 PandemicModerator：Hiroto IKEDA

Department of Emergency MedicineTeikyo University school of MedicineJAPAN

Niann-Tzyy DAIDepartment of SurgeryTri-Service General HospitalTAIWAN

ASY1-1 The impact of COVID-19 on burn care in JapanTetsuro KIYOZUMIDepartment of Defense Medicine, National Defense Medical College / Japanese Society for Burn InjuriesJAPAN

ASY1-2 Restructuring burns management during the COVID-19 pandemic: A Malaysian experience

Devananthan ILENGHOVENUniversiti Teknologi MARA MALAYSIA

ASY1-3 Application of Continuous Home Remote Visiting Mode Based on Standardized Communication System in Visiting Management of Severe Burn Patients in Post-epidemic Era

Ning LIDepartment of Burns, The First Affiliated Hospital of Army Medical University CHINA

ASY1-4 Characteristics of burn injury during COVID-19 pandemic in Tokyo Metropolis

Ryo YAMAMOTODepartment of Emergency and Critical Care Medicine, Keio University School of MedicineJAPAN

ASY1-5 Burn Care during the Covid 19 pandemicKuldeep SINGHIndraprastha Apollo Hospital INDIA

8




Management of Burn Wound InfectionModerator：Jun WU

Department of Burn and Plastic SurgeryThe First Affiliated Hospital, Shenzhen UniversityCHINA

Hiroyuki SAKURAIPlastic and Reconstructive SurgeryTokyo Women's Medical UniversityJAPAN

ASY2-1 Burn Wound Debridement for Infection Control in Massive BurnPornprom MUANGMANDepartment of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol UniversityTHAILAND

ASY2-2 Prevention of nosocomial infection in hydrotherapy in shared showers facility

Yoshitaka KUBOTADepartment of Plastic Surgery, Chiba UniversityJAPAN

ASY2-3 Wound bed preparation with maintenance debridement for engraftment skin graft

Minoru HAYASHISt. Mary's HospitalJAPAN

ASY2-4 Management of burn wound infection and unique aetiologyFarrah Hani IMRANUniversiti Kebangsaan Malaysia Medical CentreMALAYSIA

9




Infection Control in Burn ICU/Burn UnitModerator：Folke SJÖBERG

The Burn Center, Linköping University HospitalDepartment of Biomedical Clinical and Clinical Sciences (BKV), Linköping UniversitySWEDEN

Jun ODAEmergency and Critical Care MedicineTokyo Medical UniversityJAPAN

ASY3-1 Usefulness of surveillance wound cultures for severe burn patientsYasuhiko KAITADepartment of Trauma and Critical Care Medicine Kyorin University, School of Medicine JAPAN

ASY3-2 Infection Prevention and Antibiotic Stewardship in Burn Patients from Formosa Fun Coast Dust Explosion

Sheng-Kang CHIUDivision of Infectious Diseases and Tropical Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation / Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical CenterTAIWAN

ASY3-3 Application of ECMO for burnsGaoxing LUOInstitute of Burn Research, State Key lab of Trauma, Burn and Combined injury, Southwest Hospital, Third Military Medical UniversityCHINA

ASY3-4 Infectious control in the Burn ICU/Burn Unit - A holistic ApproachFolke SJÖBERGThe Burn Center Linköping University Hospital, Departments of Biomedical and Clinical Sciences (BKV), Linköping University Hospital, SWEDEN

10



Sunday, October 24　　11：00 - 12：20

Burn Treatment GuidelineModerator：David G GREENHALGH

Division of Burn SurgeryShriners Hospitals for Children Northern California and University of California, DavisUSA

Asako MATSUSHIMADepertment of Advancing Acute MedicineNagoya City University Graduate School of Medical Sciences JAPAN

ASY4-1 Chinese Burn Association expert consensus on the operation and management of deep vein catheterization in severe burn patients (2020 version)

Jun WUThe First Affiliated Hospital, Shenzhen UniversityCHINA

ASY4-2 Goal-directed fluid resuscitation protocol with early colloid intervention in major burns: The first 48 post burn hours

Hao-Yu CHIAONational defense medical center / Tri-service general hospitalTAIWAN

ASY4-3 Fluid resuscitation in new practical guidelines for burn care in JapanYukio SATODepartment of Emergency and Critical Care Medicine, Keio University School of MedicineJAPAN

ASY4-4 Burn Treatment Guidelines - Need of the hour in IndiaVinita PURISeth G S Medical College and KEM HospitalINDIA

ASY4-5 Treatment of the massive burn patientDavid G. GREENHALGHShriners Hospitals for Children Northern California and Depertment of Surgery, University of California USA

11



Sunday, October 24　　13：20 - 14：50

Scar Management and Surgery, Post-Burn Scar Contracture and Keloids

Moderator：Dong Chul KIMDepartment of Plastic and Reconstructive SurgeryAdvanced Burn Reconstruction Center, Bundang Jesaeng HospitalKOREA

Rei OGAWADepartment of Plastic, Reconstructive and Aesthetic SurgeryNippon Medical SchoolJAPAN

ASY5-1 Useful and effectiveness of Burn scar management using by FTSG with fat graft

Young Chul JANGBPS Soo HospitalKOREA

ASY5-2 RECONSTRUCTION OF LARGE BURN SCAR - DIFFICULTIES AND CHALLENGE

Vinh Quang VUVietnam national hospital of burnVIETNAM

ASY5-3 Free Tissue Transfer for Post-burn ReconstructionHiroyuki SAKURAIDepartment of Plastic and Reconstructive Surgery, Tokyo Women's Medical UniversityJAPAN

ASY5-4 Use of Tissue Expanders in Burn Reconstruction: Our experienceVinita PURISeth G S Medical College and KEM HospitalINDIA

ASY5-5 Keloid Today: 3 Year-Experience in Keelung Chang Gung Memorial Hospital

Chia-Hsuan TSAIDepartment of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung branch, College of Medicine, Chang Gung UniversityTAIWAN

12


ASY5-6 The systemic factors shaping cutaneous pathological scarring and potentially involved in scar management

Chenyu HUANGBeijing Tsinghua Changgung Hospital, Tsinghua UniversityCHINA

ASY5-7 Super tension-relieving suture technique combined with adjuvant radiotherapy in keloid management

Yixin ZHANGDepartment of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital / Shanghai JiaoTong University School of MedicineCHINA

13



Sunday, October 24　　15：50 - 17：35

Laser/Aesthetic Treatment in Burn CareModerator：Jui-Yung YANG

Plastic & Reconstructive surgery, Burn CenterChang Gung Memorial Hospital and UniversityTAIWAN

Taro KONODepartment of Plastic SurgeryTokai UniversityJAPAN

ASY6-1 Improvement of hypertrophic scar by early intervention with ablative fractional carbon dioxide laser

Jianglin TANInstitute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Army Medical University CHINA

ASY6-2 Effect analysis of early application of sequential laser in treatment of hypertrophic scar in children with burn

Chunhui XIEThe First Hospital of Jilin UniversityCHINA

ASY6-3 Aesthetic Burn Reconstruction -from Laser and Make-up Therapy to Surgery-

Rei OGAWADepartment of Plastic, Reconstructive and Aesthetic SurgeryNippon Medical SchoolJAPAN

ASY6-4 Management of burn scar with dermabrasion and non-cultured regenerative epithelial suspension

Liang QIAODepartment of Burn and Plastic Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiaotong UniversityCHINA

ASY6-5 Laser treatments in burn and traumatic scarsWhoraphong MANUSUKIATTIDepartment of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol UniversityTHAILAND

14


Sponsored Seminar 1 Live-streaming

Thursday, October 21　　11：50 - 12：30 Presentation language Japanese

Moderator : Naoto YAMAMOTO, MD, PhDPlastic and reconstructive surgery Jichi Medical University Saitama Medical CenterJAPAN

Perspective of plastic surgeon in the advanced critical care and emergency medical center Wound conservative treatment, Surgery and perioperative management, Outpatient treatment, Home-based care

Misato KUROYANAGI, MD, PhDAdvanced Critical Care and Emergency Medical Center Yokohama City University Medical CenterDepartment of Emergency MedicineYokohama City University Granduate School of MedicineDepartment of Plastic and Reconstractive SurgeryYokohama City University Granduate School of MedicineJAPAN

Co-sponsored : ALCARE Co., Ltd / Olympus Terumo Biomaterials Corp.



Moderator : Kenichi SHIMADA, MD, PhDDepartment of Plastic and Reconstructive Surgery Kanazawa Medical UniversityJAPAN

Burn Management Using Wound Dressings at our HospitalKunihiro SHIRAI, MD, PhDEmergency , Critical Care Center Hyogo Medical UniversityJAPAN

Usefulness of basic fibroblast growth factor impregnated collagen-gelatin sponge in reconstructive surgery for various acute skin defects

Hajime MATSUMINE, MD, PhDAssociate Professor and Department Director Department of Plastic and Reconstructive Surgery Yachiyo Medical Center, Tokyo Women’s Medical UniversityJAPAN

Co-sponsored : ConvaTec Japan KK / GUNZE LIMITED

15




Moderator : Hiroyuki SAKURAI, MD, PhDDepartment of Plastic and Reconstructive Surgery Tokyo Women’s Medical UniversityJAPAN

New findings of bFGF based on accumulated scientific insightKenichi SHIMADA, MD, PhDDepartment of Plastic and Reconstructive Surgery Kanazawa Medical UniversityJAPAN

Co-sponsored : KAKEN PHARMACEUTICAL CO.,LTD.


Friday, October 22　　11：50 - 12：30 Presentation language Japanese

Moderator : Jun ODA, MD, PhDDepartment of Emergency and Critical Care Medicine Tokyo Medical UniversityJAPAN

Evolving Burn Care at Chukyo Hospital 2021Akinori OSUKA, MD, PhDDepartment of Trauma Critical Care Medicine and Burn Center Japan Community Healthcare Organization Chukyo HospitalJAPAN

Co-sponsored : Japan Tissue Engineering Co., Ltd.

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Friday, October 22　　14：30 - 15：10 Presentation language English

Moderator : Hajime MATSUMURA, MD, DMSc, FACSDepartment of Plastic and Reconstructive Surgery Tokyo Medical UniversityJAPAN

The Recent Advancement in Burn Treatment : Clinical Trial Report on the Use of RECELL Ⓡ Autologous Skin Cell Suspension in the US

Jeffrey E CARTER, MD, FACSAssociate Professor, Louisiana State University Medical Director, University Medical Center New Orleans Burn CenterUSA

Co-sponsored : COSMOTEC Co., Ltd.


Friday, October 22　　16：40 - 17：20 Presentation language Japanese

Moderator : Yoshiaki INOUE, MD, PhDDepartment of Emergency and Critical Care Medicine University of TsukubaJAPAN

Surgical Strategy in Extensive BurnYasuhiko KAITA, MD, PhDDepartment of Trauma and Critical Care Medicine Kyorin University, School of MedicineJAPAN

Co-sponsored : Century Medical, Inc.

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Saturday, October 23　　15：00 - 15：40 Presentation language English

Moderator : Hajime MATSUMURA, MD, DMSc, FACS, Department of Plastic and Reconstructive Surgery Tokyo Medical UniversityJAPAN

Update of burn treatment - practice under a new normalJeremy RAWLINS, MB ChB(Hons) MPhil FRCS(Plast) FRACS(Plast)Head Of Department - Plastic and Reconstructive Surgery at Royal Perth HospitalAUSTRALIA

Clinical utility of Versajet Ⅱ hydrosurgery system in surgical wound careHajime MATSUMINE, MD, PhDAssociate Professor and Department Director Department of Plastic and Reconstructive Surgery Yachiyo Medical Center, Tokyo Women’s Medical UniversityJAPAN

Co-sponsored : Smith + Nephew PLC


Sunday, October 24　　10：10 - 10：50 Presentation language English

Moderator : Hajime MATSUMURA, MD, DMSc, FACSDepartment of Plastic and Reconstructive Surgery Tokyo Medical UniversityJAPAN

Utilization of AmnioFill and EpiBurn in a limb salvage protocol for extremities at high risk for amputation: lessons from a community burn center

Marc R. MATTHEWS, MD, MS, MCG, FACS, FASGSAssociate Professor of Surgery, University of Arizona, Creighton University Midwestern University and AT Still University Schools of Medicine Associate Director of Burn Surgery at the Arizona Burn Center, Phoenix, AZ Program Director, Burn / Surgical Critical Care Residency, The Arizona Burn Center, Phoenix, AZ Medical Director, Wizard (Pre-Hospital Medical) Education, Peoria, AZUSA

Co-sponsored : MIMEDX Group, Inc.

18




Moderator : Junichi SASAKI, MD, DMScEmergency and Critical Care Medicine Keio University School of MedicineJAPAN

Is there a silver lining? For infection control and scar treatment in burn treatment

Roy KIMBLE, DMed (res), MBChB, FRCS, FRACS (Paed Surg)Director of Paediatric Surgery Urology, Burns & TraumaThe Queensland Children's Hospital and Head of the Centre for Children's Burns and Trauma ResearchAUSTRALIA

Rei OGAWA, MD, PhD, FACSDepartment of Plastic, Reconstructive and Aesthetic Surgery Nippon Medical SchoolJAPAN

Co-sponsored : Mölnlycke



Moderator : Taro KONO, MD, PhDDepartment of Plastic Surgery Tokai University HospitalJAPAN

Reconstruction of lower facial burn contracture with expanded visor flapKeijiro HORI, MD, PhDDivision of Plastic and Reconstructive Surgery Tokyo Women's Medical UniversityJAPAN

Co-sponsored : Syneron Candela K.K.

19


APBC Free Paper On demand

Basic Research

AO-01 Adjustable biodegradability of low-swelling hydrogels prepared from recombinant peptides based on human collagen type 1

Takashi NAKANODepartment of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, JAPAN

AO-02 BMSCs derived exosomes alleviate smoke inhalation lung injuryGuang-Hua GUOThe First Affiliated Hospital of Nanchang University, CHINA

AO-03 Role and mechanism of PI3K/AKT/FoxO1/PDX-1 signaling pathway in functional changes of pancreatic islets in rats after severe burns

Bohan ZHANGThe Fourth Medical Center of Chinese PLA General Hospital, CHINA

AO-04 Study on changes of insulin secretion and signal transduction mechanism in rats at early stage post severe burns

Dawei LIThe Fourth Medical Center of Chinese PLA General Hospital, CHINA

AO-05 Long-term influence of burns on isletsXinzhu LIUThe Fourth Medical Center of Chinese PLA General Hospital, CHINA

AO-06 Tideglusib Promotes Wound Healing in Aged Skin by Up-regulating Epidermal Growth Factor Receptors

Jiachen SUNThe Fourth Medical Center of Chinese PLA General Hospital, CHINA

AO-07 Adiponectin receptor agonist AdipoRon blocks skin inflamm-aging by regulating mitochondrial dynamics


AO-08 Protective effects of ginsenoside Rc against severe burn-induced myocardial injury in rats

Yan XUEthe Department of Burn Surgery, the First Hospital of Jilin University, CHINA

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AO-09 Resistance reversal of methicillin-resistant Staphylococcus aureus through regulation of MecA gene by sub-high temperature photothermal and its mechanism

Xinxin CHENThe Department of Burn Surgery, the First Hospital of Jilin University, CHINA

AO-10 Cucurbitacin E induces autophagy-involved apoptosis in intestinal epithelial cells

Huapei SONGState Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University, CHINA

AO-11

AO-12 Creating a third-degree burn model using Japanese fire belly newtIkkei TAKASHIMIZUDepartment of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, JAPAN

AO-13 Network analysis revealed central genes expressions in the blood in patients with severe burns.

Yuki TOGAMIDepartment of Traumatology and Acute Critical Medicine, Osaka University Graduate School, JAPAN

AO-14 Ellagic acid exerts anti-fibrotic effects via TGF- β 1/Smad2/3 pathway suppression in hypertrophic scar fibroblasts

Xianglong MENGDepartment of Burns Surgery, the First Hospital of Jilin University, CHINA


Burn Care Facility

AO-15 a new burn unit in UttarakhandVishal MAGOAIIMS Rishikesh, INDIA

21


Withdrawal


Clinical and Intensive-Care

AO-16 The Effect of Direct Peritoneal Resuscitation on Mice with Severe Burn Shock and Its Mechanism

Dawei LIThe Fourth Medical Center of Chinese PLA General Hospital, CHINA

AO-17 Blood Loss in Burn Surgeries: Prediction and Its Related FactorsLeorca AURINOFaculty of Medicine Universitas Indonesia, INDONESIA

AO-18 ROLE OF ACUTE KIDNEY INJURY IN SEVERELY BURNED PATIENTSZhiqiang YUANInstitute of burn research, Southwest hospital, CHINA


Disaster-Management

AO-19

AO-20 Triage and transportation for Kyoto Animation Arson AttackKenichiro TAKASHINAEmergency and Critical Care Medicial Center, Japanese Red Cross Society Kyoto Daiichi Hospital, JAPAN


Electrical and Chemical Burns

AO-21 A Case of Chemical Injury Around the Anus After Drinking KeroseneYohei SUGIDepartment of Emergency and Critical Care, National Hospital Organization Kumamoto Medical Center, JAPAN

AO-22 Chemical burn of the face, mouth, pharynx, and esophagus caused by alkaline powder ingestion: a case report

Ryosuke YUNOKITrauma and Emergency Center, Fukaya Red Cross Hospital, JAPAN

22


Withdrawal

AO-23 The Evaluation of Golden Period of Fasciotomy for High Voltage Electrical Burn Injury Patients with Compartment Syndrome

Almahitta Cintami PUTRIDivision of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjajaran (FK UNPAD), Dr. Hasan Sadikin Hospital / Graduate School of Biomedical Sciences, Doctoral Program, FK UNPAD, INDONESIA

AO-24 Epidemiology of electrical burns: A 5 year retrospective analysis of 131 cases at dr Kariadi Central General hospital between January 2015 and December 2019

Silvina SUTEDJODiponegoro University Medical Faculty, INDONESIA

AO-25 Amputation of Upper Limb Following Electric Burn Injury: Bangladesh Experience

Most. Nurunnahar BEGUMSheikh Hasina National Institute of Burn and Plastic Surgery, BANGLADESH

AO-26 COMPARATIVE ANALYSIS OF MIDLINE VS CONVENTIONAL TYPE FASCIOTOMY IN COMPARTMENT SYNDROME OF UPPER LIMB IN POST ELCTRIC BURN PATIENTS

Manish M BHARADWAJPatna medical college and hospital, INDIA

AO-27 Outcome of Transposition flap in Scalp Reconstruction following Electric Burn

Most. Nurunnahar BEGUMSheikh Hasina National Institute of Burn and Plastic Surgery, BANGLADESH


Epidemiology

AO-28 When does a burn patient die?Akinori OSUKADepartment of Trauma, clitical care & burn centerJCHO Chukyo Hospital, JAPAN

AO-29 Survey on the current status of self-immolation attempts in Akita Prefecture

Yasuhito IRIEDepartment of Emergency and Critical Care Akita University Graduate School of Medicine, JAPAN

23


AO-30 The epidemiology of alcohol burns in Beijing, China: 163 cases from 2015 to 2020

Wen ZHANGThe Fourth Medical Center of Chinese PLA General Hospital, CHINA

AO-31 Retrospective analysis of bloodstream fungal infections in severe burn patients

Cheng ZHANGSouthwest Hospital, CHINA

AO-32 The trends of burn patients in Tokyo analyzed the data of TBUA during recent 30 years

Naoki MORITADepartment of Plastic and Reconstructive Surgery Tokyo Metropolitan Hiroo Hospital, JAPAN

AO-33 Burns First Aid and Burn-Related Nutrition Among 2437 Inhabitant in Saudi Arabia: A Nationwide Survey

Faisal Ali AL JABRCollege of Medicine, King Faisal University, SAUDI ARABIA

AO-34 Epidemiological Study of Burn Patients in only tertiary care center in resource crunch state of Eastern India

Ashutosh SHANKHDHARPatna medical college and hospital, INDIA


Ethics

AO-35 The value of renal injury marker protein in the early clinical diagnosis of burn delayed resuscitation of acute renal injury

Xiaoliang LIZhengzhou first people hospital, CHINA


Infection Control

AO-36 A single center study on antimicrobial use and bacterial resistance in burn ward

Dou YIRuijin Hospital, Shanghai Jiaotong University School of Medicine, CHINA

24


AO-37 Discovery of a Novel lytic bacteriophages of carbapenem-resistant Klebsiella, kpssk3

Yizhi PENGBurn Institute, Southwest Hospital, The Third Military Medical University, CHINA


Management of Burns in Developing Countries

AO-38 The prognostic value of serum procalcitonin measurements in severe burn patients: A retrospective study

Zhaoxing LIUThe Fourth Medical Center of Chinese PLA General Hospital, CHINA

AO-39 Intermingled skin allograft and autograft use in the treatment of major burns in older adults

Hongmin LUOGuangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, CHINA

AO-40 Epidemiology and Knowledge of First Aid Treatment Related to Burn Injury in the Rural Region of Kulon Progo, Indonesia

Almas Nur PRAWOTOWates Regional Hospital, INDONESIA

AO-41 The predictive value of first operation after burn in extremely severe burn patients

Wei ZHUInstitute of Burn Research, Southwest Hospital, Army Medical University, CHINA

AO-42 Clinician Interviews to Determine Opinion on Risk Factors for Burn Contracture Formation

Ruthann FANSTONEGlobal Centre for Burn Injuries Policy and Research, Swansea University, UK

AO-43 Out of the box solutions for tissue protection in postoperative periodArmaan KHOSASeth GS Medical College & KEM Hospital, INDIA

AO-44 Holistic Burn Care To All: Survival and BeyondRaghav SHROTRIYADepartment of Plastic Surgery, Seth GS Medical College and KEM Hospital, INDIA

25


AO-45 Retrospective evaluation of geriatric burn patients treated in a tertiary care burn unit.

Raghav MAGODepartment of Plastic & Reconstructive Surgery, K.E.M Hospital, INDIA


Nursing

AO-46 Study on Application and Therapeutic Effect of Citric Acid In-vitro Anticoagulation Standard Nursing Intervention Techniques in Blood Purification Treatment for the Severely Burned

Ning LIDepartment of Burns, The First Affiliated Hospital of Army Medical University, CHINA

AO-47 Application of sequential rehabilitation nursing technology in new healing skin care after deep burn of face and neck

Ning LIDepartment of Burns, The First Affiliated Hospital of Army Medical University, CHINA

AO-48 Humanistic care in continuous care to reduce incidence of delirium and the application of large area burn patients

Ting Ting HEThe First Hospital of Jilin University, CHINA

AO-49 Analysis of causes of hypothermia and nursing intervention in patients with severe burn

Wu Ming ZHANGThe First Hospital of Jilin University, CHINA

AO-50 Clinical application of intravenous anesthesia combined with ultrasound guided PICC catheter in children with severe burns

Yan MAThe First Hospital of Jilin University, CHINA

AO-51 Application of fast track surgery in patients with deep stress injuryDan CHENGThe First Hospital of Jilin University, CHINA

AO-52 Application of MDT with Hand Function Rehabilitation Video Production in Home Nursing Care for Children with Burns

Duo CAIThe First Hospital of Jilin University, CHINA

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AO-53 INFECTION CONTROL HANDS THAT HEAL SHOULD NOT BE THAT HAND THAT KILLS… SPREAD THE CARE AND NOT THE GERMS!

Vijayalakshmi PILLAIMilitary Hospital Jalandhar Punjab India, INDIA

AO-54 BURN DRESSING AN ART Lone nurse an artist has been painting for three hours yet feels like 30 minutes have gone by

Vijayalakshmi PILLAIMilitary Hospital Jalandhar Punjab India, INDIA


Outcome Measures

AO-55 Post-burn incidence of contractures in one year.Ankit MISHRAChoithram Hospital And Research Centre, INDIA

AO-56 PREVENTION OF LONG TERM BURN COMPLICATIONS - PIVOTAL ROLE FOR BURN NURSES

Siji BHASKARANMaharashtra University of Health Sciences / Armed Forces Medical College Pune / Command Hospital Kolkata, INDIA


Pain Management

AO-57 HEALING TOUCH WITH HOLISTIC NURSING - PATHWAY TO PAIN MANAGEMENT IN BURNS

Siji BHASKARANNational Academy of Burns India / Command Hospital Eastern Command Kolkata / Maharashtra University of Health Sciiences / Indian Nursing Council / Trained Nurses Association of India / Society of Midwives India, INDIA


Pediatric Burn

AO-58

27


Withdrawal

AO-59 A scalded 2-year-old child associated with acute encephalopathy: a case report

Keiichiro NAKAGOMITrauma and Emergency Center, Fukaya Red Cross Hospital, JAPAN

AO-60 Autologous scar-related tissue for reconstruction of large area burn scars of children

Juntao HANDepartment of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, CHINA

AO-61 Is Fever in Pediatric Burn relevant to successive Infection?Erina KAWABATAPlastic Surgery, Osaka Medical College, JAPAN

AO-62 Hypnotherapy for Procedural Pain, Itch and State Anxiety in Children with Acute Burns: A Feasibility and Acceptability Study Protocol

Daly GEAGEACentre for Children’s Burns and Trauma Research / The University of Queensland, AUSTRALIA

AO-63 Pattern of Presentation of Pediatric Burn During Covid -19 PandemicMost. Nurunnahar BEGUMSheikh Hasina National Institute of Burn and Plastic Surgery, BANGLADESH

AO-64 Retrospective evaluation of paediatric burn patients treated in a tertiary care burn unit

Armaan KHOSASeth GS Medical College & KEM Hospital, INDIA


Pre-Hospital Burn Care

AO-65 Estimation of Total Body Surface Area Burned - A Comparison Between Burn Unit and Referring Facilities

Hui Lian HODepartment of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah / Reconstructive Science Unit, School of Medical Sciences, Universiti Sains Malaysia, MALAYSIA

AO-66 Knowledge of burn first aid practices among the community and challenges faced by healthcare workers in managing burn injury at primary health care in Kota Selatan, Gorontalo.

Azmi Ritana NANOKota Selatan Primary Health Care, INDONESIA

28



Prevention

AO-67 Does a respiratory circuit equipped with a heated humidifier cause moderate-temperature burns? - Measurement of circuit surface temperature -

Masato AKIMOTODepartment of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, JAPAN

AO-68 Prevention of microstomia in patients having peri-oral burnsRaghav SHROTRIYADepartment of Plastic Surgery, Seth GS Medical College and KEM Hospital, INDIA


Psychological Reaction

AO-69 Impact analysis of India’s only Pediatric Burn Survivor Camp: Preliminary findings

Vinita PURISeth G S Medical College and KEM Hospital, INDIA


Quality of Life

AO-70 Withdrawal

AO-71 Effectiveness of rehabilitation makeup therapy for burn-induced hypertrophic scars with an uneven surface

Rintaro ASAHINippon Medical School, JAPAN

AO-72 THE QUALITY OF OUTCOME MUST BE WORTH THE PAIN OF SURVIVAL

Siji BHASKARANMaharashtra University of Health Sciences / Armed Forces Medical College / Command Hospital Kolkata, INDIA

29



Reconstruction and Scar Management

AO-73 Ablative Fractional CO2 Laser Surgery Improving Sleep Quality, Pain and Pruritus in Adult Hypertrophic Scar Patients: A Prospective Cohort Study

Kaiyang LVDepartment of Plastic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, CHINA

AO-74

AO-75 Effect of extracorporeal shock wave therapy on hand function after skin grafting in adult hand burns

Xiao Chuan XUThe First Hospital of Jilin University, CHINA

AO-76 Childhood Burns Leading to Skeletal and Soft Tissue DeformitiesRaghav SHROTRIYADepartment of Plastic Surgery, Seth GS Medical College and KEM Hospital, INDIA

AO-77 The Superficial circumflex iliac artery perforator flap for reconstruction of post burn neck contracture.

Daisuke FUJISAWADepartment of Plastic and Reconstructive Surgery, Dokkyo Medical University, JAPAN

AO-78 Long-Term Follow-up of Breast Development and Optimal Correction in Female Patients with Anterior Chest Burns

Masami MURAKAMIDepartment of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, JAPAN

AO-79 Use of IntegraR after release of post burn contractures: Our experienceVinita PURISeth G S Medical College and KEM Hospital, INDIA

30


Withdrawal


Registries

AO-80 Association between perineal burns injury and in-hospital mortality: A retrospective observational study from the nation-wide burn registry in Japan

Tetsuya HOSHINODepartment of Emergency and Critical Care Medicine, University of Tsukuba Hospital, JAPAN


Rehabilitation

AO-81 Preliminary study on correlation between DASH Questionnaire initial score and time to functional independence in burn patients

Li CHANGSunshine Social Welfare Foundation, TAIWAN

AO-82 Pressure therapy intervention for a case of burn hypertrophic scars on dorsal aspect of forefoot

Chen-Jui HSUSunshine Social Welfare Foundation, TAIWAN

AO-83 The effect of gait assisted robot training on the biomechanical properties of burn scars

Yoon Soo CHODepartment of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, KOREA

AO-84 Design and Application of Comprehensive Evaluation APP of Burn Hand Function

Xiu-Hang ZHANGThe First Hospital of Jilin University, CHINA

AO-85 Secondary injuries caused by inappropriate rehabilitation treatments: a series of case reports

Siyuan MAInstitute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, the Army Medical University, CHINA

AO-86 Exploring use of 3D printing in facemask fabrication for patients with facial burns

Anna TANSingapore General Hospital, SINGAPORE

31



Surgical Techniques

AO-87 Using large skin sheets alternately spliced from autologous and allogeneic micrografts for repairing extensive deep burn wounds

Chuanan SHENThe Fourth Medical Center of Chinese PLA General Hospital, CHINA

AO-88 A case report of sever contact burn with exhaust pipe at lower limbYoshitaka MATSUURAOtsu red cross hospital, JAPAN

AO-89 Two-step coverage of split-skin Meek-Isles after 7-10 days with a polylactide membrane (Suprathel®)

Matthias RAPPClinic for Orthopedics, Trauma Surgery and Sports Traumatology - Burn Center, Marienhospital Stuttgart, GERMANY

AO-90 Our time tested technique of full thickness skin graft immobilisation over mobile regions of face

Nishanth SADHANALADepartment of plastic surgery, KEM HOSPITAL, SETH G S MEDICAL COLLEGE, INDIA


Systemic Infection

AO-91 Comparison of Morbidity and Mortality in Burn Patients with Multi-Drug Resistant Organisms (MDRO) and Non-MDRO Bacteria in Sanglah Hospital Bali

Gede Wara SAMSARGADivision of Plastic and Reconstructive Surgery, Faculty of Medicine Udayana University, Sanglah General Hospital, INDONESIA

AO-92 Early diagnosis of sepsis in severe burn patientsMitsuhide HAMAGUCHIDepartment of Emergency & Crinical Core Medicine,Kindai University Faculty of Medicine, JAPAN

32



Tissue Engineering, skin substitute and Cell thera

AO-93 Preventive Effect of The First Epidermal Growth Factor Motif of Coagulation Factor 9 on Keloid and Hypertrophic Scar

Tsutomu KASHIMURADepartment of Plastic and Reconstructive Surgery, Nihon University School of Medicine, JAPAN

AO-94 Placental-based allografts in complex limb salvage: a pilot studyMarc R. MATTHEWS, The Arizona Burn Center, Phoenix AZ / Department of Surgery, Valleywise Health Medical Center, USA

AO-95 The synthetic, resorbable, temporary, epidermal skin substitute Suprathel® for the treatment of burns, burn-like-syndromes and donor sites


AO-96 Identification of biologically relevant laminins to culture keratinocytes for potential treatment of burns

Alvin CHUASingapore General Hospital / Duke-NUS Medical School, SINGAPORE

AO-97 Clinical application of autologous dermal keratinocytes for chronic, diabetic, difficult-to-heal wounds

Niann-Tzyy DAIDivision of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, TAIWAN

AO-98 Evaluation of pre-vascularized 3D skin substitutes in full-thickness skin defects

Hiromi MIYAZAKIDivision of Traumatology, Research Institute, National Defense Medical College, JAPAN


Wound Management・Others

AO-99 Simple and effective technique for calculating burn wound surface area and its applications

Nishanth SADHANALADepartment of plastic surgery, KEM HOSPITAL, SETH G S MEDICAL COLLEGE, INDIA

33


AO-100 Vacuum sealing drainage with instillation in treatment of necrotizing soft-tissue infection: a retrospective analysis

Hongjie DUANDepartment of Burns and Plastic Surgery, the Fourth Medical Center of PLA General Hospital, CHINA

AO-101 Combination of 3 different NPWT application and free ALT flap for open elbow joint injury with extensive burn

Junya OSHIMADepartment of Plastic and Reconstructive Surgery, University of Tsukuba, JAPAN

AO-102 Tideglusib Promotes Wound Healing in Aged Skin by Up-regulating Epidermal Growth Factor Receptors


AO-103 NLRP3 Activation Induced by Neutrophil Extracellular Traps Sustains Inflammatory Response in the Diabetic Wound

Dan LIUBurn Department, Ruijin Hospital, Shanghai Jiaotong University, CHINA

AO-104 The practice of negative pressure wound therapy with ostomy paste, as a skin graft bolster dressing.

Kazuki MATSUMURADepartment of Emergency and Critical Care Medicine, Keio University School of Medicine, JAPAN

AO-105 Experience with silver-containing dressings for burn woundsShimpei NARAPlastic surgery, Towa Hospital, JAPAN

AO-106 A case of burn ulcer with bone exposure successfully treated using PELNAC Gplus® without invasive procedures

Yosuke OJIMADepartment of Plastic & Reconctructive Surgery, Tokyo Medical University Hospital, JAPAN

AO-107 Investigation and management of the heat-press injury to the handsNorio FUKUDAPlastic and Reconstructive Surgery, Yamagata University Hospital, JAPAN

AO-108 The treatment of toxic epidermal necrolysis (TEN) with Suprathel® - the Stuttgart treatment concept


34


AO-109 Efficacy of acetic acid for wound managementRaghav MAGODepartment of Plastic & Reconstructive Surgery, K.E.M Hospital, INDIA

35


AO-110 EFFECT OF TOPICAL CORTICOSTEROID TIME OF APPLICATION ON FIBROBLAST AND TYPE III COLLAGEN EXPRESSION ON DEEP DERMAL BURN WOUND (BEST TIME TO START TOPICAL CORTICOSTEROID APPLICATION IN PREVENTING HYPERTROPHIC SCAR)

Loelita LUMINTANGDepartment of Surgery, Division of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, INDONESIA

Special LectureAbstract

Special Lecture

Future Management of Burn Sepsis

Sepsis remains the leading cause of mortality after burn injuries. This unfortunately has not changed for decades whilst other aspects of burn care have progressed hugely.Future advances in developing early warning systems would be on 3 main fronts: First, robust infection control and adoption of new “test and trace” lessons learned from COVID-19 with regular sequencing for all offending micro-organisms. Secondly, early prediction of vulnerable patients who are prone to sepsis and the development of new strategies to protect them. Finally, to identify and validate new and existing early markers for detecting early bacteraemia and fungaemia.Multi drug resistant organisms (MRDO) are a major challenge across the world. Adopting and implementing a global stewardship program in all disciplines, was up until now, unfortunately an elusive goal. In our new green post COVID world, implementing legislation restricting antibiotic use in farming in High Income Countries (currently 73% of all antibiotic use) would reduce the damage. In addition, we still should aspire to an agreed global antimicrobial stewardship program in all disciplines.

Naiem S MOIEMEN

President, International Society for Burn Injury (ISBI)Consultant Burn and Plastic SurgeonProfessor, University of Birmingham School of Medicine (Hon)Director, Scar Free Foundation Burn Research Centre, UK

37

Special LectureThe 47th JSBI & The 13th APBC

BIOGRAPHY

Naiem Moiemen, MB BS, MSc, FRCS (Plast) is Professor at the University of Birmingham and a consultant plastic and burns surgeon at University Hospital Birmingham. He is Director of the ScarFree Foundation Centre for Burn Research in Birmingham. He is the Clinical Lead of the Midland Burns Care Network, serving a population of 13 million in the midland region.

Naiem is President of the International Association of Burn Injury (ISBI), Past President of European Burn Association Executive, and past Chairman of the British Burn Association (BBA). He has published over a hundred papers in peer review journals and book chapters. He is Editor-in-Chief of the European Journal of Burn Care, the Official Journal of the European Burn Association (EBA), member of senior editorial board of BURNS and Journal of Burn Care and Research and was deputy editor of Journal of Burn and Trauma.

Naiem is on the Board of Trustees of the International Burn Foundation IBF (2014- current) and Board of Trustees of the VTCT Vocational Training Charitable Trust (2018-Current).

https://orcid.org/0000-0003-0836-5138

38


Invited LectureAbstract

Invited Lecture 1


Burn centers consist of a very broad spectrum of healthcare workers and as a total team we are able to deal with highly complex patients. As a result, burn systems are capable of pivoting in a crisis to bring resilience to healthcare systems. This has certainly been the case internationally during COVID-19 as the resilience of all nations has been tested. The lessons we have learned at the intersection of burns and COVID-19 are important as we consider how to become better able to face future threats to health security.In the present lecture we will review international data on the impact of COVID-19 on burn system capacity and implications for health security policy.

Mark FISHER MD, FACS

Clinical Associate ProfessorDivision of Plastic SurgeryThe University of Iowa Hospitals and Clinics, USA

41

Invited LectureThe 47th JSBI & The 13th APBC

BIOGRAPHY

Dr. Fisher’s clinical mission at the University of Iowa includes leading burn reconstruction services and directing the cleft and craniofacial team. As chair of the American Burn Association committee on reconstruction, he has developed new programs in burn reconstruction including the new series of courses focusing directly on this challenging area. During COVID-19, Dr. Fisher also led multiple efforts relating to the intersection of burns and covid-19. This included multiple international papers as well as the ABA series of COVID webinars.

42


Invited Lecture 2

Current Diagnosis of Inhalation Injury

Inhalation injury, then not referring to CO or Cyanide intoxication, has been a major issue since the 1940-ties when first described as a relevant issue for survival, as important as early fluid therapy in major burns. Ever since, it has been a challenge and topic of debate due to the issues of deciding the diagnosis and possible concomitant treatments. The diagnosis being made mainly through bronchoscopy and medical history (indoor fire). A recurring problem in studies of inhalation injury is the lack of strong correlation between bronchoscopy findings and the ensuing ventilatory treatment needs. Also, recently a graded bronchoscopy evaluation in patients failed to depict such a relationship. Furthermore, it appears that there is also a separate correlation to burn size. When it comes to other competing and possible reasons for respiratory failure in burns, these include: Fluid resuscitation effects (oedema), Acute respiratory distress syndrome (ARDS), Ventilatory acquired pneumonia (VAP), and Ventilatory induced lung injury (VILI). It is well known that especially fluid overload leads to diffusion difficulties in the lung. In some studies, it has been difficult to differentiate inhalation injury from ARDS using set criteria. The only parameter that differed between inhalation injury and ARDS was lung compliance, being less in ARDS. The long ventilatory times seen in burns (as compared to general ICU care) increases the risk of VAP as does the immunosuppression of the burn injury. Also, the high metabolic induced by the burn, together with long ventilatory times in burns leads to larger ventilatory volume needs and pressures which predispose to VILI. Given all these possibilities it is relevant to claim less importance of inhalation injury.Other findings that support a more complex picture underlying respiratory failure in burns include that very distinct findings in CT scans that are believed to be strictly due to inhalation injury have been show in smaller case series and in single patients. However, others attempting to depict similar findings in larger set of patients have repeatedly failed. It may be concluded that respiratory failure is common in burns, but recent findings support that this is not as commonly thought only due to inhalation injury, but other factors and processes contribute.

Folke SJÖBERG

The Burn Center, Linköping University Hospital / Department of Biomedical and Clinical Science (BKU), Linköping UniversityDirector of the Burns intensive care unit (National burns unit), SWEDEN

43


BIOGRAPHY

Chief of staff Department of Anesthesiology and Intensive Care, Linköping University hospital (1999-2004) President European Burns Association (EBA) (2007 – 2009). Member of executive board International Society for Burn Injuries ISBI (World organization Board member) - ongoing. Previous member of the "Verification Committee" American Burns Association. Supervised > 40 PhD students. Primary investigator > 170 clinical trials, ranging from phase I-IV.Author/co-author of more than 300 original peer reviewed scientific papers, including book chapters and books.

Citations and complete publication list at: https://scholar.google.com/citations?user=q1Jo7_8AAAAJ&hl=sv

44


Invited Lecture 3

The Need for a Surviving Sepsis After Burn Campaign

If one survives the initial shock of burn injury (approximately 48 hours) the ultimate cause of death is from sepsis. If the body is unable to handle the stress of sepsis, then multiple organs fail and eventually the entire body fails – leading to death. It is well known that if someone has an infection then the earlier that infection is treated then the better the chance for survival. There have been excellent efforts to identify the early signs of infection and sepsis and then identify the best early treatments for improving survival. The best efforts have resulted from the “Surviving Sepsis Campaign” which was developed for patients without burns who present to Emergency Departments with sepsis and infection. However, there are no guidelines for the diagnosis and early treatment of patients with burns who develop sepsis. Burn patients are quite unique because they have lost their primary barrier to infection – the skin – and thus have a more profound and delayed sepsis response. Also, burn patients develop their infections weeks to months after their injury when they are already critically ill, which makes the diagnosis of sepsis uniquely difficult. We believe that the current Surviving Sepsis Campaign guidelines do not apply to burn patients. There is a need to define the early signs of infection and sepsis in burn patients that trigger the initiation of treatment and develop guidelines for the earlier treatment of burn-related infection and sepsis. To complete these aims there is a need to mirror the Surviving Sepsis Campaign techniques and convene many experts in burn infections to review the current scientific evidence in the literature for treating burn-related infections and sepsis. These experts will need to perform detailed reviews of the literature and then use a standard evaluation tool called “GRADE” to evaluate the quality of the available literature on burn sepsis. Next, a series of meetings will need to be held where all of the experts discuss their findings and come up with a variety of recommendations for the diagnosis and treatment of sepsis in the burned patient. These findings would then be published and would be recognized as the best-practices guidelines for all clinicians, worldwide, for the care of burn patients with sepsis.

David G. GREENHALGH, MD

Shriners Hospitals for Children Northern California, Chief of BurnsProfessor, Department of Surgery, University of Calfornia, Davis, USA

45


BIOGRAPHY

David G. Greenhalgh, MD, was named Chief of Staff for Burn Surgery at the Shriners Hospitals for Children Northern California and Chief of the Burn Division, Department of Surgery, for the University of California, Davis School of Medicine in 1997. Dr. Greenhalgh graduated from the State University of New York Upstate Medical Center in Syracuse, New York, and completed his General Surgery Residency at the Medical Center Hospital of Vermont. He did Research Fellowships at the University of Vermont, followed by a one-year Research Fellowship at University of Washington and then burn Fellowship at Harborview Medical Center in Seattle, Washington. Upon completion of his Fellowships in 1989, Dr. Greenhalgh was employed at Shriners Hospitals for Children Cincinnati and the University of Cincinnati. In 2006-2007, Dr. Greenhalgh served as President of the American Burn Association and he is currently President-elect for the International Society for Burn Injuries.

46


Plenary Speech

Plenary Speech

Historical Perspectives and the next ten years of APBA

BIOGRAPHY

Dr Ahuja's experience in Burns & Plastic Surgery spans over 3.5 decades, of which 22 years he has headed the most prestigious department in the specialty.

Dr Ahuja is the Founder President of Asia Pacific Burn Association and Past President of the International Society for Burn Injuries (ISBI) in 2016 and the President of the 9th Asia Pacific Burn Congress and Chairman of the World Congress of International Society for Burn Injuries in 2018.

He has been a strong leader in the global burn care community for many years. He has led APBA for many years, and there is no doubt that he will continue to lead APBA into the future.In this plenary Speech, Dr. Ahuja will present the next 10 years of APBA.

Rajeev AHUJA

Plastic & Cosmetic Surgery, Sir Ganga Ram Hospital, INDIA

50


Presidential SpeechAbstract

Presidential Speech

The Importance of Prevention and Treatment of Infections in Burn Care

In a single word, burns are the loss of the barrier between the body and the outside world.The loss of this barrier causes a variety of reactions. The loss of the barrier and the necrosis of the skin induce inflammatory reactions and fluid leakage from the body. At the same time, bacteria can easily penetrate the burn wound that has lost its barrier function due to necrosis, skin defects, or mucosal damage. This can lead to local infection followed by systemic inflammation and infection.In the treatment of burns, it is important to control the infection caused by the loss of the barrier function, and at the same time, to consider how to restore the barrier - in other words, how to close the wound.In order to achieve these things, autologous skin graft is commonly used. However, skin donor site is always necessary, and it becomes a new barrier function loss site, which is a dilemma. The solution to this, as far as possible, is cultured epithelial autograft or temporally coverage by allo-skin graft or artificial dermis. However, cultured epithelial autograft and artificial dermis are weak to wound infection, here, we caught in a dilemma again. Therefore, it is especially important to control the infection to improve the outcome of burn treatment. From the above, we decided on "THE NEXT DYNAMIC CHANGE IN BURN CARE - Coping with Infection, Infection prevention and control -" as the theme of APBC 2021. With participants of this meeting, we would like to develop strategies to face this challenge for the next burn care.

Hajime MATSUMURA

Professor Department of Plastic & Reconstructive Surgery, Tokyo Medical University, JAPAN

53

Presidential SpeechThe 47th JSBI & The 13th APBC

BIOGRAPHY

Hajime Matsumura, MD, DMSc, FACS is Professor at Tokyo Medical University and a chief surgeon of Plastic and Reconstructive Surgery, Tokyo Medical University Hospital.

After graduation of Tokyo Medical University, he started his surgical residency at the National Hospital Tokyo Medical Center.Later, he obtained a specialty board in plastic surgery at Tokyo Medical University. Between 1985 and 1997, he had the opportunity for studying abroad at the Division of Plastic Surgery, Department of Surgery, University of Washington in Seattle USA, as a visiting physician under Washington state license.

Currently, he is a president of the 13th Asia Pacific Burn Congress and the 47th Japanese Society for Burn Injuries, International editorial consultant of the Journal of Burn Care and Research, editorial board member of Burns Open and other scientific journals.His clinical and research works are focused on the field of wound healing including acute wound care/burns, scar, and keloid.

54


APBC SymposiumAbstract

APBC Symposium 1 ASY1-1

The impact of COVID-19 on burn care in Japan

We investigated the impact of the first wave of COVID-19 on burn care in Japan.

The survey was conducted over time from immediately after the first state of emergency was declared in urban areas on April 7, 2020, to after May 25, 2020, when the state of emergency was fully lifted, covering 103 certified burn specialist training facilities.

In April, only 34.1% of respondents said that they could treat burn patients with COVID-19, and in May, 45.5% responded, and in June, 59.1% responded. This was thought to be due to the decrease in the number of facilities that said they "could not determine". On the other hand, the number of facilities that said it would be difficult to accept severe burns regardless of whether or not they had COVID-19 increased from 9.1% to 13.6%, suggesting that the response to the COVID-19 may have affected normal burn care. It is necessary to establish a coordination system to support the implementation of appropriate burn care.

Tetsuro KIYOZUMI1), Ichiro HASHIMOTO2), Hiroyuki SAKURAI3)

Department of Defense Medicine, National Defense Medical College / Japanese Society for Burn Injuries, JAPAN1)

Japanese Society for Burn Injuries / Department of Plastic Suergery, Tokushima University, JAPAN2)

Japanese Society for Burn Injuries / Department of Plastic Suergery, Tokyo Women's Medical University, JAPAN3)

57

APBC

Symposium



Restructuring burns management during the COVID-19 pandemic: A Malaysian experience

Since December 2019, the outbreak of coronavirus disease 2019 (COVID-19) has become a global public health threat and this pandemic has drastically changed the way we handle burn patients. Malaysian Ministry of Health had identified designated Covid-19 hospitals and prepared guidelines on the Management of Emergency Surgeries. During this unprecedented crisis, we implemented certain changes in the management of burns in Malaysia to ensure the health system would be able to handle the anticipated surge in demand for hospital beds and acute care facilities with the progress of the pandemic. Emphasis on patient and health care workers' safety was given utmost priority. Implementation of these strategies has helped us to prevent COVID-19 infection among the doctors and nurses in our nation.

Devananthan ILENGHOVEN, Shah Jumaat Mohd YUSSOF

Universiti Teknologi MARA, MALAYSIA

58



Application of Continuous Home Remote Visiting Mode Based on Standardized Communication System in Visiting Management of Severe Burn Patients in Post-epidemic Era

To understand the visiting needs of patients with severe burns and construct a continuous home remote visiting mode based on standardized communication system. A self-designed questionnaire on visiting needs of patients with severe burn injuries was designed to investigate the needs of patients and their families, to construct a continuous home remote visiting model based on standardized communication system, and to analyze the evaluation indexes of anxiety score and satisfaction of patients and their families statistically. Between the two groups, there was no significant difference in sex, age, education, burn degree, family income. The anxiety score of the experimental group and the family members was significantly better than that of the control group, and the degree of relief increased with the increase of hospitalization time. The satisfaction score of family visit management increased from 73.28% to 95.37%. Establishing a continuous home remote visiting model based on standardized communication system for burn patients during BICU period in the post-epidemic era is an exploration of the quality nursing model of patients and family-centered nursing for burn patients. Effective use of the Internet to improve social support system management, meet the needs of patients, improve the quality of nursing services.

Ning LI

Department of Burns, The First Affiliated Hospital of Army Medical University, CHINA

59

APBC

Symposium



Characteristics of burn injury during COVID-19 pandemic in Tokyo Metropolis

Background: Coronavirus Disease 2019 (COVID-19) has drastically changed daily life across the world, which would have also affected patients with burn injury. We aimed to elucidate characteristics and clinical consequences of burns in an urban area during COVID-19 pandemic.

Methods: A descriptive study was conducted using Tokyo Burn Unit Association registry (1999-2020), including 14 burn centers in Tokyo, Japan, where the first COVID-19 case was recognized in January 2020. On-pandemic burn was defined as injury in 2020, and demographics, mechanisms, severity, and clinical outcomes were compared with pre-pandemic injury. Characteristics of burn injuries under the stay-home order (April to May) were also examined.

Results: A total of 7061 patients were identified in the registry. Number of on-pandemic burn injuries were lower than pre-pandemic (203 vs 343 per year) and was decreasing toward the end of 2020. Patients during the pandemic were older than pre-pandemic (58 vs 50 years) and had more scald or contact burns (38.5% vs 33.4%), less associated inhalation injury (36.5% vs 42.0%), shorter length of hospital stay (3 vs 5 days), and lower in-hospital mortality (8.9% vs 11.9%). More patients under the stay-home order suffered from flame burns.

Conclusions: Characteristics of burns during COVID-19 pandemic were captured.

Ryo YAMAMOTO, Yukio SATO, Junichi SASAKI

Department of Emergency and Critical Care Medicine, Keio University School of Medicine, JAPAN

60



Burn Care during the Covid 19 pandemic

The world saw the Covid pandemic unfold from Wuhan in end 2019, escalating to a peak varied from China in February 2020 to India in September 2020. A second wave came as new variants developed, again ravaged the globe, sparing some countries this time. Burns Units the world over, though initially resisted the takeover had to temper services to a reduced level, especially centers where Burns units shared critical beds with General trauma Services. They modified strategies to adapt to depleted resources and manpower, aggressive surgical management reduced to a varying degree. Burns patients turning Covid positive were shifted to Covid ICUs, and surgical care restricted to bare minimum. Coupled with a paucity of Cadaver allograft, the pandemic affected Burns care like nothing seen before. The world seemed to be coming out of all this, especially India, where by December 2020 cases had come down to a minimum. The second wave hit the world, India in Mid-April 2021, a second hit to burn care services, this time a lot of staff testing positive. Authors will analyze the temporal and physical effects of the Covid pandemic on Strategies and outcomes of burn care delivery in India & the world.

Kuldeep SINGH, Shahin NOOREYEZDAN

Indraprastha Apollo Hospital, INDIA

61

APBC

Symposium



Burn Wound Debridement for Infection Control in Massive Burn

Large burn wounds could increase risk of wound infection and it is a challenge for surgeon to perform wound debridement. The technique of massive burn wound excision and debridement followed by wound closure should be carefully planned. Some inexperienced surgeons might perform too deep tangential wound excision which frequently cause more bleeding and prone to heal with hypertrophic scar. Hydrosurgical debridement can preserve more viable dermis and promote spontaneous healing by epithelialization. The technique of massive wound debridement for prevention or treatment of burn wound infection in our center will be discussed. We believe that the combination of sharp debridement and hydrosurgery can effectively remove infected burn tissues, reduce risk of wound infection, promote wound epithelialization, and also shorten operative time.

Pornprom MUANGMAN

Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, THAILAND

62



Prevention of nosocomial infection in hydrotherapy in shared showers facility

BackgroundThe risk of nosocomial infection has been reported with hydrotherapy in shared facilities. We report the results of our joint efforts with the infection control team (ICT) to prevent the spread of MRSA in a shower facility.Case 1: 80-year-old woman with 4% TBSA burn. The patient was treated without hydrotherapy in shared facilities. The epithelialization was achieved on the 55th day of the disease. Wound cultures were negative during treatment.Case 2: A 52-year-old female patient with gas gangrene of the perineum. After hydrotherapy using a shared shower was started, the wound became positive for MRSA, which had not been detected before.Infection-control measures: The shower facility was thought to be the cause of MRSA adhesion. The environmental culture was performed and MRSA was detected in multiple locations. After the introduction of the countermeasure, MRSA was no longer detected in the shower room. The average number of MRSA-positive patients per month decreased significantly after the introduction of the countermeasure compared to before the introduction of the countermeasure (2.0 ± 1.7 vs 0.7 ± 0.7, P < 0.05).ConclusionIn collaboration with the ICT, we obtained MRSA-negative shower facilities and a reduction in the number of MRSA patients.

Yoshitaka KUBOTA, Saori YASUDA, Minami ARAI, Hideyuki OGATA, Shinsuke AKITA, Nobuyuki MITSUKAWA

Department of Plastic Surgery, Chiba University, JAPAN

63

APBC

Symposium



Wound bed preparation with maintenance debridement for engraftment skin graft

We always ensure proper infection control protocol following the shock period for massive burn patients. It is critically important to ascertain the most efficient course of action, from debridement to skin graft implementation. In our strategy, we recommend complete debridement during week one. We often use artificial dermis on the wound after debridement. Typically, Trafermin is administered to quicken wound bed compatibility. It is important to accurately evaluate and observe wound bed condition continuously, as artificial dermis is easily infected. When artificial dermis is infected, it is imperative to remove all parts of infectious artificial dermis immediately. For daily treatment, soap may be used to wash out the bacteria, slime, and so on. If necessary, further maintenance debridement may be administered every day. Furthermore, the above method ensures good wound bed to skin graft compatibility correlated with an accurate engraft rate. In case of a massive burn patient, it is important to engraft the epithelium completely and quickly to survive. Thus, if the general condition is maintained, we should aim for better treatment to prevent the quality of scar formation for the patient.

Minoru HAYASHI

St. Mary's Hospital, JAPAN

64



Management of burn wound infection and unique aetiology

The overall aims of medical and surgical treatment in burn care are multi-faceted. One of the main principles is prevention and management of burn wound infection locally and systemically. The overarching approach is to minimise infection risk, optimise underlying comorbid conditions and address the presence of any clinical or sub-clinical infection. A key feature is completing a thorough history and physical examination that leads to comprehension of the aetiology and mechanism of injury. This allows the experienced burn surgeon to predict the potential course of infection, duration of hospital stay, and effective decision making with regards to surgery. In this session, we will explore burn wound infection, relation to unique aetiologies of burn injuries and our role in management and subsequent prevention.

Farrah Hani IMRAN

Universiti Kebangsaan Malaysia Medical Centre, MALAYSIA

65

APBC

Symposium



Usefulness of surveillance wound cultures for severe burn patients

ObjectiveAs infection is the leading cause of death in severe burn patients, infection control must be more stringent for these patients. Although surveillance cultures play an important role in infection control, there are few studies regarding the use of surveillance cultures for burn patients. The purpose of this study was to clarify the clinical significance of surveillance wound cultures for severe burn patients.MethodsData from 29 severe burn patients with 2 sets of positive blood cultures were analyzed. We investigated the microorganisms detected in the blood cultures and the prior surveillance cultures of the burn wounds. ResultsThe main microorganisms identified in the wound and blood cultures were Candida species, methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa. The results of the blood cultures and surveillance wound cultures were the same for 80% of the patients. There were variations in the time when each microorganism was detected in the wound and blood cultures.ConclusionsSurveillance wound cultures might be useful for administering appropriate antibiotic treatment to severe burn patients.

Yasuhiko KAITA, Yoshihiro YAMAGUCHI

Department of Trauma and Critical Care Medicine Kyorin University, School of Medicine, JAPAN

66



Infection Prevention and Antibiotic Stewardship in Burn Patients from Formosa Fun Coast Dust Explosion

ObjectiveInfection is the most unpleasant event of any operation and it is even more troublesome in burns. If patients can survive the resuscitation phase of burns, the number one cause of subsequent deaths is infection.Methods A retrospective study to evaluate the demographic, clinical characteristics, infection types, and causative pathogens among burn patients from the Formosa Fun Coast Dust Explosion who were hospitalized in Tri-Service General Hospital.ResultsFifty-eight patients were admitted (36 males, mean age: 22.6 years). The mean burned total body surface area (TBSA) was 40% for all patients. The most common infections were burn wound infections (214, 55%) and pneumonia (66, 17%). Eighteen (31%) patients with mean TBSA of 80% had 66 episodes of bloodstream infections caused by 92 isolates. Twelve (18.2%) episodes of bloodstream infections were polymicrobial. Acinetobacter baumannii (19, 20.7%), Ralstonia pickettii (17, 18.5%), and Chryseobacterium meningosepticum (13, 14.1%) were the most common pathogens causing bloodstream infections. Approximately 21.1% of A. baumannii strains were resistant to carbapenem. No fetal cases were observed after treatment.ConclusionAntibiotic treatment should be administered based on the specific pathogens’ susceptibility. Infectious diseases specialist consultation and closely cooperation with burn care team can lead to a better outcome.

Sheng-Kang CHIU1), Tzu-Chao LIN2), Feng-Yee CHANG3)

Division of Infectious Diseases and Tropical Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation / Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, TAIWAN1)

Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, TAIWAN2)

Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, TAIWAN3)

67

APBC

Symposium



Application of ECMO for burns

ECMO (Extra Corporeal Membrane Oxygenation) can supply oxygenation of blood and motive force for circulation, which means it can replace both of lung and heart functions. Therefore it can be apply to rescue some severe burn patients with lung and/or heart failures. Actually this technique is seldom used for burn patients. In our own or literature experiences, ECMO is mainly used for burn patients with respiratory failure to replace the function of lung. Hence, when the patients with severe inhalation or pulmonary infection result serious shortage of oxygenation, ECMO should be used. Recent years five patients were rescued with ECMO in our department. This manuscript report our own experience and review the relative literatures about application of ECMO for burns. Finally, some key notes such as anticoagulation, turning over of the burnt body, simultaneous application of CRRT, dressing changing, operation, paraenterial nutrition and others were discussed during ECMO using on burn patients.

Gaoxing LUO

Institute of Burn Research, State Key lab of Trauma, Burn and Combined injury, Southwest Hospital, Third Military Medical University, CHINA

68



Infectious control in the Burn ICU/Burn Unit - A holistic Approach

The challenge of infections in burn care is well known through history. Also, today burn wound infections, and ensuing Sepsis and Septic shock, are a major issue for burn care complications and mortality. Another significant factor is the developing microbial resistance towards antibiotics. Today there are many guidelines and accepted care bundles based on scientific grounds to support the battle against infections in the care of the burn injured. Most of these principles were already clearly stated in the work of Florence Nightingale and Ignaz Semmelweis during the 18th century. There is an increasing and ongoing awareness and interest in infection control, shown by the no of published papers and downloads from the internet on specific infections related search terms. There is in parallel also evidence that most of the infections registered in patient care are directly care related. In recent years the infection control principles have been better supported scientifically, with examples such as: construction of the patient room, by using a single room reduces infections 4 times and the most advanced rooms with look and pressure accomplices a reduction by 25000 times (Lidwell 1976). WHO have summarized the evidence supporting proper hand hygiene, which is the first and main target for infectious related patient work (39 papers with adequate quality; 60 other studies as a part of the treatment bundle). The adequate treatment approach includes alcohol-based disinfectant on hands properly exposed from the lower arm. Further restrictions on jewelry and nail maintenance needs to be included. The burn care staff should be familiar with the most important contamination routes and their risks. The effect of staffing (over/under) issues is important. Further the personal needs to be aware of the most common care related infections (symptoms) to properly avoid them or detect them early when present. Knowledge about infection dose is also important in issues to minimize spread. Lastly and specifically for the burn unit, is:

- to include in its standard operating procedures (care bundles) to do infection surveillance and culturing - a technique to register/avoid contamination and spread, especially of multiresistant microbes.

- to be aware of the specific challenges in the burn care setting, wound cleansing/dressing change situations, especially if not adhering to a complete single room strategy.

- Attention to ventilation and decontamination procedures and facilities.

Folke SJÖBERG

The Burn Center, Departments of Hand and Plastic Surgery, and Intensive Care / Linköping University Hospital, SWEDEN

69

APBC

Symposium



Chinese Burn Association expert consensus on the operation and management of deep vein catheterization in severe burn patients (2020 version)

Deep vein catheterization is an important method to prevent and treat burn shock in severe burn patients, monitor hemodynamic changes and provide venous nutritional support. Although deep vein catheterization has been applied widely, there is no standard operation and management process. In order to guide the operation and management of deep vein catheterization in severe burn patients in a more scientific and standard manner, Chinese experts in burn field discussed and reached a consensus mainly in selection of deep catheter and the catheterization site, the method of catheterization operation, catheter maintenance, and prevention and treatment of catheter-related complications. This consensus aims to provide practical guidance for the operation and management of deep vein catheterization for severe burn patients.

Jun WU1), Lijun ZHANG1), Jingning HUAN1), Zhaohong CHEN2)

The First Affiliated Hospital, Shenzhen University, CHINA1)

Xiehe Hospital, Fujian Medical University, CHINA2)

70



Goal-directed fluid resuscitation protocol with early colloid intervention in major burns: The first 48 post burn hours

Objective:Effective fluid resuscitation during early postburn period is vital. Fluid creep usually results from inaccuracies in calculating fluid requirement.Methods:We conducted a retrospective cohort study of 8 major burn patients at the Tri-Service General Hospital during 2017 to 2020. All patients were mechanically ventilated and followed the goal-directed fluid resuscitation protocol during the first 48 hours post-burn. Fluid administration was adjusted to achieve a urine output of 0.4-0.6 body weight(kg)/h, cardiac index >2.5 L/min/m2, and stroke volume variation (SVV) <12%. The hourly crystalloid and colloid fluid infusion rate were titrated based on SVV and hourly urine output.Results:Of the 8 critically burned patients admitted to the ICU, the mean age (years) was 43.0, the mean total body surface area (TBSA) burned (%) was 39.0. The fluid volume administered to patients in the first 24 hours and the second 24 hours (mL/kg/%TBSA) were 2.43 and 1.46. The urine output in the first 24 hours and the second 24 hours (mL/kg/h) were 1.30 and 1.42.Conclusion:SVV-based goal-directed fluid resuscitation protocol with early colloid fluid intervention leads to less unnecessary fluid administration during the first 48 post burn hours.

Hao-Yu CHIAO, Niann-Tzyy DAI, Chih-Hsin WANG, Yuan-Sheng TZENG

National defense medical center / Tri-service general hospital, TAIWAN

71

APBC

Symposium



Fluid resuscitation in new practical guidelines for burn care in Japan

Background:Shock occurs if 15-20% of the total body surface area is burned, and thus fluid resuscitation is performed in burn patients. A large volume of fluid is often administered to maintain the hemodynamics. In 2000, Pruitt reported the Parkland volume formula for estimating fluid volume for resuscitation, which is widely used; however, its usage may provide more fluid than needed to patients, and it may cause adverse effects due to edema formation affecting the prognosis. Since then, many studies have been conducted to reduce fluid volume.Methods:To update the practical guidelines for burn care, the scientific committee from the Japan Society for Burn Injuries conducted a literature search and review of fluid resuscitation between 2000 and 2020.Results:Nine randomized control studies and two systematic reviews were examined. These studies investigated the use of albumin, fresh frozen plasma, hydroxyethyl starch, hypertonic lactated saline, high-dose ascorbic acid, and new monitoring devices for burn care. The albumin administration in children with burns between 8 and 12 hours post burn could reduce the edema formation.Conclusion:The grade for the clinical application recommendations of the treatment options was deemed weak because of the mixture of positive and negative results.

Yukio SATO


72



Burn Treatment Guidelines - Need of the hour in India

Objective:Clinical guidelines help to improve the quality of care received by patients. Guidelines should be systematically developed such that they can assist the physician to make appropriate decisions about management for specific clinical circumstances.Methods:For Burn care the guidelines will have to cover a very wide variety to topics from Acute burn all the way to reintegration of patient back to society. The first step towards making the guidelines would be to list all the subtopics which the guidelines should cover. Country specific guidelines will help the practitioner follow the guidelines better as compared to a common one across the world. A minimum set of guidelines also helps for those places which are unable to have their own guidelines.Results:Just like checklists, guidelines have many benefits but one needs to keep in mind that they also have the potential of harm if they are not tweaked to the circumstances unique to the patient when needed. But rigorously developed evidence based guidelines minimise the potential harm. Conclusions:In a low resource setting, having recourse to and following guidelines will go a long towards making sure that maximum number of patients derive benefit from the available scarce resources.

Vinita PURI

Seth G S Medical College and KEM Hospital, INDIA

73

APBC

Symposium



Treatment of the massive burn patient

Experience with the massive burn (>60% TBSA) is becoming less common due to the decreased frequency of these severe injuries. Unlike many burn centers in the United States, we continue to have massive burns. Last year, during the COVID-19 pandemic we admitted five patients with over 80% TBSA burns and eight patients over 60% TBSA. For successful treatment of these massive injuries, we have developed the following strategy. In the first day of admission, we focus solely on fluid resuscitation. On the day after injury, we take the patient to the operating room for a tracheostomy, and excision of all extremities and the anterior trunk. For this initial operation we include a team of 3-4 attending surgeons, 1-2 fellows, residents and students. The large team shortens the duration of the procedure so that the patient does not develop hypothermia. If the wounds are not too deep, we will harvest autograft and start covering the hands and arms, since they are important functionally. When autograft is gone, we cover the remaining wounds with the polyurethane foam Biodegradable Temporizing Matrix (“BTM”, Polynovo, Inc.). We also will obtain a biopsy to grow cultured epithelial autograft (CEA). On the second day, we excise and place BTM on the back. On the third or fourth day we excise and place BTM on the face. Therefore, the patient’s wounds are excised within a few days. We then wait for donor sites to heal to cover the vascularized BTM over time. When the CEA is available, we will place the CEA over 6:1 meshed autograft. This technique has allowed us to save several patients with massive burns.

David G. GREENHALGH

Shriners Hospitals for Children Northern California and Department of Surgery, University of California, Davis, USA

74



Useful and effectiveness of Burn scar management using by FTSG with fat graft

Since the past and up to date, full thickness skin graft concept has been less changed. FTSG is a very important surgical option in aesthetic and reconstructive plastic surgeries for functional recovery of hand surgery or joint area, replacement of good skin texture and redundant for aesthetic and functional purpose. The most unchanged FTSG concept may be the removal of subcutaneous fat tissue, using pattern for actual replacement of skin defect as possible as its size to minimize contracture rate, fear of low take rate and high complication rate. Author has had numerous numbers of experiences with good results to share with.The important points to share are:1. Preserve subcutaneous fat tissue layer which contain reticular dermis with subcutaneous fat layer, not dermal shaving at all.2. FTSG doesn’t need to be same size as skin defect. It can be a little smaller since the mild change of engrafted tension and change of direction do not affect graft take rate and post-operative contracture rate.3. The fat layer attached on the FTSG graft has great effects shown as increasing the graft take rate and markedly reduce the maturation period in long term follow up results.

Young Chul JANG

BPS Soo Hospital, KOREA

75

APBC

Symposium



RECONSTRUCTION OF LARGE BURN SCAR - DIFFICULTIES AND CHALLENGE

According to WHO (2000), every year there are about 100 million people worldwide who suffering from new scars on the body due to many reasons: injury, burns, surgery, cosmetic procedures, insect bites… Most cases of scarring will develop normally (the result is normal scars) if preventive measures is used; on the contrary, some percentage of scars may have abnormal development if there is no good prophylaxis applied, especially in high-risk patients (44% of hypertrophic scarring and 17% of keloid formation. There are many preventive and treatment methods for keloids, hypertrophic scars have been applied. However, in extensive burn scar patient how to control scar development or finding good material for reconstruction is too difficult. Since 2000 up to now, Center of plastic and reconstructive of Vietnam National Hospital Of Burn was applying microsurgery super-thin flap for severe neck and face contracture scar reconstruction. Occipito-Cervico-Dorsal supercharging super-thin flap, Supraclavicular supercharging and Double pedicle dorsal perforators free flap were used successfully to obtain both cosmetically and functionally.

Vinh Quang VU

Vietnam national hospital of burn, VIETNAM

76



Free Tissue Transfer for Post-burn Reconstruction

Although skin grafts are generally used for post-burn reconstruction, the flap coverage is superior in both functional and aesthetic stand points under certain situations. Therefore, burn care has also been included in this expanding role of the free tissue transfer.On the other hand, severe burn patients, to whom the free flap transfers are often adapted, are characterized by a shortage of available donor tissue for flap elevation. In addition, one of major drawbacks of the conventional free flap is the bulk of the tissue. The technique of tissue expansion first introduced in early 1980’s can reduce the donor site morbidity and the bulkiness of the flaps. In burn patients, this technique has been well indicated for alopecic deformities of the scalp. Moreover, it can extend the indication of the free flap transfer for severe burn patients.

Hiroyuki SAKURAI, Keijiro HORI, Yosuke NIIMI, Wataru KAMEI, Yuki HASEGAWA

Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, JAPAN

77

APBC

Symposium



Use of Tissue Expanders in Burn Reconstruction: Our experience

Background:Use of adjacent normal tissue has been considered to be the best option for reconstruction and resurfacing. Tissue Expanders increase the amount of available skin and makes the reconstruction easier. In this paper the authors describe their experience of using tissue expander for post burn scars.Methodology and Results:Retrospective data over 8 years from Jan 2012 to Dec 2019 was collected from hospital records and analyzed. 26 patients were operated over a period of 8 years for resurfacing of the post burn scars and scar alopecia. 12 patients were male and 14 females. All patients were satisfied with the results and complications like expander exposure, partial flap necrosis, junctional scarring were few. Multiple sessions were needed for the final result though.Conclusion:Tissue expansion is a useful tool in the armamentarium of the plastic surgeon when we are treating Burn deformities. It provides a near-perfect match of colour, texture & hair-bearing skin. In properly selected patients, this technique provides excellent quality donor tissue, with minimal donor site morbidity.

Vinita PURI, Raghav SHROTRIYA


78



Keloid Today: 3 Year-Experience in Keelung Chang Gung Memorial Hospital

Keloids and hypertrophic scars are fibroproliferative disorders of the skin that result from abnormal healing of injured or irritated skin. Multiple studies suggest that genetic, systemic, and local factors may contribute to the development and/or growth of keloids and hypertrophic scars. Moreover, the severity of scarring is shaped by interactions between these local factors, genetic factors, and systemic factors such as hypertension and sex hormones. The Asian population is challenged with a high incidence of keloid occurrence with a specific genetic predominance. The annual reported incidence of new keloid cases in Taiwan is around 30,000. Nowadays keloid therapy included: surgery plus radiotherapy, compression therapy, steroid injection, and laser treatment. Surgery with adjuvant radiotherapy approach is thought to have the most significant effect on decreasing recurrence rate. At present, I will present some preliminary reports revealed convincing evidence of feasibility and effectiveness of applying adjuvant radiotherapy after keloid excision at Keelung Chang Gung Memorial Hospital in the Taiwanese population.

Chia-Hsuan TSAI

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung branch, College of Medicine, Chang Gung University, TAIWAN

79

APBC

Symposium



The systemic factors shaping cutaneous pathological scarring and potentially involved in scar management

Cutaneous pathological scars are fibrotic lesions that demonstrate the potentials to grow continuously, invade the adjacent skin, and are erythematous, itchy, and painful. Their etiology remains unclear but may involve genetic, local mechanical, and systemic factors. Here, we will summarize the main systemic factors that shape cutaneous pathological scarring, especially keloid formation and aggravation, targeting at their potential roles in scar management. These systemic factors include circulating cytokines, chemokines, growth factors, particular cell types, sex hormones, the systemic reninangiotensin system, and vitamin D, all of which directly shape the angiogenesis, inflammation, fibrosis, and remodeling in pathological scars. There are also several environmental factors that more indirectly influence pathological scar formation or progression, namely diet, smoking, psychological stress, and exercise. Additionally, we describe two new avenues of keloid research that may greatly improve our understanding of pathological scarring and the systemic factors that affect it, which may enlighten future therapeutic strategies. One is the multiple similarities between keloids and tumors; the other is the different stem-cell populations in keloids. We expect this research will greatly aid the development of diagnostic biomarkers for cutaneous pathological scars and drugs/techniques/regimens that prevent, improve, or cure these scars.

Chenyu HUANG, Rei OGAWA

Beijing Tsinghua Changgung Hospital, Tsinghua University, CHINA

80



Super tension-relieving suture technique combined with adjuvant radiotherapy in keloid management

ObjectiveSurgical excision with adjuvant radiotherapy has been widely recommended for keloids and many tension-relieving sutures are applied to help lower the recurrence rate. This study aimed to present a novel super tension-relieving suture technique and compare its effectiveness to buried vertical mattress suture as a treatment regimen in keloids.MethodsA retrospective study was performed on patients who underwent keloid excision followed with postoperative radiotherapy between 2019 and 2020. 20 patients with 22 keloids were treated with super tension-relieving suture and simple interrupted suture while 50 patients with 56 keloids with buried vertical mattress suture and simple interrupted suture while. Radiotherapy started within 24 hours and 20 Gy was delivered in 4 fractions. Patients were followed over 12 months. The recurrence rate and postoperative complications were recorded.ResultsAt 12 months, keloids treated with super tension-relieving suture combined with adjuvant radiotherapy showed a much lower recurrence rate of 9.1% compared with 25.0% in buried vertical mattress suture group, while there was no significant difference (P > 0.05). The groups did not differ in complications. The super tension-relieving suture group reported an average scar width as 1.5mm.ConclusionsSuper tension-relieving suture can achieve good treatment results and cosmetic scar appearance in keloids.

Yixin ZHANG

Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital / Shanghai JiaoTong University School of Medicine, CHINA

81

APBC

Symposium



Improvement of hypertrophic scar by early intervention with ablative fractional carbon dioxide laser

Objectives:This study was designed to assess the efficacy and safety of ablative fractional CO2 laser for burn hypertrophic scars, and analyze the efficacy and safety in early period with less than 3 months after injury. Methods:We performed a retrospective study on 221 hypertrophic scar patients. According to the time of first laser treatment after injury, patients were divided into five subgroups, including less than 1 month, 1 to 3 months, 3 to 6 months, 6 to 12 months and more than 12 months. One month after the last laser treatment, the scar were assessed by photograph, Vancouver Scar Scale (VSS), durometer and spectrocolorimeter.Results:There were 118 males and 103 females in included patients. The average age was 33.6 years old. The fire/flame was the first injury factor. 36.2% patients had at least one time of fractional CO2 laser treatment. All the included patients including the patients within 1 month after injury had significant decrease in VSS assessment after the laser treatment.Conclusions:This study demonstrated that the optimal time of laser application on the burn patients can be starting up within 1 month after injury. Durometer and spectrocolorimeter were effective to assess scars as objective modalities.

Jianglin TAN

Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Army Medical University, CHINA

82



Effect analysis of early application of sequential laser in treatment of hypertrophic scar in children with burn

ObjectiveTo investigate the efficacy of intensive Pulsed Light (IPL) and carbon dioxide laser sequential treatment of hypertrophic scar in children with burn.MethodsFor retrospective cohort study, subjects will be compared against themselves. We analyzed 145 medical records which met the inclusion criteria of children with early post-burn hypertrophic scar, they were admitted to the Department of Burn Surgery of the First Hospital of Jilin University from January 2016 to December 2018. Among them, 82 were males and 63 were females.ResultsVSS scores before treatment: 2(2,3),3 (2,3),2 (2,3),2 (1,2), 9(7,10); VSS score after treatment: color, vascular distribution, thickness, flexibility and total score were 2(0,2),1 (0,1),1 (0,1),1 (0,1), 3(2,5), respectively. VSS scores after treatment were significantly lower than those before treatment (all P < 0.001). ConclusionEarly application of IPL and carbon dioxide laser in sequential treatment of hypertrophic scar in children with burns has obvious curative effect, higher satisfaction and less adverse reactions.

Chunhui XIE, Xinxin GAO, Jiaao YU

The First Hospital of Jilin University, CHINA

83

APBC

Symposium



Aesthetic Burn Reconstruction -from Laser and Make-up Therapy to Surgery-

Post-burn hypertrophic scars (HSs) occur within weeks after burn, rapidly increase in size for 3-6 months, and then begin to regress. Early initiation of treatment leads to cosmetic results. In the treatment of post-burn HSs, indication of surgery should be decided whether scar contracture is associated with HSs. Releasing scar contractures improves joint function, and even if it is partial releasing of contractures, accelerates maturation of surrounding immature scars and HSs. However, small and linear HSs with mild scar contractures can be treated with complete surgical resection radically or with nonsurgical multimodal therapy. Skin grafting, Z-plasty, W-plasty, local flaps, and super-charged flaps could be selected on a case-by-case basis. After these treatments, long-term follow-up and conservative therapies are needed for complete functional and cosmetic recovery. Corticosteroid tape/plaster is effective in reducing inflammation. The pulsed dye laser (PDL) and long-pulsed Nd: YAG (LPY) laser which target capillary vessels can be used for post-burn scar treatment. Moreover, fractional lasers can also be used for post-burn scars. Make-up therapy should also be considered in the management of the psychological stress of patients, as these therapies improve not only the cosmetic appearance of scars but also reportedly promote physiological changes.

Rei OGAWA

Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, JAPAN

84



Management of burn scar with dermabrasion and non-cultured regenerative epithelial suspension

Objectives: We challenged the noncultured regenerative epithelial suspension in 3 difficult burn scars. The cases presented comprise of a superficial burn scar with hyperpigmentation on the face of an 18-year-old male, a superficial burn scar with hypopigmentation on the thoracic region of a 12-year-old girl, and a challenging to heel burn scar with hyperpigmentation on the right leg of a 20-year-old gentleman. Methods:The scars were treated with microdermabrasion, then the ratio of about 1:60-1:150 autologous noncultured regenerative epithelial suspension was obtained and sprayed to the wound. The caregivers regularly assessed these wounds till healing, including clinical, planimetric, and photographic records to 3 months.ResultsA total of 3 patients with superficial scars treated by non-cultured regenerative epithelial suspension technology combined with microdermabrasion showed significant improvement in skin texture and color. DiscussionChallenging scars are detrimental to the health-related quality of life of the burn patients, increases financial burdens, and moreover, tests the clinician’s ability to treat these scars. Regenerative epithelial suspension can lead to the restoration of wounds and repigmentation, which can treat scar and depigmentation diseases.

Liang QIAO

Department of Burn and Plastic Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, CHINA

85

APBC

Symposium



Laser treatments in burn and traumatic scars

Laser treatment is most appropriate for thick, raised scars. These scars — also known as hypertrophic scars — result from abnormal or excessive healing. They are often red or inflamed and frequently cause significant functional impairment such as the limitation in the range of motion, etc. They may also cause emotional distress when they are located on the face, neck or other visible area.

While laser treatment will not completely remove burn or traumatic scars, it can improve functional abilities the patients may have lost due to scarring. In addition, laser treatment can also soften the scar consistency and lessen scar itching. Laser treatment may also be offered as part of a more comprehensive burn scar reconstructive treatment program tailored for the patients. Application of lasers for the treatment of burn and traumatic scars will be shred and discussed.

Whoraphong MANUSUKIATTI

Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, THAILAND

86


APBC Free PaperAbstract

89

APBC

Free PaperThe 47th JSBI & The 13th APBC

APBC Free Paper [On demand] AO-01

Adjustable biodegradability of low-swelling hydrogels prepared from recombinant peptides based on human collagen type 1

Takashi NAKANO1), Hiroki YAMANAKA1), Michiharu SAKAMOTO1), Yasuhiro AIKI2), Ie NIE1), Sunghee LEE1), Yasuhiro KATAYAMA1), Eiichi SAWARAGI1), Itaru TSUGE1), Susumu SAITO1), Naoki MORIMOTO1)

Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, JAPAN1)

Bio Science & Engineering Laboratory, FUJIFILM Corporation, JAPAN2)

Background:Recently, a novel low-swelling hydrogel was developed by cross-linking a recombinant peptide, modeled on human collagen type 1 (RCPhC1), with a four-arm poly(ethylene glycol). We hypothesized that the biodegradability of the RCPhC1 hydrogel was adjustable by altering its initial polymer concentration.Methods:Three types of RCPhC1 hydrogels were prepared at different concentrations of the initial polymer, and their swelling ratio, collagenase-degradability, cytocompatibility, biocompatibility, and biodegradability were compared.Results:The results revealed a low swelling ratio. The higher the concentration of the initial polymer, the longer it took to degrade by collagenase. The average cell proliferation ratio was over 92% in the direct contact method. In vivo, there was no death, tumorigenesis, exposure, or skin necrosis associated with the subcutaneous implantation of the hydrogels in mice. Histological evaluation revealed the formation of a thin fibrous capsule, which suggests acceptable biocompatibility. Furthermore, the biodegradability could be adjusted by changing the initial polymer concentration.Conclusion:The ability of RCPhC1 hydrogels to fine-tune biodegradability demonstrates their potential for use in various clinical applications; in treating ulcers and burns.


BMSCs derived exosomes alleviate smoke inhalation lung injury

Guang-Hua GUO, Bin XU, Chun-Xia GAN, Jia-Qi LI, Ming-Zhuo LIU

The First Affiliated Hospital of Nanchang University, CHINA

Accumulating evidence have shown that exosomes have been implicated in multiple injury related disease. Here, we intend to investigate the role of bone marrow mesenchymal stem cell (BMSCs)-derived exosomes on smoke inhalation lung injury.In this study, we initially isolated exosomes from BMSCs and identified them by western blotting and transmission electron microscopy. BMSCs-derived exosomes were then used to treat the model of smoke inhalation lung injury in vivo and in vitro. Pathologic alteration of lung tissue, the level of inflammatory factors and apoptosis-related factors, the expression of HMGB1 and NF-κB were measured to evaluate the therapeutic effect of treatment with BMSCs-derived exosomes. We found that BMSCs-derived exosomes could alleviate the injury caused by smoke inhalation. Smoke inhalation could increase the level of inflammatory factors, apoptosis-related factors, the expression of HMGB1 and NF-κB, while the increase could be reversed by BMSCs-derived exosomes treatment. HMGB1 overexpression could further upregulates the decrease of inflammatory factors, apoptosis-related factors and NF-κB induced by exosomes treatment.Collectively, these results indicated that BMSCs-derived exosomes could effectively alleviate smoke inhalation lung injury by through inhibition of HMGB1/ NF-κB pathway, suggesting that a potential strategy against inhalation lung injury could be therapy with exosomes as a non-cellular measure.

90



Role and mechanism of PI3K/AKT/FoxO1/PDX-1 signaling pathway in functional changes of pancreatic islets in rats after severe burns

Bohan ZHANG, Chuanan SHEN

The Fourth Medical Center of Chinese PLA General Hospital, CHINA

Objectives:The phosphoinositide 3-kinase (PI3K)/serine threonine kinase (AKT)/forkhead box protein O1 (FoxO1) signaling pathway can regulate insulin secretion by modulating the expression of pancreatic and duodenal homeobox-1 (PDX-1). This study aimed to explore the role and mechanism of the PI3K/AKT/FoxO1/PDX-1 signaling pathway in functional changes of pancreatic islets in rats post severe burns. Methods:Rats were grouped, subjected to full thickness burn injuries involving 50% total body surface area, and injected intraperitoneally with BPV (HOpic) or DMSO once a day for three days. Glucose metabolism related indexes were measured by the glucometer, transmission electron microscopy and ELISA. PI3K/AKT/FoxO1/PDX-1 signaling pathway related indexes were detected through immunofluorescence, western blot and RT-qPCR analyses. Results:Dysglycemia and impaired insulin secretion occurred, the activity of the PI3K/AKT/FoxO1/PDX-1 signaling pathway in the islets fell, and PDX-1 was translocated from the nucleus to the cytoplasm post severe burns. When BPV (HOpic) was used, glucose metabolism and insulin secretion were improved, the activity of the PI3K/AKT/FoxO1/PDX-1 signaling pathway in the islets was up-regulated, and PDX-1 was redistributed from the cytoplasm to the nucleus. Conclusions:The activity of the PI3K/AKT/FoxO1/PDX-1 signaling pathway declined following severe burns. When its activity was up-regulated, insulin secretion improved, thus ameliorating hyperglycemia.


Study on changes of insulin secretion and signal transduction mechanism in rats at early stage post severe burns

Dawei LI, Chuanan SHEN


Objectives:This study attempts to explore the early changes of insulin secretion and signal transduction mechanism in rats post severe burns.Methods:Rats were grouped, subjected to full thickness burn injuries involving 50% total body surface area, and injected intraperitoneally with BPV (HOpic) or DMSO once a day for three days. Glucose metabolism related indexes were measured by the glucometer, transmission electron microscopy and HE staining. Pancreatic Akt phosphorylation was detected through western blot.Results:The following changes took place in rats post severe burns: the level of fasting blood glucose was increased; the morphology of islets was incomplete, the vacuoles in islets were common, some of the cytoplasm of islet beta cells was lightly stained or translucent, and islet beta cells were irregularly arranged; the number of docked granules per 10 μm membrane of islet beta cells was decreased; the level of pancreatic Akt phosphorylation was decreased. When BPV (HOpic) was used, pancreatic Akt phosphorylation elevated, glucose metabolism improved.Conclusions:The activity of pancreatic PI3K/Akt signaling pathway and the function of insulin secretion are reduced post severe burns. Improving rats’ activity of pancreatic PI3K/Akt signaling pathway can improve the function of insulin secretion and recover glucose metabolism.

91

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Long-term influence of burns on islets

Xinzhu LIU, Chuanan SHEN


Objectives:Burn patients have a higher risk of diabetes. This study aimed to explore the long-term influenced of burns on mice islets.Methods:Mice were grouped and subjected to full-thickness burn injuries of 30% TBSA. At two months after severe burns, fasting blood and intraperitoneal glucose tolerance were detected. Islets were isolated for mRNA sequencing. Cell cycle, metabolism and insulin regulatory genes were analyzed.Results:At two months after severe burns, fasting blood glucose was significantly higher and glucose tolerance was impaired. Through mRNA sequencing, 128 differentially expressed genes were selected. The pathways of cell cycle and oxidative phosphorylation were downregulated. And most of beta-cell-specific disease genes showed a downregulated trend.Conclusions:There is the disorder of glucose metabolism in mice at two months after severe burns, which is caused by the low rate of islet cell replication and it is also related to the low rate of oxidative phosphorylation.


Tideglusib Promotes Wound Healing in Aged Skin by Up-regulating Epidermal Growth Factor Receptors

Jiachen SUN, Chuanan SHEN


Objectives:This study aimed to explore the effect and mechanism of small molecule Tideglusib on wound healing in aged skin.Methods:The efficacy of EGF in wound healing was compared in rats of different ages. Immunofluorescence, Western Blotting and bioinformatics analysis were used to detect changes in the EGF/EGFR/PI3K/Akt signaling pathway, and the levels of cell proliferation and apoptosis in vivo. The mechanism of Tideglusib affecting EGFR expression was explored through knockdown and overexpression experiments.Results:Decreased epidermal growth factor receptor (EGFR) impaired the activity of the PI3K/Akt/mTOR pathway in aged skin and in ESCs, thereby slowing wound healing and impeding the efficacy of epidermal growth factors (EGF). Knockdown and overexpression experiments demonstrated that Tideglusib, a small molecule drug, could increase the expression of EGFR via the GSK-3β/β-Catenin/MMP9 pathway. Consequently, the activity of the PI3K/Akt/mTOR pathway was enhanced, thus promoting proliferation and inhibiting apoptosis in ESCs, and accelerating wound healing in aged rats.Conclusions:The declined expression of EGFR in aged skin which diminishes the efficacy of EGF can be restored by Tideglusib through a positive feedback. This mechanism is expected to offer novel clues for understanding skin aging and developing new therapeutics.

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Adiponectin receptor agonist AdipoRon blocks skin inflamm-aging by regulating mitochondrial dynamics

Jiachen SUN, Chuanan SHEN


Objectives:This study aims to explore the role of AR on mitochondrial damage induced by skin inflamm-aging and its underlying mechanism.Methods:Male C57BL/6 (B6) mice were housed in a specific pathogen-free microisolator environment at our burn center. AR (10 mg/kg, 20 mg/kg, 40 mg/kg) was dissolved in 0.5% sodium carboxymethyl cellulose solution and was provided to 23M mice in therapy group once daily via intragastric gavage for 4 weeks. 0.5% sodium carboxymethyl cellulose solution was provided to 1M, 13M, and 23M mice in the control group once daily via intragastric gavage for 4 weeks. N=8 for each group. Subsequently, wound study, immunofluorescence, western blot, TUNEL staining, cell culture and treatments, transmission electron microscopy, mitochondrial detection, and cell migration assay were performed.Results:AR treatment exerted dose-dependent protective effects in aged skin, which attenuated inflammatory factors and apoptosis that increased with age, and improved mitochondrial morphology and function. Further research revealed that this process at least partly depended on the suppression of Dynamin-related protein-1 (Drp1)-mediated excessive mitochondrial division.Conclusions:AR rescues the mitochondria in aged skin by suppressing its excessive division mediated by Drp1. Therefore, AR may be a potential therapeutic agent for the treatment of skin SASP and inflamm-aging.


Protective effects of ginsenoside Rc against severe burn-induced myocardial injury in rats

Yan XUE

the Department of Burn Surgery, the First Hospital of Jilin University, CHINA

Ginsenoside Rc is one of the cardinal bioactive components of Panax ginseng. The present study aimed to investigate whether ginsenoside Rc exerted protective effects against severe burn-induced myocardial injury in rats. Forty rats were randomly assigned into four groups: control, model, ginsenoside Rc (10 mg/kg), and ginsenoside Rc (20 mg/kg) groups. Rats were intragastrically administrated with ginsenoside Rc (10, 20 mg/kg) or vehicle daily for seven days. On the seventh day, the shaved back of rats except the control group was immersed into 95-100°C hot water for 15s, generating a full-thickness burn model with 40% TBSA. Ginsenoside Rc significantly improved cardiac function, diminished the activities of LDH, AST and CK-MB (P < 0.05 or P < 0.01). Furthermore, ginsenoside Rc could attenuate myocardial histological changes and structural abnormalities, decrease apoptotic cells and reduce the mRNA levels and activity of TNF-α, IL-1β and IL-6 (P < 0.01). In addition, ginsenoside Rc upregulated the expressions of SIRT1, Bcl-2 and procaspase-3, and downregulated that of Bax (P < 0.01). The results of the current study suggested that ginsenoside Rc could alleviate severe burn-induced myocardial injury in rats by inhibiting cardiomyocyte apoptosis via regulating SIRT1 expression and attenuating the inflammatory responses.

93

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Resistance reversal of methicillin-resistant Staphylococcus aureus through regulation of MecA gene by sub-high temperature photothermal and its mechanism

Xinxin CHEN, Jiaao YU, Xiuhang ZHANG

The Department of Burn Surgery, the First Hospital of Jilin University, CHINA

Methicillin-resistant Staphylococcus aureus (MRSA) infection severely affects the wound healing process, antibiotic pan-resistant Staphylococcus aureus greatly limits clinical efficacy. Studies have shown that MRSA express a special penicillin-binding protein PBP2a in large quantities by MecA genes forming resistance to β-lactam antibiotics. Photothermal therapy (PTT) has been reported to be effective in killing MRSA in vitro via PBP2a and confirmed in skin wound infection rat model. However, the high temperature(55℃) produced by photothermal materials to remove bacteria also damage healthy tissues and limit clinical application promotion. In order to solve this problem, this project plans to make photothermal nano-preparations through the weak interaction between black phosphorus nanosheets and antibiotics to produce a local microenvironment with sub-high temperature (temperature between 37℃ and 42℃)by regulating irradiation intensity and time, to improve the sensitivity of MRSA to antibiotics The efficiency and protein activity of inhibiting MecA gene expression of PBP2a are tested to reverse MRSA resistance to β- lactam antibiotics. This study provides new ideas for the treatment of clinical multidrug-resistant bacteria based on the clinical application prospect of photothermal materials.


Cucurbitacin E induces autophagy-involved apoptosis in intestinal epithelial cells

Huapei SONG

State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University, CHINA

Apoptosis plays a crucial role in maintaining the structural and functional integrity of the intestinal epithelial barrier. Autophagy mediates injury to and repair of the intestinal epithelial barrier through multiple pathways in pathophysiological conditions. Our earlier study has found that cucurbitacin E (CuE) regulates the proliferation, migration and permeability of human intestinal epithelial cells (IECs); however, its effects and mechanisms on apoptosis and autophagy are still unclear. This study reports that CuE induces apoptosis and promotes autophagy of IECs in a concentration-dependent manner. The results show that CuE can induce G2/M cell cycle arrest, inhibit the expression of apoptosis-related protein Bcl-2 and drive the of caspase-3 and its substrate poly (ADP-ribose) polymerase. CuE can also facilitate the expression of endoplasmic reticulum stress-related proteins CHOP and Grp78 and autophagy-related proteins Beclin1 and LC3 while inhibiting the phosphorylation of AKT and mammalian target of rapamycin (mTOR). An autophagy inhibitor, 3-methyladenine, reduced CuE-induced apoptosis. These results suggest that endoplasmic reticulum stress may mediate CuE-induced apoptosis and autophagy in IECs via the PI3K/AKT/mTOR signalling pathway and that autophagy participates in the pro-apoptotic process induced by CuE.

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Creating a third-degree burn model using Japanese fire belly newt

Ikkei TAKASHIMIZU, Shunsuke YUZURIHA

Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, JAPAN

Objective:The Japanese fire belly newt, which maintains its ability to regenerate for a lifetime, does not form scars or keloids even if it is got deeply injured. If deep burn wounds heal without scars, elucidation of the healing mechanism will lead to new burn treatments, so in this study, we attempted to create a newt burn model.Methods:Burn wounds in 6mm diameter were made on the back of 15 adult newts with a heated metal rod at different temperatures and times. Wounds were observed over time, various stains were performed after tissue section preparation, and histological evaluation was performed on the depth of burns and the degree of cell infiltration.Results:No newt died from burns in this study. Blisters and carbonized tissue caused by burns formed ulcers in few days. Under the condition of 200°C or higher and 2 seconds or longer, degeneration of collagen fibers in the subcutaneous tissue was observed beyond the thin dermis layer. Inflammatory cell infiltration was also observed in the subcutaneous tissue under all conditions.Conclusions:We created a third-degree burn model for newts.

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95

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Network analysis revealed central genes expressions in the blood in patients with severe burns.

Yuki TOGAMI, Hisatake MATSUMOTO, Shinya ONISHI, Hiroshi OGURA

Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, JAPAN

Objective:Bioinformatics technology is developing rapidly due to advances in genome analysis. Although personalized medicine with bioinformatics based on genetic information has advanced in malignant diseases, it has not yet been sufficiently examined in the field of acute critical care.Methods:We searched the public gene expression database (GEO: Gene Expression Omnibus) using the keyword "Burn". Comprehensive whole blood genes expressions data (mRNA; messenger RNA) within 24 hours after severe burns injury (TBSA ≥ 20%) was extracted. A principal component analysis was performed to evaluate differences in gene expressions between the burn group and the healthy control group. Weighted Gene Correlation Network Analysis (WGCNA) was used to access the central gene expressions in the burn group.Results:The 27415 gene expressions were extracted in both the burn group (n=13) and the control group (n=28). The results of the principal component analysis showed different distributions of gene expressions between the burn group and the control group. The results of WGCNA revealed 10 central gene expressions, e.g., PSAP, FLOT2, and ARF5.Conclusions:We found that gene expression changes and 10 central genes in the early stage after severe burn injury. These central genes might play an important role in the pathogenesis of acute burns.


Ellagic acid exerts anti-fibrotic effects via TGF-β1/Smad2/3 pathway suppression in hypertrophic scar fibroblasts

Xianglong MENG1), Xianjun LIU2), Xinxin GAO1), Hao LI2), Zhandong LI2), Li ZHANG3), Bo WANG4), Jian YU3), Xinxin CHEN1), Jiaao YU1)

Department of Burns Surgery, the First Hospital of Jilin University, CHINA1)

College of Food Engineering, Jilin Engineering Normal University / Measurement Biotechnique Research Center, Jilin Engineering Normal University, CHINA2)

College of Food Engineering, Jilin Engineering Normal University, CHINA3)

Institute for Interdisciplinary Biomass Functional Materials Studies, Jilin Engineering Normal University, CHINA4)

BackgroundHypertrophic scar (HS) is a kind of serious pathological scar with no currently effective treatment. HS fibroblasts (HSFs) are the main effector cells for HS formation. The role of ellagic acid (EA) in HS remains unclear.ObjectiveThis study aimed to evaluate the effect of EA on the fibrotic phenotypes of HSFs and to further investigate the downstream signaling mechanism.MethodsHSFs proliferation was assessed using the cell counting kit-8 assay. HSFs migration was assessed using wound healing assay. Moreover, the expression of collagen I and III was investigated. Real-time quantitative PCR and western blotting were performed to measure genes expression. The phosphorylation levels of Smad2 and Smad3 were detected to evaluate the Smad2/3 pathway.ResultsEA inhibited the proliferation and migration of HSFs and collagen expression in HSFs in a dose-dependent manner. Furthermore, EA not only suppressed the Smad2/3 pathway but also reversed TGF-β1-induced activation of the Smad2/3 pathway and up-regulation of the fibrotic cellular phenotypes in HSFs.ConclusionsThese findings demonstrate that EA exerts anti-fibrotic effects on HSFs by blocking the TGF-β1/Smad2/3 pathway, which indicates that EA is a potential therapeutic candidate for treatment of HS.

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a new burn unit in Uttarakhand

Vishal MAGO, Anand AGRAWAL, Nishank MANOHAR, Praveen A J

AIIMS Rishikesh, INDIA

Objective1. To outline the epidemiological profile of burn patients in hilly area of Uttarakhand2. To describe burn care in covid pandemic timesMethodsThis study was done to describe the epidemiological profile of burn patients admitted in emergency of AIIMS Rishikesh over a period of one year during the pandemic and outline the management protocol.Management and outcomes were recorded in proformas over a period of one year in the pandemic times.ConclusionStep down mechanisms for curbing the difficult covid pandemic times with burn patients were made and new treatment guidelines will be discussed.


The Effect of Direct Peritoneal Resuscitation on Mice with Severe Burn Shock and Its Mechanism

Dawei LI, Chuanan SHEN


Objectives:This study aimed to observe the effect of early direct peritoneal resuscitation (DPR) on the survival rate, vital signs and organ damage of mice with severe burn shock.Methods:Male C57BL/6C mice were subject to full-thickness burns of 30% TBSA. The experimental procedures consisted of three parts to observe the survival rate, vital signs, and organ damage.Results:(1) The 24h and 48h survival rates of mice undergoing DPR increased significantly compared with the NR group. The PR-B group increased the most from 33.3% and 0% to 93.3% and 66.7%, respectively. (2) At 3, 6, 12, 24, and 48 h after injury, the mean arterial pressure and body temperature of mice undergoing DPR increased significantly, while the heart rate was significantly lower compared with the NR group. The PR-B group had a greater increase in mean arterial pressure and body temperature, and a more significant decrease in the heart rate. (3) At 3 h after injury, the degree of inflammation in mice undergoing DPR decreased compared with the NR group.Conclusions:Early and appropriate DPR shows a definite effect on mice with severe burn shock, which can remarkedly improve the survival rate after injury.

97

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Blood Loss in Burn Surgeries: Prediction and Its Related Factors

Leorca AURINO1), Clara MENNA1), Aditya WARDHANA2)

Faculty of Medicine Universitas Indonesia, INDONESIA1)

Division of Plastic Surgery, Faculty of Medicine Universitas Indonesia, INDONESIA2)

Blood loss is a vital problem in burn surgery, and with patients often requiring blood transfusions, estimation of blood transfusions needed prior to surgery is essential. Some studies have devised formulas that can predict blood loss during burn surgery to a certain extent, whilst assessing a variety of unaccounted factors that might influence it. Until today, there is no universally accepted standardized formula.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE database for cohort and trial studies that quantitatively investigate blood loss in burn surgeries.We included 15 studies from 1982 to 2018, 13 of which are cohort studies and 2 RCTs, with a total of 1613 subjects. We found trends of blood loss within each variable and summarized them in tables.Varying results in the amount of blood loss and its related factors were found. This was due to confounding factors and dissimilarities between studies. However, several studies proposed prediction formulas, which pose promising benefits to betterment in burn surgeries. Based on these findings, clinician attending to burn patient should apply judgement accordingly to the patient individual situation. Further research with consistent variables should be done to construct a standardized blood loss estimation formula.


ROLE OF ACUTE KIDNEY INJURY IN SEVERELY BURNED PATIENTS

Zhiqiang YUAN, Bo YOU, Gaoxing LUO, Yizhi PENG

Institute of burn research, Southwest hospital, CHINA

Introduction:The aim of this study was to describe the epidemiological, clinical and pathological characteristics of acute kidney injury (AKI) in severe burns, and identify the risk factors for early AKI and late AKI, respectively. Methods:A retrospective, descriptive study was performed to 637 adult patients with total body surface area (TBSA) burns of more than 30%, They were admitted to the Institute of Burn Research, Southwest Hospital of Army Medical University of China during last six-year period. The basic characteristics and prognosis were compared, the risk factors of AKI were filtered by multifactor logistic regression analysis.Results:A total of 637 patients were included in analysis, 235 patients were diagnosed AKI, with an incidence of 36.89%,. The mortality of patients with AKI was 34.23%.age, male sex, TBSA,full-thickness TBSA, pre-existing hypertension or/and diabetes, tracheotomy, hypovolemic shock of early burn were independently associated with both early and late AKI, furthermore, sepsis was only with late AKI. Hypovolemic shock of early burn and sepsis increased the risks of late AKI 8.83 times, 13.76 times, respectively.Conclusions:AKI remains prevalent and is associated with high mortality in severe burn patients. Late AKI had a lower occurrence rate, but more severity and worse prognosis.

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Triage and transportation for Kyoto Animation Arson Attack

Kenichiro TAKASHINA1), Tetsuro TAKEGAMI1), Yoshinori MURAO2)

Emergency and Critical Care Medicial Center, Japanese Red Cross Society Kyoto Daiichi Hospital, JAPAN1)

Department of Emergency and Critical Care Medicine, Kindai University Hospital, JAPAN2)

IntroductionWe had been prepared for mass casualty incident in case of burn injuries at the Tokyo Olympic 2020 games. However, we had an incident in July 2019 called Kyoto Animation Arson Attack where a number of people died from burns caused by gasoline. We report on the management of triage and transportation of patients in around Kyoto City and to other medical facilities outside Kyoto City. OverviewIn July 2019, triage and transportation were provided for mass casualties (36 dead and 33 injured) in the Kyoto Animation Arson Attack. Thirty-six patients were initially transported to the local hospitals. Five of the 36 patients had extensive burn of more than 80% and subsequently transported to hospitals outside Kyoto prefecture for further treatment. ConsiderationIn the case of mass casualty burn incident, there were difficulties in triage and information collection. The following problems were encountered such as selection of methods, centralized or distributed transportation due to the number of medical facilities around the local site of incident. Even in urban areas, there are very few medical facilities that can treat extensive major burn patients. Further, wide-area secondary transportation of patients to other prefectures is important.

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99

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A Case of Chemical Injury Around the Anus After Drinking Kerosene

Yohei SUGI, Takayuki SHIBUSAWA, Hiroyuki FUKAMI, Yushi MATSUO, Shu YAMADA, Maki KITADA, Toshihiro SAKURAI, Chikako SHIMIZU, Masahiro HARADA, Takeshi TAKAHASHI

Department of Emergency and Critical Care, National Hospital Organization Kumamoto Medical Center, JAPAN

A 61-year-old man with a history of depression attempted suicide by drinking 200 mL of kerosene and overdosing with 20 triazolam tablets. After 3.5 hours, his wife found him and called an ambulance. On initial examination in the emergency room, redness was observed on the medial side of both thighs. He was then admitted to the hospital and monitored. The next day, blisters and epidermal peeling around the anus were observed. The injuries on the medial side of both thighs were first-degree burns, and the perianal injuries were second-degree burns, which affected 3% of the total body surface area. These injuries were considered to be chemical injuries owing to the excretion of kerosene. We treated the lesions by washing and applying Vaseline daily. On day 11, the cells were almost completely epithelialized. Injected kerosene is barely absorbed by the digestive tract, and almost all of it is excreted via the anus. When excrement is left in a diaper, the skin of the perineum comes in contact with kerosene for a long time, causing chemical injuries. Thus, frequent observation of the perineum is considered essential because the excretion of kerosene may be unnoticed.


Chemical burn of the face, mouth, pharynx, and esophagus caused by alkaline powder ingestion: a case report

Ryosuke YUNOKI1), Naoyuki KANEKO1), Ryuji UCHIDA2)

Trauma and Emergency Center, Fukaya Red Cross Hospital, JAPAN1)

Department of Plastic Surgery, Fukaya Red Cross Hospital, JAPAN2)

Alkalis cause Liquefactive necrosis with saponification of fats and solubilization of proteins, resulting in deep penetration into tissues. We here report a case of severe alkali burn caused by sodium hydroxide(SH) ingestion. A 51-year-old woman suffering from insomnia swallowed SH(commercially available caustic soda powder) in a suicide attempt. A physical examination showed blackish brown coloration of the mouth and its surrounding facial skin. Tracheal intubation was performed for avoiding the risk of airway obstruction, and a tracheostomy was done on day 2. A gastrostomy was added on day 23. On day 34, endoscopy uncovered liquefacted epiglottis, edematous vocal cord, and esophageal erosion. She could not swallow even saliva, which constantly dripped from her mouth. On day 51, a plastic surgery for ameliorating the contraction of the lips was performed. Endoscopy on day 85 unveiled the adhesion of the residual epiglottis to the peripheral tissue, and revealed severe oropharyngeal stenosis. The tongue gradually contracted and became unworked. The dysphagia was considered unimproved. She is currently in a psychiatric hospital with the tracheostomy and gastrostomy. We surmise that the high-concentration alkaline powder, which stagnated in the pharynx longer than liquids, made much stronger damage.

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The Evaluation of Golden Period of Fasciotomy for High Voltage Electrical Burn Injury Patients with Compartment Syndrome

Almahitta Cintami PUTRI1), Jessica Nadia TOBING2), Lisa HASIBUAN1), Ahmad FARIED1), Johanes Cornelius MOSE1)

Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjajaran (FK UNPAD), Dr. Hasan Sadikin Hospital / Graduate School of Biomedical Sciences, Doctoral Program, FK UNPAD, INDONESIA1)

Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjajaran (FK UNPAD), Dr. Hasan Sadikin Hospital, INDONESIA2)

Introduction:Electrical burn injuries may cause variable acute manifestations that necessitate surgeons to make early decisioning, such as fasciotomy for compartment syndromes. Early decompression can become ‘golden period’, once done for limb salvation. This study evaluates the duration of burn to fasciotomy (B-F time) and amputation.Methods:A cross sectional study was performed on medical record. Inclusion criteria are patients with high voltage electrical injuries and compartment syndrome. Exclusion criteria are patients whose extremities were already non-vital on admission and lost to follow up. Demographic information, burn surface area and time period from burn to fasciotomy (B-F time) for patients amputated above elbow (AE amputation), below elbow (BE amputation), and no amputation (Non-amputated) were investigated.Result:The age group of most patients are in 31-40 years old. The average of burn surface area is 16.99%. More than 50% patients received amputation and 60% had less than 18 hours B-F time. The mean duration of B-F time for Non-amputated are 18 hours and amputated are 20.38 hours. The B-F time for AE amputation and BE amputation are 23 hours and 19.4 hours. Conclusion:The recommended value of B-F time is 18 hours maximum, which could potentially lower the risk of amputation.


Epidemiology of electrical burns: A 5 year retrospective analysis of 131 cases at dr Kariadi Central General hospital between January 2015 and December 2019

Silvina SUTEDJO1), Vandalita Kusuma WARDHANI2), Nathania CHRISTIKA3), Najatullah NAJATULLAH4)

Diponegoro University Medical Faculty, INDONESIA1)

Maranatha Christian University Medical Faculty, INDONESIA2)

Tarumanegara University Medical Faculty, INDONESIA3)

Division of plastic reconstructive and aesthetic surgery Dr Kariadi Central General Hospital, INDONESIA4)

ObjectiveAnalyze the sociodemographic characteristic of electrical burn patients in dr Kariadi Hospital Semarang to provide reference for prevention and treatment of electrical burns.MethodWe evaluated retrospectively medical records of 131 patients with electrical burns admitted to dr. Kariadi hospital between January 2015 and December 2019. The characteristic of the study population such as average admission of the case yearly, statistic of age and gender, the origin region of referral, total body surface area (TBSA) and treatment method of electrical burn.ResultThere were 131 cases of electrical burns admitted to dr. Kariadi hospital between January 2015 and December 2019. The victims were mainly men (97,7%) with the ratio of man to woman is 42,6:1. Most of the patients aged 20 to 60 years (80,9%). Most of them were referred from Semarang city (25,6%). The overall median of TBSA was 21-30%. The treatment method of electric burn as debridement (100%), graft (19,9%), flap (17,2%), fasciotomy (8,3%), amputation (12,2%) and escharotomy (2,29%), are most common treatment at dr Kariadi hospital.ConclusionMales and productive age are the most vulnerable groups of electrical injury. Good procedure occupational health and safety could prevent larger incidence of young worker electrical injury.Keyword : epidemiology, electrical burns, dr Kariadi Central General Hospital

101

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Amputation of Upper Limb Following Electric Burn Injury: Bangladesh Experience

Most. Nurunnahar BEGUM, Dr. Tanveer AHMED, Dr. Zahangir ALAM, Prof. Abul KALAM

Sheikh Hasina National Institute of Burn and Plastic Surgery, BANGLADESH

Objective:High voltage electrical burn injury is one of the most devastating burn injury involving upper limbs. It causes disfigurement, loss of function and even loss of the whole upper limb. The aim of this study is to see the severity of electric burn injury involving upper limbs pausing amputations which causes lifelong sufferings of the patient.Method:A prospective observational study was done in Burn and Plastic Surgery Unit, Dhaka Medical College Hospital and Sheikh Hasina National Institute of Burn and Plastic Surgery from January 2019 to December 2019. Hundred and sixty-nine (169) patients with high voltage electrical burn involving upper limb underwent amputations at different limb levels were analyzed.Results:Male predominance (89%) was observed where right upper limb was involved in 49% of the cases and more significantly, 11% were bilateral. About 57.4% patients were below the age of 21 years. Below elbow amputations were done in 48.5% patients followed by above elbow amputations in 32.54% of the studied patients. In the most serious injuries shoulder joint dis articulation were done in 3 patients.Conclusion:Loss of limb is the most serious complication of burn injury. These injuries are preventable with proper education and strict monitoring.


COMPARATIVE ANALYSIS OF MIDLINE VS CONVENTIONAL TYPE FASCIOTOMY IN COMPARTMENT SYNDROME OF UPPER LIMB IN POST ELCTRIC BURN PATIENTS

Manish M BHARADWAJ, Ashutosh SHANKHDHAR, Puneet KUMAR

Patna medical college and hospital, INDIA

Objective:The purpose of this study was to determine whether an alternative method of fasciotomy (mid line ) can be used as limb salvage procedure in high voltage electric burns.Material and Method:A prospective analysis of 243 electric burn patients who underwent admission in emergency department in Patna Medical College And Hospital, India. From OCTOBER 2018 to SEPTEMBER 2020 total of 135 patients underwent fasciotomy of either types on random basis . Conventional by Volar ulnar incision in 81 and midline in 88. Three groups included were of fasciotomies within 8 hrs of injury, 8 to 24 hours of injury and finally from 24 to 48 hours after injury. The comparison was made on various entities including closure of defect, rate of amputation etc .Results:The midline group had lower major amputation rate (13.6%) than the conventional group (33.3%) (p < 0.001), less mortality, more primary closure and less requirement of flap for defect site closure.Conclusion:Early fasciotomy preferably within 8 hours particularly mid line type remarkably reduced the major amputation rate after high-voltage arc injury.

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Outcome of Transposition flap in Scalp Reconstruction following Electric Burn

Most. Nurunnahar BEGUM, Dr. Tanveer AHMED, Dr. Zahangir ALOM, Dr. Ks ARJU, Prof. Abul KALAM


Introduction:Electrical burn injury of the scalp causes extensive tissue destruction. Reconstruction usually challenging, management includes debridement of all devitalized tissue, removal of dead bone and coverage by STSG, multiple local flap and free tissue transfer. Local transposition flap with STSG at donor site is a reliable option for reconstruction.Method:A prospective observational study was carried out in Dhaka Medical College Hospital and Sheikh Hasina National Institute of Burn and Plastic Surgery from July 2018 to June 2020. Thirty-eight (38) patients with soft tissue defect scalp with exposed skull bone following high voltage electric burn injury were included in the study and reconstruction was done by local transposition flap. Patients were followed up for six month post operatively.Result:All flaps survived and reconstruction outcome was excellent. Partial graft loss (about 5-10%) occurred in three patients. One patient presented with discharging sinus 3 month after operation. 92% was male and only 8% was female. About 37% patients were below the age of 21 years. Conclusion:Local transposition flaps are reliable option for scalp reconstruction. Donor site morbidity is minimal and cosmetically acceptable. Tissue expander can be used for aesthetic scalp reconstruction specially for reconstruction of grafted donor area.


When does a burn patient die?

Akinori OSUKA, Daiki MIYAO, Takahisa TOZAWA, Shinji NAKAJIMA, Yuichi KUROKI

Department of trauma, critical care & burn center JCHO Chukyo Hospital, JAPAN

Background:There are few papers on the timing of death in patients with severe burns.Objective:To study the time of death and its causes.Patients and Methods:Patients admitted to our burn center between January 1, 2015 and December 31, 2019. Patient information and time and cause of death were retrospectively collected from medical records.Results:Of the 342 patients admitted during the period, 48 died. The time of death was within 24 h in 9 cases, within 3 days in 7 cases, within 1 week in 5 cases, within 2 weeks in 4 cases, within 3 weeks in 3 cases, within 30 days in 6 cases, within 60 days in 5 cases, and after 60 days in 9 cases. Causes of death in the acute phase were hypoxic encephalopathy, extensive burns over 80%, severe heat stroke, and acute coronary syndrome; causes of death after 3 days were sepsis, pneumonia, intestinal ischemia, pancreatitis, and worsening of chronic diseases.Conclusion:In the group of patients who passed the resuscitation period, about 40% died after 60 days. In burn care, treatment planning should consider not only the short-term prognosis but also long-term prognosis.

103

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Survey on the current status of self-immolation attempts in Akita Prefecture

Yasuhito IRIE, Hajime NAKAE, Tasuku NARA, Kasumi SATOH, Koumei KAMEYAMA, Toshiharu KITAMURA, Manabu OKUYAMA

Department of Emergency and Critical Care Medicine Akita University Graduate School of Medicine, JAPAN

BackgroundIn Japan, little research has been done in recent years on the actual situation of patients who attempted self-immolation in Japan. Therefore, we conducted a survey of patients who attempted to commit suicide by burning who were transported to medical institutions in Akita Prefecture.MethodsA questionnaire was sent to 13 fire departments in Akita Prefecture to survey burn patients who occurred during the 5-year period.ResultsResponses were obtained from all fire departments. Of these, 155 cases were examined after excluding duplicates, missing, and non-flame data. There was no significant difference in TBSA and PBI between suicide attempt groups and non-suicide attempt group. A comparison between the two groups of clothes catching fires also showed no significant difference. The severity of burns was divided into mild and severe cases in suicide attempt group. We analyzed the association between the severity of burns and the suicide method, and arson was significantly more common in mild cases.DiscussionThere is a need to support patients as part of a society-wide effort, and the provision of clothes that are difficult to ignite may be considered for high-risk suicide attempt patients and the elderly who live alone.


The epidemiology of alcohol burns in Beijing, China: 163 cases from 2015 to 2020

Wen ZHANG, Chuanan SHEN


This study was designed to explore the epidemiological characteristics and potential preventive strategies of alcohol burns. Totally 163 patients with alcohol burns admitted from January 1, 2015 to May 31, 2020 were included, with a male-to-female ratio of 1.1:1, a mean age of 34.1 ± 16.8 years, and a mean burn size of 13.3 ± 13.7% total body surface area (TBSA). The number of patients with alcohol burns was similar year by year during the five-year period (2015-2019). About half of patients (51.5%, 84/163) sustained third-degree burn injury, which was significantly associated with the length of hospital stay and whether to have surgery. The most prevalent etiology was cupping (29.5%, 49/163), which was followed by hotpot (22.7%, 37/163). Seven patients sustained the injury during experiments at school and one patient suffered the injury when using alcohol spray for disinfection against COVID-19. The incidence of facial burn injury (64.4%) was significantly higher than reported data (33.2%). The result of the study showed that cupping and hotpot are the main causes for alcohol burns in Beijing, which should be taken into consideration for prevention. It is necessary to strengthen safety management of experiment classes at school and educate the general public of proper disinfection against COVID-19.

104



Retrospective analysis of bloodstream fungal infections in severe burn patients

Cheng ZHANG

Southwest Hospital, CHINA

ObjectiveTo provide scientific basis for prevention and clinical treatment of bloodstream fungal infections in severe burn patients by retrospective analysis of risk factors, pathogen distribution and drug resistance of severe burn bloodstream fungal infections.MethodsA total of 4839 blood fungal culture samples were collected from severe burn inpatients in the burn intensive care unit (BICU) of the author's hospital from July 2011 to May 2019. Retrospective analyses of the predisposing factors of bloodstream fungal infection, onset time, pathogenic distribution and drug resistance were performed by investigating the fungal culture results and clinical data. For one patient, if the results of multiple samples cultured at different periods were the same fungus, it was counted as one strain of the same fungus. Statistics were performed using WHONET 5.6 software.


The trends of burn patients in Tokyo analyzed the data of TBUA during recent 30 years

Naoki MORITA1), Hiroyuki SAKURAI2), Satoru ARAI3), Junichi SASAKI4)

Department of Plastic and Reconstructive Surgery Tokyo Metropolitan Hiroo Hospital, JAPAN1)

Department of Plastic and Reconstructive Surgery Tokyo Women's Medical University, JAPAN2)

Tokyo Medical Association, JAPAN3)

Department of Emergency and Critical Care Medicine Keio University Hospital, JAPAN4)

The Tokyo Burn Unit Association (TBUA) was founded in 1982 by 7 burn units, and as of 2021, consists of 14 burn units in Tokyo. The purpose of this study is to show the time-series trends of burn injury in Tokyo using TBUA data from 1991 to 2020. There were 9737 hospitalizations data included for this epidemiological analysis. The survey items included age, sex, cause of burns, % BSA, burn index (BI) and mortality, and were analyzed in every 5-years.

The male to female ratio is 1.8 : 1 at a period of 1991-1995 and the ratio gradually decrease to 1.5 : 1 as compared with a period of 2016 to 2020. The mean age of patients increases 40.1years to 48.4years (1991-1995 VS 2016-2020 period likewise). The mean extent of burn was 18.8% BSA and decreased to 10.4% BSA. Flame was the most common cause. However the number decrease from 50% to 33% but Scald increase and changes the order (30% to 33%), on the other hand, Inhalation injury clearly increase from 4.5% to 19%. The overall mortality rate of burn patients decrease from 16.1% to 9.8%. PBI of the fatal cases gradually increase from 110.8 to 121.3.

105

APBC



Burns First Aid and Burn-Related Nutrition Among 2437 Inhabitant in Saudi Arabia: A Nationwide Survey

Faisal Ali AL JABR1), Tareq ALYAHYA2), Aqeel Hussain ALRASHID1), Fahad Khalifah ALMULHIM1), Mohammed Tayi ALMUTAIRI1), Rayan Abdulwahab BUHLAIM1)

College of Medicine, King Faisal University, SAUDI ARABIA1)

College of Medicine, Assistant Professor at King Faisal University, Plastic Surgery Consultant, SAUDI ARABIA2)

Objective:The objective of this study is to determine the practice of first aid and measure the knowledge of burns and burns-related nutrition. Methods:Data have been collected using an online questionnaire. The questionnaire has been distributed to the Saudi general population and it was analyzed using SPSS version 21. Results:A total of 2437 people were enrolled in this study. Most of the respondents were females (59.5%). More than half of subjects are between 19 to 25 years of age, with a majority of them from eastern, central, and western region. It was found that the mean score of knowledge was 7.34 (SD 2.23) out of 16 points. Of these numbers, 51.8% were classified as negative knowledge, 47.5% were classified into neutral and only 0.7% were classified into positive knowledge. For practices, the mean score was 3.62 (SD 2.44) out of 9 points with 61.9% were classified into poor practices, 31.9% were of moderate practices and 6.2% were classified into good practices. Conclusion:Our study suggests that there is a significant lack of knowledge and practice of burns first aid and burn-related nutrition. Thus, burn first aid courses, training, and awareness campaigns are highly recommended.


Epidemiological Study of Burn Patients in only tertiary care center in resource crunch state of Eastern India

Ashutosh SHANKHDHAR, Manish M BHARADWAJ, Puneet KUMAR

Patna medical college and hospital, INDIA

Aims and objectives:To study epidemiological aspects of burn admission in tertiary care burn centre of Bihar.Materials and Methods:This study is prospective hospital based observational study, conducted at Patna Medical College Hospital (PMCH), Patna from 1.1.2019 to 31.12.2019. All burn patients (n = 1272) admitted during this period were included in this study.Results:In our study female patients were 63.4% of total, though electric burn was more common in males, patients of age group 21-30 years were most commonly affected (28.8%). Minimum age was 7day old female child and maximum age of 95 year old male. Flame burn leaded the cause followed by electric burn. Most burn victims belonged to rural background & low socio-economic strata. Kitchen was the most common place & kerosene oil most common agent causing burn. Majority of patients (43.56%) presented within 8 hours of burn. In our study, overall mortality rate of burn patients is 48.4%.Conclusion:Mortality rate is high in patients with TBSA > 70%. Appropriate preventive & therapeutic measures need to be taken to reduce the incidence & improve survival outcome of burn patients.

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The value of renal injury marker protein in the early clinical diagnosis of burn delayed resuscitation of acute renal injury

Xiaoliang LI

Zhengzhou first people hospital, CHINA

ObjectiveTo compare the value of different renal injury markers in the early clinical diagnosis of delayed resuscitation acute kidney injury (AKI).MethodThe burn inpatients with delayed resuscitation in the burn diagnosis and treatment center of Zhengzhou first people's Hospital from May 2018 to May 2020 were selected as the research objects. Urine samples and clinical data of all subjects were collected.The patients were divided into AKI group (23 cases) and non AKI group (20 cases) according to whether AKI occurred in shock stage or 7 days after shock stage. The clinical and laboratory data of the selected patients were collected and recorded, including age, gender, burn area, deep burn area, acute physiology and chronic health status score, fluid infusion volume at 12h, 24h and 48h after burn, serum SCR, serum albumin, serum fibrinogen, urine HSP-70, TIMP-2, IGFBP-7, NGAL and other indicators. Receiver operating characteristic curve (ROC) was drawn to evaluate the critical value, sensitivity and specificity of ROC in acute kidney injury induced by delayed resuscitation.


A single center study on antimicrobial use and bacterial resistance in burn ward

Dou YI

Ruijin Hospital, Shanghai Jiaotong University School of Medicine, CHINA

ObjectivesThis study analyzed the relationship between bacterial epidemiology and antibiotics in single center burn ward for 9 years, and discussed the influence of antibiotics used in burn ward on bacterial epidemiology.MethodsInvestigate the epidemiological data of pathogenic bacteria and the use of common antibiotics in burn ward in the past 9 years. The antibiotics use density was calculated by defined daily doses (DDDs)/ 1000 patient-days.Results1.Carbapenems use density was positively correlated with resistance rate of Klebsiella pneumoniae to ceftazidime (r=0.741, P=0.022), imipenem (r=0.718, P=0.029) and some other antibiotic. 2.Ciprofloxacin use density was negatively correlated with the Pseudomonas aeruginosa resistance rate to ceftazidime (r= － 0.751, P=0.020), Ciprofloxacin (r= － 0.873, P=0.002) and with the Klebsiella pneumoniae resistance rate to ceftazidime (r= － 0.712, P=0.031), imipenem (r= － 0.780, P=0.013), ciprofloxacin (r= － 0.871, P=0.002) and some other antibiotic.ConclusionsCarbapenems can induce Klebsiella pneumoniae to be multiple drug resistance. Reducing the use of ciprofloxacin did not restore the sensitivity of Pseudomonas aeruginosa and Klebsiella pneumoniae to it, and may also cause the increase of bacterial resistance to other antibiotics. It shows the strategy of only restricting a certain antimicrobial agent may not restore the bacterial sensitivity.

107

APBC



Discovery of a Novel lytic bacteriophages of carbapenem-resistant Klebsiella, kpssk3

Yizhi PENG

Burn Institute, Southwest Hospital, The Third Military Medical University, CHINA

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an increasing global threat on public health. Previous studies have shown that bacteriophages can be used effectively to deal with multidrug-resistant pathogens. We have recently discovered a novel lytic phage, kpssk3, which is capable of lysing CRKP and degrading exopolysaccharide (EPS). Morphologically, kpssk3 has a polyhedral head and a short tail, indicating that it belongs to the Podoviridae family. We used clinically isolated CRKP strains to test the lysis ability of kpssk3 and found that kpssk3 could lyse 25 out of 27 (92.59%) strains. Moreover, it showed high stability to temperature and pH alterations. kpssk3 has a linear dsDNA genome of 40,539 bp with 52.80% G+C content and 42 putative open reading frames (ORFs). It is identified that kpssk3 is a new T7-like virus and belongs to the subfamily Autographivirinae. Our study on kpssk3 will deepen the understanding of phage biology and shed new light on the cure of CRKP infection.


The prognostic value of serum procalcitonin measurements in severe burn patients: A retrospective study

Zhaoxing LIU, Chuanan SHEN


Objectives:This study aimed to evaluate the clinical significance of procalcitonin (PCT) as a prognostic biomarker in severe burn patients.Methods:The clinical data of patients with extensive burns covering ≥ 50% TBSA admitted from January 1, 2014 to December 31, 2019 were retrospectively analyzed and grouped. The demographic characteristics of the two groups of patients were analyzed. The ROC curve and multivariate logistic regression analysis were used for statistical analysis.Results:Totally 139 severe burn patients were enrolled, 112 of which survived and 27 died. Compared with the survivors, dead patients had a higher age (P=0.048), burn area (P ＜ 0.001), burn index (P ＜ 0.001), proportion of inhalation injury (P= 0.004), APACHE II score (P ＜ 0.001), SOFA score (P ＜ 0.001), and a longer delayed resuscitation time (P=0.009). The peak PCT during and after the shock period of the dead patients were significantly higher than those of the survivors, and the area under the ROC curve for predicting the prognosis of death was 0.788 (P ＜ 0.001) and 0.926 (P ＜ 0.001).Conclusions:PCT can be used as an effective biomarker for the evaluation of the severity of the condition and the prognosis of patients with extensive burns.

108



Intermingled skin allograft and autograft use in the treatment of major burns in older adults

Hongmin LUO, Wen LAI, Huining BIAN, Chuanwei SUN

Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, CHINA

Mortality rate in older adults after burn injury is extremely high, and the treatment is very difficult. The main problem is the lack of autogenous skin to cover the wound quickly and effectively. Authors present a case of extensive burn injury in a 68-year-old female successfully treated with intermingled skin allograft and autograft. The patient was accidentally burned by gas flame, resulting in a major burn injury with 80% Total body surface area (TBSA) burned. Early burn wound excision was performed and the wound was temporarily covered with irradiated porcine skin in the first week after injury. Autologous stamp skin grafting was performed but was not very successful, as near half of the skin graft did not take. Finally, The wounds were covered with intermingled skin allograft and autograft 8 weeks after injury: small skin autograft (0.5cm × 0.5cm) + moderate close relative fresh allograft (1cm × 1cm)+ large cryopreservation allograft (2cm × 2cm).


Epidemiology and Knowledge of First Aid Treatment Related to Burn Injury in the Rural Region of Kulon Progo, Indonesia

Almas Nur PRAWOTO1), Rianto Noviady RAMLI2), Nyoman Putu RIASA3), Iswinarno Doso SAPUTRO4), Ahmad Fawzy MAS'UD5)

Wates Regional Hospital, INDONESIA1)

Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Dr. Sardjito Hospital, INDONESIA2)

Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, INDONESIA3)

Department of Plastic, Reconstructive and Aesthetic Surgery, Airlangga University, Dr. Soetomo Hospital, INDONESIA4)

Department of Plastic, Aesthetic and Reconstructive Surgery, General Soedirman University, INDONESIA5)

Background:Around 44% of Indonesia’s population resides in rural areas. We surveyed the epidemiology and burn patients knowledge about the first aid of burn.Materials and Methods:A retrospective study analyzing the medical records of patients with burns admitted to two of Kulon Progo’s largest referral hospitals between January 2018 and December 2019. A survey was distributed to the patients and their families regarding their knowledge on the first aid of burns. Results:A total of 115 patients were reviewed in this study. The highest proportion of total burn injuries occurred in children. The major etiology of all burn cases were caused by scald (54%). Housewives and children were at a higher risk for scalds and laborers were at a higher risk for electrical and chemical burns (p = 0.001). There was a statistically significant correlation between the TBSA and the length of hospital stay (p = 0.0001). The majority of survey respondents (66%) had poor knowledge on the first aid of burns.Conclusions:Children, laborers, and housewives have a significant risk of suffering from a burn injury. A majority of people still have poor knowledge on the first aid of burns with no correlation of their education level.

109

APBC



The predictive value of first operation after burn in extremely severe burn patients

Wei ZHU

Institute of Burn Research, Southwest Hospital, Army Medical University, CHINA

ObjectiveTo investigate the prognostic value of first operation after burn in extremely severe burn patients.MethodsFrom January 2012 to December 2017, 139 adult patients with extremely severe burn who met the inclusion criteria were selected and divided into survival group (n = 104) and death group (n = 35) according to whether the patients died. Results1. Univariate Cox regression analysis and Multivariate Cox regression analysis showed that burn index and intraoperative blood loss were independent risk factors for death of patients with extremely severe burn (P <0.01). 2.The area under the ROC curve was 0.731, the optimal threshold of intraoperative blood loss was 750ml. 3. The amount of intraoperative blood loss during the first operation after burn at the same time of admission to BICU, The cumulative survival rate of intraoperative blood loss < 750ml group was significantly higher than that of intraoperative blood loss ≥ 750ml group.ConclusionTh blood loss in the first operation after burn has a strong clinical significance for the prognosis of patients with extremely severe burn, and can be used as an important early warning indicator to predict the prognosis of extremely severe burn.


Clinician Interviews to Determine Opinion on Risk Factors for Burn Contracture Formation

Ruthann FANSTONE, Trish PRICE, Tom POTOKAR

Global Centre for Burn Injuries Policy and Research, Swansea University, UK

IntroductionThere is a lack of high-quality published evidence on the risk factors for burn contracture formation. The vast majority of research is from HICs, where many potential risk factors are controlled for by standardised and high-quality healthcare systems. To augment the published literature, burn care professionals with LMIC experience were interviewed for their opinion on risk factors for burn contracture formation. MethodSeventeen semi-structured interviews were conducted (13 burn surgeons and 4 therapists). The average length of experience in burn-care was 13 years. Participants represented: Ghana, Ethiopia, Malawi, Nigeria, South Africa, Nepal, India. ResultsParticipants reported ninety risk factors. Risk factors were later collated according to topic: Non burn individual factors (n=11), Burn injury factors (n=14), Family and community factors (n=9), Treatment factors (n=19), Complications (n=2), Healthcare capacity factors (n=24) and Societal and environmental factors (n=12). The top five most frequently cited risk factors were: lack of splinting, lack of physiotherapy, lack of early excision and skin grafting, low socioeconomic status, presence of infection.ConclusionBurn care professionals have a huge wealth of knowledge on the risk factors for burn contracture formation, many risk factors mentioned by participants do not yet have a robust evidence base in the literature.

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Out of the box solutions for tissue protection in postoperative period

Armaan KHOSA, Raghav SHROTRIYA, Vinita PURI

Seth GS Medical College & KEM Hospital, INDIA

Background:The high burn case load and occasional shortage of resources in developing countries incentivizes the burn surgeons to keep finding new ways to provide optimum results to their patients. In this paper, the authors describe the use of few innovative methods that they have found useful in reconstructive practice.Methodology and Results:Authors have used the following out of the box solutions:1. Foam and stainless steel mesh dressing: In HFN region where pressure and immobility is required after FTSG application, use of foam distributes the pressure evenly and the stainless steel mesh splints the otherwise mobile area2. Plastic guard made of empty IV bottle over K-wire frame: To prevent the patients from injuring themselves with their K wire pins3. Finger Crepe: strips cut from the extra rolls of Crepe bandage in OT provides cheaper alternative for coban wrapsConclusion:These minor modifications have helped the authors achieve desirable results in patients of post burn reconstruction.


Holistic Burn Care To All: Survival and Beyond

Raghav SHROTRIYA, Vinita PURI

Department of Plastic Surgery, Seth GS Medical College and KEM Hospital, INDIA

Background:Survivors of burn injuries are physically scarred, financially drained, psychologically affected and socially ostracized. Holistic Burn Care (HBC) should address all of these issues for proper reintegration of the patient back into the society. This paper discusses our experience of providing HBC to burn victims.Methodology:Various supportive strategies for burn patients include provision of burn care at minimal cost with the help of various NGOs. Low cost splints and subsidized pressure garments help the poor patients to continue treatment after discharge. Post burn contracture patients are also financial support by organizations like Resurge International (USA). Pediatric burn survivor camp (2013, 2015, 2016-2019) has attempted towards reintegration of burn survivors back into the society. In course of this camp, each camper built on self confidence, made new friends and indulged in various physical, social and recreational activities.Inference:Burns injury is a major physical and psychological problem for the patients. In addition to medical management, things like financial support, vocational and psychosocial rehabilitation go a long way in achieving self sufficiency and social reintegration and therefore are essential part of providing holistic burn care.

111

APBC



Retrospective evaluation of geriatric burn patients treated in a tertiary care burn unit.

Raghav MAGO, Sudesh WANKHEDE, Vinita PURI

Department of Plastic & Reconstructive Surgery, K.E.M Hospital, INDIA

Introduction:Elderly burn care represents a vast challenge, as it is one of the fastest growing populations and susceptible to burn injuries. With advent & improvement in medical care although increased mortality with advancing age, more geriatric patients are surviving & living meaningful life. Purpose of this study is to see the effect of age & comorbidities on the outcome, the effect of various factors and to get epidemiological data following geriatric burn partients.Material & Methods:A retrospective observational study. Time Period of Data collection is August 2014 to August 2019. Study Period 5 years as mentioned above i.e. from August 2014 to August 2019 and study population of 42 patients.Results:Mortality rate for age above 60 years was double compared to younger adults.Mortality rates were almost double for TBSA as compared to younger adults. Geriatric patients with co morbidities were having 24 % more mortality. Time to reach tertiary care unit- 2.581 days.Conclusion:Increasing awareness of general population for special care required by geriatric population. Close control of any pre existing pathology. The best way to avoid mortality is avoiding it, as mostly it occurs in domestic environment which can be prevented. Well organised protocol driven approach to provide proper medical care.


Study on Application and Therapeutic Effect of Citric Acid In-vitro Anticoagulation Standard Nursing Intervention Techniques in Blood Purification Treatment for the Severely Burned

Ning LI, Ling Hua CHEN, Bo YOU


It is to study the influence of citric acid in-vitro anticoagulation standard nursing intervention techniques in blood purification treatment for the severely burned on the relevant indicators. select 46 patients in burn department of a hospital in Chongqing from January to December 2017 were selected as the control group, and 48 patients from January to December 2018 were the experimental group. The ICU length of the interference rate of operation time, the continuity of CBP treatment, the related coagulation and biochemical indexes were used as observation indexes. After the development of standardized nursing technique of anticoagulant in vitro, the average hospitalization time and cost ICU patients in the experimental group were lower than those in the control group, Compared with the control group, the average life time, the use time of the filter, the unplanned operation rate and the interference rate of the operation time were better than those of the control group. The total calcium concentration in the experimental group was lower than that in the control group (P<0.05). Renal function index, mean arterial pressure and arterial blood gas analysis index (PO2/FiO2, HCO3- and Lac) in both groups were statistically different. So the techniques improves the therapeutic effect.

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Application of sequential rehabilitation nursing technology in new healing skin care after deep burn of face and neck

Ning LI


To study the application and effect of sequential rehabilitation nursing technique in new healing skin after deep burn of face and neck. Methods: From January to December 2019, 109 patients with facial and neck burns in a hospital in Chongqing met the inclusion criteria. The patients were divided into 54 cases in the experimental group and 55 cases in the control group. The experimental group evaluated the newly healed skin condition of the patients, and then used the sequential rehabilitation nursing mode, including the nursing of the newly healed skin management from the skin cleaning, moisturizing and skin care, and then used the self-made traditional Chinese medicine mask combined with the laser to select the strong pulse light to compare the therapeutic effect of the two groups. Compared with the control group, the experimental group decreased the new healing skin scar score, scar hardness score, colorimeter color score, the compliance of the patients increased from 69.8% to 97.9%, and the patient satisfaction increased from 90.03% to 98.01%. So sequential rehabilitation nursing technology can effectively improve all kinds of skin problems of newly healed skin of severe burn, improve the quality of life and satisfaction with treatment.


Humanistic care in continuous care to reduce incidence of delirium and the application of large area burn patients

Ting Ting HE


Objective: Discuss Humanistic care in continuous care to reduce incidence of delirium and the application of large area burn patients.Method: The author unit treated and meet the criteria for the 80 cases large area burned patients, according to random number table is divided into control group and experimental group, 40 cases in each between July 2014 - July 2017. Control group given routine care, experimental group to give continuous nursing humanities, to establish the psychological pain nursing team, recording video propaganda and education, etc. Compare two groups of patients the incidence of delirium through Compare two groups of patients the incidence of delirium and Richmond agitation sedation scale, RASS. Result: Control the incidence of delirium delirium was 17.5%, the experimental group the incidence of delirium is 7.5%, two groups of patients were compared with difference was statistically significant (P < 0.01). Conclusion:Continuing nursing care can significantly reduce the incidence of large area burn patients delirium, shorten in-hospital time, improve the prognosis of patients, worthy of clinical application and spread.

113

APBC



Analysis of causes of hypothermia and nursing intervention in patients with severe burn

Wu Ming ZHANG


Objective:To explore the factors affecting hypothermia in patients with severe burns, and put forward the relevant nursing measures.Methods:From January 2019 to December 2020, 47 patients with severe burns were treated in the First Hospital of Jilin University, statistics on hypothermia, comparison of injury area, operation site, operation area, operation time, operating room temperature, irrigation fluid temperature, BMI and emotional state, logistic factor regression was used to analyze the impression factors of hypothermia and targeted nursing intervention.Results:There were 13 cases of hypothermia in 47 cases, the incidence was 27.66%. Comparison of the incidence of hypothermia in patients with different BMI values (P < 0.05). A multivariate logistic regression analysis showed, the larger the area of injury, more surgical sites or trunk, buttocks, longer operation time, lower operating room temperature, lower washing fluid temperature, more infusion or blood transfusion during operation, emotional instability of patients are the risk factors for hypothermia.Conclusion:Because of the large area of skin barrier damage, the probability of hypothermia during surgery is higher, and there are many factors affecting hypothermia, targeted nurse intervention for related factors, the body temperature of patients with severe burn was effectively improved during operation.


Clinical application of intravenous anesthesia combined with ultrasound guided PICC catheter in children with severe burns

Yan MA


Aim:To investigate the clinical effect of ultrasound-guided PICC catheter in severe burn patients.Methods:40 children aged 2-10 years with a total area of burning (scalding) more than 15% or three degree burning (scalding) more than 10% were selected.Results:In the observation group, the success rate of one puncture catheterization was higher than that of the control group (x2/t =12.379, P=0.000<0.05); Compared with the control group (x2/t =11.905, P=0.000<0.05); Compared with the control group (x2/t =5.714, P=0.016<0.05) The time of catheterization in the observation group was significantly lower than that in the control group (x2/t P=7.2717, P=0.001<0.05); Compared with the control group (x2/t =10, P=0.001<0.05); Compared with the control group (x2/t =4.8%), P=0.028<0.05).Conclusion:Compared with non-anesthetic ultrasound guided PICC catheter, intravenous anesthesia combined with ultrasound guided placement of PICC catheter can improve the success rate of one-time puncture, reduce the incidence of catheter waste, shorten the time of catheterization, reduce the incidence of subcutaneous hemorrhage and bleeding after catheterization.

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Application of fast track surgery in patients with deep stress injury

Dan CHENG


Objective:To explore the effectiveness of fast track surgery in patients with deep pressure injury.Methods:This study retrospectively analyzed 26 patients with traditional deep pressure injury treated from January 2019 to October 2020 as the control group, and 28 patients with pressure ulcer rapid recovery from January 2019 to October 2020 were selected as the experimental group, The wound healing time, complications and total hospital stay of the two groups were compared. From October 2019 to October 2020, 54 patients with deep pressure injury were treated by IBM SPSS statistics 24.Results:independent sample t-test or paired t-test was used for the measurement data in line with normal distribution, chi square test was used for the count data, and Fisher's exact test was used for the calculation of complications.Conclusion:fast track surgery is worthy of promotion in patients with deep pressure injury.


Application of MDT with Hand Function Rehabilitation Video Production in Home Nursing Care for Children with Burns

Duo CAI


ObjectiveTo investigate the effects of the application of multidisciplinary team (MDT) with hand function rehabilitation video production in home nursing care for children with burns.MethodsEnrolled in the prospective randomized controlled study were 70 children with burns. The control group was followed up by the conventional method, with nurses primarily responsible for informing the precautions on scar observation MDT-based child hand rehabilitation scheme was adopted based on the existing content and form of propaganda and education.Results(1) The TAM recovery rate in the treatment group was significantly higher than that in the control group in 3 and 6 months after discharge (P<0.05). (2) The VSS score in the treatment group was significantly lower than that in the control group in 3 and 6 months after discharge (P<0.05); (3) In terms of the family members’ satisfaction with the children’s hand appearance, it was higher in the treatment group than the control group (P<0.05). ConclusionsMDT with hand function rehabilitation video production can promote the children with burns and the caregivers to be proactive in performing active and passive functional exercises.

115

APBC



INFECTION CONTROL HANDS THAT HEAL SHOULD NOT BE THAT HAND THAT KILLS… SPREAD THE CARE AND NOT THE GERMS!

Vijayalakshmi PILLAI

Military Hospital Jalandhar Punjab India, INDIA

Role of health care worker gets overlooked: might be most crucial for ensuring ongoing operation of our practice and safety of everyone in it.Burn wounds are at high risk of developing nosocomial infection because of destroyed skin barrier, supressed immune system: invasive therapeutic and diagnostic procedures. Infection control for nurses in burn unit is, Stressful as many skills, procedures and responsibility demands.Challenging because of essential role in the bio psycho social assessment and management of patients. Rewarding as it gives an opportunity to demonstrate a role of holistic care.The nurse to provide a clean safe environment for closely scrutinizing wound to defeat early signs of infection. Diligent compliance with infection control practice, use of laminar airflow reduces risk of infection with nosocomial bacteria. Plants and flowers not allowed they harbour gram negative organisms.Limit infections by providing education to staff, creating policies, procedures that prevent infection, auditing hospital’s existing procedures for efficiency, compliance: making purchasing recommendations for anti-infection equipment.Health care providers, patients need to be adequately protected from risk associated with administering, receiving medical care: means adopting most current anti infection technologies that enable high standard of patient care and are safe for health care environment.


BURN DRESSING AN ART Lone nurse an artist has been painting for three hours yet feels like 30 minutes have gone by

Vijayalakshmi PILLAI

Military Hospital Jalandhar Punjab India, INDIA

Witnessing severe burns, dressing change are physically emotionally demanding and challenging. Nurse should enjoy hands on wound, have to stay positive by realistic without being negative.Caring wounds like eschar burns, autograft, skin bud wounds, exposed muscles, tendons are extremely challenging. Principles of wound management is to promote wound healing, ease patient discomfort by observing,　•　Adequate perfusion　•　Minimising bacterial contamination　•　Minimise negative effects of inflammation　•　Providing optimal wound environment　•　Adequate nutrition, fluid management　•　Adequate pain management　•　Promoting re epithelization　•　Provide pressure garmentsFollowing concepts for above observations in wound management 　•　 Cleansing–A shower with warm normal saline during dressing change to ensure wound surface is free of slough, exudate,

haematoma and creams.　•　Debridement–Remove loose, devitalised tissue, non-surgical removal of eschar.　•　Primary dressing for optimal moisture to promote healing　•　Appropriate absorbency level dressing for exudate management　•　Wet dressing completely before removal to reduce pain, trauma, bleeding.　•　Long term dressing in children.In India dressing changes being done by trained burn nurses under IV sedation. Photographs of wound help assess and monitor healing progress. Watching patients heal, return to their lives, with more love for their life is the contentment. Teaching patients, families to care wound is an art and craft.

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Post-burn incidence of contractures in one year.

Ankit MISHRA, Anant SHARMA, Shobha CHAMANIA, Rajpal SINGH, Arpit SETHIYA

Choithram Hospital and Research Centre, INDIA

Objective:To find the incidence of post-burn contractures in burn survivors discharged from burn unit from Feb 2019 to Oct 2020. Method:This prospective observational study included 75 patients with acute burn injury involving major joints i.e. neck, axilla, elbow, hip and knee. Active range of motion in all planes at involved joints was measured at the time of discharge, 1 month, 3 months, 6 months following discharge using manual goniometer. Patients were supervised by rehab team.Results:Median(IQ) age of patients was 28(7-36) years. Adult:pediatric patient ratio was 2.1:1. Male:female ratio was 2:1. Median(IQ) %TBSA of patients was 20% (12-30%). Burns were caused due to flame (44%), scald (36%), electrical (16%) and chemical (4%). Overall, incidence of contracture was nearly 80%. Incidence of contracture was as follows: elbow (35.7%), shoulder (15.7%), knee (13.6%), neck (8.4%) and hip (4.2%). Mild contractures (75%), achieved good range of motion and functional ability over time. Moderate contractures in 15% and severe contractures in 10% required interventions. Conclusion:There is high incidence of contracture following burn injury. Early referral to burn care facilities, early wound closure, and therapy with regular follow ups can lead to decrease in contracture.


PREVENTION OF LONG TERM BURN COMPLICATIONS - PIVOTAL ROLE FOR BURN NURSES

Siji BHASKARAN

Maharashtra University of Health Sciences / Armed Forces Medical College Pune / Command Hospital Kolkata, INDIA

Optimal care of every burn patient requires a distinctive multidisciplinary team. At the centre of the burn team is the burn nurse, the coordinator of all patient care activities and a specialist in care of burn wounds. Neglected burn cases often causes severe physical complications from shock, infections, sepsis to scar, keloids and contractures with deformity in the long run. As long term burn wound complications have more influence in the future life of burn victims, the burn nurse has a challenging role to perform in this speciality. Kowledge and efficiency of a well trained burn nurse with constant, continous and dedicated care with empathy plays a vital role in reducing these complications to a great extend. The paper discusses the measures to be adhered in a dedicated burn nursing care plan that aims to reduce the adverse effects caused by the injury in terms of maintaining range of movement, minimising contracture development and impact of scarring, maximising functional ability, psychological wellbeing and social integration.

117

APBC



HEALING TOUCH WITH HOLISTIC NURSING - PATHWAY TO PAIN MANAGEMENT IN BURNS

Siji BHASKARAN

National Academy of Burns India / Command Hospital Eastern Command Kolkata / Maharashtra University of Health Sciiences / Indian Nursing Council / Trained Nurses Association of India / Society of Midwives India, INDIA

A good pain control is the foundation of efficacious burn care from initial injury to the long term recovery. Inadequate pain management can lead to secondary morbidity of higher pain levels like long term anxiety, PTSD and delayed wound healing. A burn nurse being the coordinator of the multidisciplinary team and the first line managers; has pain management as a major concern and challenge in the overall management of burn patients. It is important for a burn nurse to accept that, pain has an emotional component that needs to be considered and ministered along with wound care to gain trust of the patient. This paper discusses the contemporary clinical practices to be adapted by the burn nurses. These practices include methods such as healing touch, aromatherapy, progressive muscle relaxation, meditation and behavior therapy; apart from the pharmacological measures. A holistic nursing approach is the need of the hour for treating the person as a whole from inside to out, simultaneously while treating the pain. Frequent and continuous evaluation of patients response with the analgesics and non pharmacological measures using the assessment tools act as the guidelines to an effective nursing care leading to improved quality of life and recovery.


Withdrawal

118



A scalded 2-year-old child associated with acute encephalopathy: a case report

Keiichiro NAKAGOMI, Naoyuki KANEKO, Ryosuke YUNOKI

Trauma and Emergency Center, Fukaya Red Cross Hospital, JAPAN

Acute encephalopathy (AE) in children is rare but a serious complication of viral infections, toxic shock etc. It has been reported that mortality rate is 6% and 36% of survivors are left with motor and intellectual impairment. We present a case of a 2-year-old child with persistent seizure after getting scaled on his face and right-sided chest and arm, and being diagnosed with AE. The wound depth and size were second-degree and 18% of total body surface area, respectively. A generalized convulsion attacked first in 24 hours after admission. Although the convulsion could be controlled by bolus intravenous administration of benzodiazepine drugs, it occurred repeatedly. On day 3, he was intubated and mechanically ventilated to attain deep sedation with continuous administration of benzodiazepines. Although the convulsions could be managed well, he did not come to himself. The laboratory data showed hyponatremia and pancytopenia. The diffusion-weighted MRI of the brain unveiled widespread hyperintensity on bilateral cerebral cortex, and the electroencephalogram probed abnormal waves on left temporal region of the brain. He was diagnosed with AE. After rehabilitation, his physical functions including eating was well recovered. However, he was left with intellectual disability and discharged on day 51.


Autologous scar-related tissue for reconstruction of large area burn scars of children

Juntao HAN

Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, CHINA

BackgroundWe introduce a novel method to reconstruct large area burn scars of children with autologous scar-related tissue combined with spit-thickness skin grafting (ASTCS). MethodsFrom Jan 2006 to Jan 2016, a total of 41 sites from 25 children were included in this article. The autologous scar-related tissue was composed by scar mesh and split-thickness skin was harvested from the scalp. The scar was cut and punched by meshing machine which thickness was from 0.3 to 0.5 mm in a ratio of 1:1. The secondary wounds were covered by the epidermis from donor site. The surgical areas were bandaged for 7 to 10 days before the first dressing change. ResultsThe functional outcomes were reviewed after 12-month follow-up. 39 sites of 41 transplanted tissues survived well, 2 sites were cured after two weeks of dressing changes. Patients with scar deformities in joint areas achieved satisfactory function. The Vancouver Burn Skin Score and Barthel Index Scale Scores were also improved in 12-month follow-up assessment.ConclusionThe present study provided an novel method for treating large area burn scars with autologous scar-related tissue and spit-thickness skin grafting and present better functional results of children.

119

APBC



Is Fever in Pediatric Burn relevant to successive Infection?

Erina KAWABATA1), Shigeo KYUTOKU2), Norifumi KUROKAWA3), Kazuhiro OTANI2), Madoka ASAI1), Koichi UEDA1)

Plastic Surgery, Osaka Medical College, JAPAN1)

Reconstructive Plastic Surgery, Nara City Hospital, JAPAN2)

Plastic Surgery, Takatsuki General Hospital, JAPAN3)

Introduction:Fever as an indicator of infection remains controversial in pediatric burn patients. In this study, the medical conditions of burn injury patients and their thermal status were investigated.Objective and methods:Fifty-four pediatric burn patients under 15 years of age treated between 2007 and 2015 at our unit were retrospectively examined regarding age, sex, total burn surface area, and highest temperature without an antipyretic.Results:The infection group comprised 23 patients (42.6%), including two with severe bacterial infections (3.7%). The fever group (above 38.5℃ ) consisted of 21 patients (38.9%), and a significant association was suggested between fever and infection (p ＜ 0.01).Discussion and Conclusion:Fever above 38.5℃ is thought to be infection when low-grade fever caused by absorption is generally observed. But antibiotics in the case of fever may not always necessary.


Hypnotherapy for Procedural Pain, Itch and State Anxiety in Children with Acute Burns: A Feasibility and Acceptability Study Protocol

Daly GEAGEA1), Bronwyn GRIFFITH2), Roy KIMBLE1), Vince POLITO3), Devin TERHUNE4), Zephanie TYACK1)

Centre for Children’s Burns and Trauma Research / The University of Queensland, AUSTRALIA1)

Centre for Children’s Burns and Trauma Research / Queensland University of Technology, AUSTRALIA2)

Department of Cognitive Science, Macquarie University, AUSTRALIA3)

Department of Psychology, Goldsmiths University of London, UK4)

ObjectivesHypnotherapy is promising as a psychological adjunct to pharmacological agents for children’s post-burn procedural pain, state anxiety and itch. Research indicates that hypnotherapy can be conducted in varied settings and populations; and has superiority to other psychological interventions for children’s procedural pain and state anxiety. In paediatric burns, rigorous effectiveness and feasibility studies are limited with no studies investigating hypnotic suggestibility screening. The proposed study will examine the feasibility, acceptability and implementation of hypnotic suggestibility screening followed by hypnotherapy for procedural pain, state anxiety and itch in paediatric burns.MethodsThe study uses an observational mixed-methods design. Children (N = 30) presenting to the study setting with acute burns requiring dressing changes will be included with parents (N = up to 30) and clinicians performing dressing changes (N = up to 20). Child participants with medium to high suggestibility will receive hypnotherapy during dressing changes. A process evaluation will target feasibility and acceptability as primary outcomes and implementation (i.e., fidelity in delivery), reach, effectiveness, and adoption of evaluation procedures and intervention as secondary outcomes. ConclusionStudy findings will guide research on the effectiveness of hypnotherapy and inform the development of child-centred hypnotic interventions in children with burns.

120



Pattern of Presentation of Pediatric Burn During Covid -19 Pandemic

Most. Nurunnahar BEGUM, Dr. Tanveer AHMED, Prof Abul KALAM


Introduction:Burn injury is one of the most critical and life threatening injury. Severe and long term complications and mortality from burn injury is very high in children. The aim of this study is to identify clinical pattern and characteristics of pediatric burn injuries during covid-19 pandemic.Method:Country’s first Covid -19 positive case was identified in March, 2020. This Prospective observational study was carried out in Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh from April, 2020 to March, 2021. Total 143 patients aged 0 to 12 yrs were included in the study.Result:School aged children(6-12yrs)affected most (40%) followed by preschool(33%),toddler(20%), infant (4%) and neonates(3%). Scalds were most common (47%) followed by flame burn(33%) and HVEB(17%). Majority of burn(74%) occurred at home(71%) by hot water(28.6%), curry and other liquid(9.7%) and fire(15.3%). Majority(54.4%) patients presented to the hospital within 1st 8 hrs and about 51% without prior management. The body surface area involved 10 to 30% TBSA in 67% cases and 52% were deep and 42% superficial partial thickness burn.Conclusion:Teaching parents about household safety, seeking early medical attention and raising public awareness can decrease incidence of burn in children.


Retrospective evaluation of paediatric burn patients treated in a tertiary care burn unit

Armaan KHOSA, Makrand THAKRE, Vinita PURI

Seth GS Medical College & KEM Hospital, INDIA

Introduction:Burns is a major cause of morbidity and mortality. In this paper we study the pediatric burn population and evaluate various epidemiological factors and suggest the preventive measures to reduce the burden of burn injury.Materials and methods:This is a retrospective observational study conducted in the a tertiary care hospital of Mumbai, India. The study was conducted between August 2015 to August 2019. Our sample size was 210 and included patients aged between 0 to 12 years of age with burn injury admitted to our burn ward.Results:61.9% were from under 5yrs age group and most had under 10% area burnt. 74.76% were scald burns in kitchen. Upper limb was the area most commonly involved. Cold water was used as first aid in 50% cases. Prevalence more in nuclear families and in slums.Conclusions:Maximum burden of cases in under 5 yrs age group in all studies. Scald burns was found to be the most common etiology, as in other studies, especially in infants and toddlers. Supervised care and increasing awareness amongst the society will be good for prevention of paediatric burns.

121

APBC



Estimation of Total Body Surface Area Burned - A Comparison Between Burn Unit and Referring Facilities

Hui Lian HO1), Ahmad Sukari HALIM2), Wan Azman WAN SULAIMAN2), Siti Fatimah Noor MAT JOHAR2)

Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah / Reconstructive Science Unit, School of Medical Sciences, Universiti Sains Malaysia, MALAYSIA1)

Reconstructive Science Unit, School of Medical Sciences, Universiti Sains Malaysia / Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, MALAYSIA.2)

Background:Accuracy of burn size estimation is critical in acute burn management.Objectives:This study aims to quantify TBSA (Total Body Surface Area) discrepancies between the Burn Unit (TBSAb) and the referring facilities (TBSAr). In addition, we seek to determine the effect of body mass index (BMI), time following burn injuries and number of burn areas on TBSA assessment and the outcomes such as duration of hospital stay and the need for surgeries.Methods:A review of year 2015 to 2019 admissions to the HUSM (Hospital Universiti Sains Malaysia) Burn Unit was performed.Results:Of 208 patients’ recruitment (111 adults and 97 paediatrics), 11.54% were hospitalised for less than 24 hours. 60.58% were overestimated, 13.46% were underestimated and 18.27% had no TBSAr documentation. Highest documented discrepancy was 21.50%. Assessment method were inappropriate mostly in patients with TBSAb <11%. %TBSA discrepancy rises with increasing burn severity and number of areas involved (P < 0.001). BMI and time interval between referral and reassessment were not statistically significant for %TBSA discrepancies.Conclusion:Significant %TBSA discrepancies result in suboptimal treatment and unnecessary hospital transfers. A standardised tool for TBSA estimation even in the hands of untrained staffs should be developed.


Knowledge of burn first aid practices among the community and challenges faced by healthcare workers in managing burn injury at primary health care in Kota Selatan, Gorontalo.

Azmi Ritana NANO

Kota Selatan Primary Health Care, INDONESIA

Background: Burn first aid awareness has been proved to reduce the morbidity and mortality in burn injury. Increasing the knowledge of burn first aid are essential, especially in remote areas. This study aims to assess the general knowledge and practices related to burn first aid among the community and explored challenges faced by healthcare workers in acute management of burn injury at primary health care.Methods:This descriptive-qualitative study conducted using a structured questionnaire for patients, followed by in-depth interviews performed on healthcare workers in the Kota Selatan primary health care, Gorontalo, Indonesia, between March and May 2020. Result:Among 100 respondents, 40% answered correctly for 25-50% of the questionnaire. Majority of the patients come days after the incident to primary health care, and used toothpaste (60%) or tomatoes (20%) in the burnt area, resulted in delayed treatment. The interview revealed the limited logistics and lack of adequate training affected the quality of acute management of burn patients.Conclusion:General knowledge regarding burn first aid was poor. Raising awareness regarding burn first aid in the local community were crucial to reduce morbidity and mortality in burn injury.

122



Does a respiratory circuit equipped with a heated humidifier cause moderate-temperature burns? - Measurement of circuit surface temperature -

Masato AKIMOTO1), Masahiko NOGUCHI2), Kiichiro YAGUCHI2), Midori KAMIJO3), Toru CHIGONO4), Shunsuke YUZURIHA1)

Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, JAPAN1)

Department of Plastic and Reconstructive Surgery, Nagano Prefectural Children’s Medical Center, JAPAN2)

Department of Nursing, Nagano Prefectural Children’s Medical Center, JAPAN3)

Department of Medical Engineering, Nagano Prefectural Children’s Medical Center, JAPAN4)

Introduction:We have treated three cases with moderate-temperature burns probably caused by contact with a respiratory circuit equipped with a heated humidifier to prevent condensation of inspiratory air. In this study, the surface temperatures of these circuits were measured to clarify whether they can cause moderate-temperature burns.Methods:Three typical respiratory circuits were examined. The surface temperatures were measured by thermography at regular intervals with the heated humidifier set to automatic mode at the ambient temperature of 23°C.Results:The surface temperature rose locally near the heater, and the average temperatures were 47.3°C (max 54.2°C), 43.8°C (max 47.3°C), and 48.5°C (max 52.2°C). No alarms were activated during the measurement period.Discussion and Conclusion:It was considered to be possible for a respiratory circuit equipped with a heated humidifier to cause moderate-temperature burns. Especially, patients with impaired consciousness or quadriplegia are at high risk. Therefore, education regarding the risk is needed for patients’ families and medical staff to prevent burn injuries.


Prevention of microstomia in patients having peri-oral burns

Raghav SHROTRIYA, Vinita PURI


Background:Facial burns are a common cause of morbidity in burn patients. Perioral burns frequently leads to microstomia. In this paper the authors discuss their experience in the prevention of microstomia in burn patients with perioral involvement.Methodology and Results:All the patients with facial and peri-oral burns who have undergone treatment in our burn unit are started on a multipronged protocol as follows: (1) mouth opening exercises; (2) objective measurement of inter-incisor distance; (3) taking large bites of uncut fruits while eating; 4) making slits at edges while applying collagen; (5) adequate lubrication of lips; and (6) application of microstomia splints along with a wet gauze covering the open part of mouth to prevent dryness. Patient compliance has been found to be good along with active participation of patients and their families.Conclusion:With diligent and persistent use of these techniques and active monitoring for development of microstomia, the authors have been successful in avoiding microstomia requiring surgical correction in all the patients.

123

APBC



Impact analysis of India’s only Pediatric Burn Survivor Camp: Preliminary findings

Vinita PURI1), Venkateshwaran N2), Armaan KHOSA1)

Seth G S Medical College and KEM Hospital, INDIA1)

Jupiter Hospital, INDIA2)

Background:The concept of burn survivor camps though tried and tested globally is novel in India and other developing countries. The described benefits of such camps include psychosocial rehabilitation, improved self-confidence and academic performance.Methodology:Department of Plastic Surgery, KEM hospital, Mumbai conducted the first burn camp in Dec 2013 for children - “Camp Karma” now called Camp Aashakiran (since 2019) and annually since then. A subjective questionnaire containing questions pertaining to psychosocial rehabilitation was given to parents of the campers and responses evaluated.Result:27/44 (61.3 %) responders showed greater than 70% improvement in academic scores. 38/44 (86.3 %) responders showed greater than 50 % improvement in confidence levels and communication skills. 27/44 (61.3%) reported greater than 50% improvement in scar and self-image acceptance. 29/44 (66%) responders were sure to attend the camp again.Conclusions:Improvement described by the responders in the questionnaire though subjective, provides a lot of hope and encouragement to the idea of conducting burn camps in our country. This first attempt at evaluating the psychosocial impact of burn camps on survivors, though preliminary and subjective gives a lot of hope and promise to the concept and to the burn surgeons involved in this activity.


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124



Effectiveness of rehabilitation makeup therapy for burn-induced hypertrophic scars with an uneven surface

Rintaro ASAHI

Nippon Medical School, JAPAN

Makeup therapy has been reported to be effectively alleviate the psychological distress caused by visible dermatological conditions. However, the disfiguring red, elevated, and uneven hypertrophic scars caused by burn are particularly difficult to hide with makeup therapy. We report here our prospective study on the effect of our rehabilitation makeup therapy on the appearance satisfaction and quality of life (QoL) of patients with burn scars. The convenience sample consisted of 37 patients, 29 and eight of whom had hypertrophic and flat scars, respectively. All patients underwent rehabilitation makeup therapy and were asked to keep applying the makeup at home for another 3 weeks. Patient satisfaction was measured before, just after, and 3 weeks after therapy with a 0-100-mm visual analogue scale. Overall QoL was measured by using two questions from the WHOQOL-26 questionnaire. Regardless of scar evenness, patient satisfaction was low before therapy and rose 4-fold immediately after therapy. At 3 weeks, satisfaction dropped somewhat but remained 2.5-fold higher. Overall QoL increased slightly for both patient groups at 3 weeks. Thus, rehabilitation makeup therapy can effectively improve patient satisfaction with their skin appearance and QoL regardless of how uneven the burn scars are.


THE QUALITY OF OUTCOME MUST BE WORTH THE PAIN OF SURVIVAL

Siji BHASKARAN

Maharashtra University of Health Sciences / Armed Forces Medical College / Command Hospital Kolkata, INDIA

When it comes to the quality of life of a post burn patient, it is a never ending ongoing struggle. Although the wounds get covered in acute phase of management, the deeper pains due to the late complications affect the survival of a burn victim in a gross manner. The major complications in the late stages reflect the role of rehabilitation in burn care. However, a lack of consistently coordinated rehabilitation and follow-up of burn patients often leads to critical variations in outcomes. As a result, burn clinicians need to be collaborative in their approach to burn rehabilitation which offers a challenging role for the burn nurses. Nursing care in burns is too demanding which includes a dedicated burn nursing care plan that aims to reduce the adverse effects caused by the injury in terms of maintaining range of movement, minimizing contracture development and impact of scarring, maximizing functional ability, psychological wellbeing, and social integration. This paper discusses the various measures to improve the physical, psychological and functional outcome.

125

APBC



Ablative Fractional CO2 Laser Surgery Improving Sleep Quality, Pain and Pruritus in Adult Hypertrophic Scar Patients: A Prospective Cohort Study

Kaiyang LV1), Huazhen LIU2), Shihui ZHU2), Haiting XU3), Shichu XIAO2), Zhaofan XIA2)

Department of Plastic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, CHINA1)

Department of Burn Surgery, the First affiliated Hospital to Naval Medical University, CHINA2)

Department of Plastic Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, CHINA3)

ObjectiveTo investigated the efficacy of CO2-ablative fractional laser (AFL) surgery versus conventional surgery in post-burn patients with hypertrophic scars with sleep quality. MethodsTotally 68 consecutive patients undergoing scar surgical treatment were recruited and including CO2-AFL surgery cohort (n=35) and conventional surgery cohort (n=33). Sleep quality, pain and pruritus were evaluated. Multiple linear regression analyses were performed to revealed the effect of CO2-AFL surgery.ResultsCO2-AFL surgery cohort had significantly lower Pittsburgh Sleep Quality Index global scores than conventional surgery cohort after the last surgical treatment. In the subgroup of patients receiving hardware sleep monitoring, CO2-AFL markedly increased deep sleep time, deep sleep efficiency and reduced initial sleep latency. Compared to conventional surgery cohort, CO2-AFL cohort presented significantly lower pain and pruritus scores. Correlation analysis showed pain and pruritus were significantly associated with PSQI scores. Multiple linear regression analysis showed that surgery method was negatively linearly correlated with VAS pain score, BPI total, VAS pruritus score, 5-D itch scale total, FIIQ total and PSQI total.ConclusionsCO2-AFL surgery significantly improved sleep quality and reduced pain and pruritus of hypertrophic scar patients. The alleviation of sleep disorder was associated with improvement of deep sleep quality.


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Effect of extracorporeal shock wave therapy on hand function after skin grafting in adult hand burns

Xiao Chuan XU


Objective:To observe the extracorporeal shock wave treatment effects on adult hand burn skin grafts successful functional methods: in May 2018 in December 2019, selection unit is in the rehabilitation center treatment of 60 cases of hand injuries, skin grafting after the rehabilitation of patients, according to random number table method is divided into the experimental group and control group, 30 cases in each group Since the hand skin graft survival after completely, the control group given hand drafting of conventional joints and exercise therapy;Results:The hand function in the observation group was significantly higher than that in the control group (P<0.05).Conclusion:Extrorporeal shock wave therapy is beneficial to the improvement of hand function after skin grafting of hand burns, and it is worth popularizing and applying.


Childhood Burns Leading to Skeletal and Soft Tissue Deformities

Raghav SHROTRIYA, Kapil AGRAWAL, Vinita PURI


Introduction:Post Burn contracture at an early age cause secondary deformity of growing skeleton and is a challenging problem to reconstructive surgeons. These patterns require staged correction, while planning for such cases consideration should be given to stepwise correction of functional followed by aesthetic deformities.Methodology and Results:22 year old female with history of post burn contracture at an early age in neck and chest region causing severe functional and aesthetic deformity leading to poor quality of life. Staged surgery was planned for correcting the functional limitation first followed by aesthetic disfigurement. Priority was given to release of the mento- sternal contracture along with bilateral anterior mandibular osteotomy to correct the dentofacial deformity.Subsequently patient was taken up for lower lip ectropion release and resurfacing of facial scar with FTSG. This was followed by symmastia release, bilateral mastopexy and nipple areola reconstruction. Presently she is satisfied with her appearance.Conclusion:Post Burn contracture at an early age must be managed with priority to avoid. Secondary skeletal deformity as it causes functional and aesthetic disfigurement. These cases need proper planning with staged correction for functional improvement and excellent cosmetic results.

127

APBC



The Superficial circumflex iliac artery perforator flap for reconstruction of post burn neck contracture.

Daisuke FUJISAWA1), Goro TAKADA2), Kohei UMEKAWA1), Hirotaka ASATO1)

Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, JAPAN1)

Department of Plastic and Reconstructive Surgery, Japanese Red Cross Ashikaga Hospital, JAPAN2)

Anterior cervical contractures of the neck represent a great challenge for plastic and reconstructive surgeons. Contractures can be reconstructed with skin flap, free flap, pre-expanding flap, super thin flap, and so on. Superficial circumflex iliac artery perforator flap; SCIP flap is easy to harvest and, without the need for postoperative debulking. A 45-years-old female suffered from the sever limitation of the neck and the mouth movement. The patient underwent cervical contracture release and artificial dermis transplant 10 months after the burn injury, followed by split-thickness skin grafting. She was dripping food and drooling because her lower lip was ectropion and difficult to close. A spindle 16 x 7 cm flap was inset to the cervico-mandibular area after scar contracture released. Postoperative 18 months, the lower lip ectropion was corrected and lip incompetence was restored.The inguinal part often avoids injury even in severe burn, is easy to become flap donor site. The SCIP flap is thin and supple, and cervical reconstruction using it is well-formed and does not require future defatting. If a large flap is required, it may be advisable to consider various pre-expanded free flaps.


Long-Term Follow-up of Breast Development and Optimal Correction in Female Patients with Anterior Chest Burns

Masami MURAKAMI, Wataru KAMEI, Yosuke NIIMI, Keijiro HORI, Hiroyuki SAKURAI

Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, JAPAN

The anterior chest burns in pre-pubertal females have a significant consequence for breast development, which may cause psychosocial burden in adolescence. Although there are many reports of skin augmentation for breast deformities after growth, the optimal methods and preferable timing of reconstructive surgery have not been well documented in especially pre-pubertal females.We reviewed 19 female cases that suffered from chest burn before the pre-pubertal period and required reconstruction for breast deformities. The age at burn injury was 2.4 ± 3.1 (mean ± SD), and the age, when received reconstructive surgery for breast deformities, was 13.3 ± 5.9. Reconstructive procedures were applied with artificial dermal grafting followed by thin STSG, expanded flap, free flap, pedicled flap, STSG, and FTSG. Artificial dermis and thin STSG showed re-contracture, especially when applied during adolescence.The anterior chest burns often lead to axilla and neck contractures. In pre-pubertal females, directional change of the contracture line may accelerate deformities after full development of the breast. Therefore, the reconstruction procedures combined with artificial dermis could be one of the useful procedures for breast growth. To ensure good cosmetic results, burns in young females require long-term follow-up and appropriate referral especially during and after puberty.

128



Use of Integra® after release of post burn contractures: Our experience

Vinita PURI, Raghav SHROTRIYA, Raghav MAGO


Background:Release of post burn contractures (PBC) is associated with chances of re-contracture in some cases. This is more frequent if the patient is pediatric or non compliant to splints and therapy or is unable to follow?up frequently for therapy. In such cases, use of dermal substitutes like Integra R provides an additional layer which resists secondary contracture. In this paper the authors discuss their experience in using the dermal template for post burn contractures in developing countries.Methodology and Results:Two patients who were treated with post burn contracture (PBC) release and resurfacing with the dermal template are presented. One was a 35 yr female with severe dorsum of hand PBC and the other was a 2yr old boy with severe plantar PBC of all toes. Both patients were operated by incisional release and resurfacing with the dermal template followed by skin grafting. Follow up of over 6 months is being presented.Conclusion:Even in a low resource setting, dermal templates may be useful in select patients of PBCs.


Association between perineal burns injury and in-hospital mortality: A retrospective observational study from the nation-wide burn registry in Japan

Tetsuya HOSHINO1), Yuki ENOMOTO2), Yoshiaki INOUE2)

Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, JAPAN1)

Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital / Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, JAPAN2)

Although perineal burn injury is included in the burn center referral criteria for Advanced Burn Life Support, clinical evidence that perineal burn injury increases mortality risk is limited. The purpose of this study is to investigate whether perineal burns affect in-hospital mortality. Using data from the nation-wide burn registry collected from April 1, 2011 to March 31, 2019, we retrospectively identified 10,179 hospitalized burn patients. The in-hospital mortality rate between the patients with perineal burn and those with other burns was compared, and the adjusted odds ratio for in-hospital mortality was determined with multivariable logistic regression analysis. One thousand one hundred forty-nine patients with perineal burn were enrolled, and the in-hospital mortality of this group was higher than that of the group of patients with other types of burns (46 vs. 5.2%, p<0.001). Multivariable analysis found that the presence of perineal burns is associated with in-hospital mortality (odds ratio 2.11 [95% confidence intervals (CI) 1.64-2.71]; p<0.001). Our data, as evidence, certified the referral criteria that perineal burn injury is associated with higher in-hospital mortality in Japan.

129

APBC



Preliminary study on correlation between DASH Questionnaire initial score and time to functional independence in burn patients

Li CHANG, Shiou-Han YANG, Ching-Yuan LIN, Yi-Jen WANG

Sunshine Social Welfare Foundation, TAIWAN

Objective:This study examines correlation between initial scores of Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) and time to activities of daily living (ADL) functional independence of burn patients.Method:This retrospective study collected data from 33 burn patients, including gender, age, education level, TBSA, number of hands involved, initial DASH score, score and evaluation date of Daily Living Function Evaluation Scale (adapted from the Taiwanese Version of the Manual Ability Measure for Burns). Spearman's rank correlation coefficient, Mann-Whitney U test, and Kruskal-Wallis Test were used to analyze data.Results:Analysis shows positive moderate correlation between initial DASH score and overall time to ADL functional independence, with specific high positive correlation for wearing pressure garments independently, and moderate positive correlation for dressing, washing and daily activities independence. There is significant between-group variance for education level and time to wearing pressure garment independently, as well as number of hands affected and time to overall ADL functional independence, and sub-items of eating, dressing and daily activities.Conclusion:Initial DASH score can be used as a reference to predict time to overall ADL functional independence, but more data analysis is needed to improve accuracy.


Pressure therapy intervention for a case of burn hypertrophic scars on dorsal aspect of forefoot

Chen-Jui HSU, Yu-Li SUNG

Sunshine Social Welfare Foundation, TAIWAN

Objective:Scar hypertrophy and contracture on the dorsal aspect of the foot may cause metatarsophalangeal (MTP) joint hyperextension and webspace syndactyly but pressure is distributed unevenly over these areas so a combination of pressure therapy tools and design modifications to pressure garment socks are necessary to effectively control scars. Method:A 23-year-old male with 2nd-3rd degree burns over lower extremities presented with scar hypertrophy over left foot, causing toe webspace syndactyly and MTP joint hyperextension. Pressure garment sock was used in combination with Otoform inserts. Photos recorded changes in scar appearance and toe range of motion, the Modified Vancouver Scar Scale was used to evaluate scars.Result:The flat dorsal aspect of the forefoot with its larger radius of curvature receives less pressure from pressure garment sock than the sides of the foot, while concave toe webspaces receive no pressure. Otoform inserts over the dorsum and inside webspaces, and double-layer pressure garment sock increase pressure over these areas. After one year, scar height and pliability had visibly improved.Conclusion:A comprehensive pressure therapy intervention must consider how structural characteristics affect pressure distribution. Better scar control effect can be achieved by combined use of different pressure therapy tools.

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The effect of gait assisted robot training on the biomechanical properties of burn scars

Yoon Soo CHO, So Young JOO, Cheong Hoon SEO

Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, KOREA

Objective:This study aimed to investigate the effect of mechanical load on burn scars during gait assisted robot (GAR) training. Methods:This is a single blind randomized controlled trial. Of 38 burn patients, eighteen received gait training using GAR and conventional gait training a day and eighteen received only conventional gait training twice a day for 12 weeks. The biomechanical scar properties and active range of motion (ROM) of hip, knee, and ankle were evaluated at pre-training, 4 and 12 weeks after training. Results:Pre-training assessment showed no significant difference between the GAR and control groups (all, p>0.05). One patient in the GAR group discontinued training due to skin abrasion and two patients in the control group were excluded for not participating in the 3rd assessment. There were no musculoskeletal or cardiovascular adverse events, such as dizziness or increased or decreased blood pressure. The GAR group showed significantly larger biological elasticity (p=0.028) and larger improvement in the differences of knee extension and ankle dorsiflexion ROM (p=0.044, p=0.006) between pre-training and 12 weeks follow-up than the control group. Conclusions:GAR training for burn patients had no adverse effect and affected the biological elasticity of burn scars positively.


Design and Application of Comprehensive Evaluation APP of Burn Hand Function

Xiu-Hang ZHANG, Lei HONG, Jia-Ao YU


AIM:To evaluate and analyze the hand function of burn patients APP a mobile phone designed by ourselves.Methods:ROM measurement, total active joint activity assessment (TAM), Jebsen hand function test, modified Barthel index evaluation, vancouver scar scale evaluation, finger pinch force measurement (Grip-pinch Power) and other assessment methods of hand function were integrated into mobile phone's APP, using this APP to conduct regular evaluation and systematic data analysis of hand burn patients.Results:The rehabilitation treatment of burn hand function started from the scientific system evaluation, more convenient understanding of the evaluation results of burn hand function, can better guide clinicians and therapists to formulate and improve the rehabilitation treatment plan.Conclusion:The evaluation and data analysis of burn hand function by using self-designed mobile phone APP can guide clinical rehabilitation treatment more simply and conveniently, which is worth popularizing and applying.

131

APBC



Secondary injuries caused by inappropriate rehabilitation treatments: a series of case reports

Siyuan MA, Ling ZHOU, Yaqin ZHOU, Lei YANG

Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, the Army Medical University, CHINA

At present, increasing attention is being focused on burn rehabilitation, and a growing number of burn patients receive rehabilitation. However, little attention has been given to the secondary injuries caused by inappropriate rehabilitation treatments. Patients, especially those in undeveloped countries, sustain injury due to the imperfect burn rehabilitation treatment system and the nonstandard implementation process of rehabilitation treatment. This study reports 5 typical cases of secondary injuries caused by inappropriate burn rehabilitation treatments in our institute, including first web space contracture caused by a single orthosis treatment, finger deformity caused by improper compression therapy with a self-adhering bandage, developmental impairment of the affected limb caused by continuous inappropriate compression therapy, and fracture caused by overly intensive rehabilitation exercise. We aimed to remind people to pay close attention to the burn rehabilitation system and standardization of treatment to reduce the secondary injuries caused by inappropriate rehabilitation treatments. The system should include specialized hospitals (burn rehabilitation centers), community hospitals, and family rehabilitation. Furthermore, increased attention should be paid to burn rehabilitation for children.


Exploring use of 3D printing in facemask fabrication for patients with facial burns

Anna TAN1), Ita Suzana MAT JAIS1), Chin Tiong NG2), Alvin CHUA1)

Singapore General Hospital, SINGAPORE1)

Nanyang Polytechnic, SINGAPORE2)

Background:Customised fabric facemask is preferred locally but is opaque and not fitting well on certain areas of the face. Hence, the aim of this project is to explore 3D printing methods in producing transparent facemasks.Method:10 healthy subjects’ faces were scanned using a handheld scanner and 3D-printed facemasks were fabricated. To compare, fabric facemask was also fabricated and interface pressure analysis between the two types of facemasks were performed. A self-rated report from the subjects were collected on their experience in using both facemasks.Results:Preliminary interface pressure analysis on the 3D printed and fabric facemask indicated that forehead and chin have the highest pressure across different subjects, however pressure range for fabric facemask is in a safer range. Half of the subjects rated high difficulty in eating with 3D facemasks and citing issues with material rigidity and limited accommodation to the facial muscles during eating. Subjects also reported more positive reactions and ease of use for 3D facemask compared to fabric facemask in public.Conclusion:While the transparency of 3D facemask is more socially acceptable, issues of varying higher pressure over different facial parts may need to be considered or remediated before use.

132



Using large skin sheets alternately spliced from autologous and allogeneic micrografts for repairing extensive deep burn wounds

Chuanan SHEN, Bohan ZHANG


Objectives:This study aims to develop a new method of alternately splicing autologous and allogeneic micrografts into large skin sheets and observe its clinical effects.Methods:Preoperatively, the allogeneic skin was cut into micrografts. Intraoperatively, the autologous skin was harvested and cut into micrografts, all micrografts were uniformly and alternately laid. A single-layer absorbent gauze was stuck on the epidermis with a biological adhesive to obtain a large skin sheet. Two patients with extensive deep burns underwent skin grafting four times using large skin sheets. In each skin grafting, autologous and allogeneic micrografts were alternately and directly transplanted in a 10 ×10 cm wound. The time of preparing and transplanting large skin sheets per unit area (10 × 10 cm) was calculated. The skin grafts were observed postoperatively.Results:Totally 9349 cm2 of large skin sheets were prepared. The time of preparing and transplanting large skin sheets per unit area was 3.87 ± 1.14 min and 1.30 ± 0.21 min, respectively. The time of transplantation directly with autologous and allogeneic micrografts on burn wounds unit area was 8.67 ± 0.99 min. The average survival rate of the micrografts was 83.3 ± 2.8%.Conclusions:This method can significantly promote the intermingled transplantation of autologous and allogeneic micrografts in extensive deep burns.


A case report of sever contact burn with exhaust pipe at lower limb

Yoshitaka MATSUURA, Toshihiro ISHIKO, Koh OGAWA, Yuki ITANO, Akiko SHOJI, Kozo ISHIKAWA

Otsu red cross hospital, JAPAN

Traffic injury causes many kinds of fracture in human. We also know it can cause flame burn with igniting gasoline. While, sever contact burn with exhaust pipe in traffic accident may be rare. In this report, we show a case with lower limb’s contact burn and pelvic fracture.A 42-year-old male driving motor bike fell down at traffic accident (motorbike VS car). Then, he unfortunately lied under a car with his prone position. His left foot, leg and posterior thigh were injured contact burn with the exhaust pipe for long time. His burn area was already full-thickness burn when he was taken to emergency room in hospital. His thigh with burn was dent, so not only skin but also muscle thermal injury was suspected. And, we had to take into consideration with twice or third times surgical operations for burn treatment such as debridement and skin transfer. After debridement, the bone and achilles tendon was exposed at left leg. Skin grafting was applied to posterior thigh and free anterolateral thigh flap was applied to cover bone and achilles tendon. The take of skin graft and flap was good, finally he could walk to discharge hospital.

133

APBC



Two-step coverage of split-skin Meek-Isles after 7-10 days with a polylactide membrane (Suprathel®)

Matthias RAPP1), Robert SCHAPPACHER2), Saskia RAPP3), Ulrich LIENER1)

Clinic for Orthopedics, Trauma Surgery and Sports Traumatology - Burn Center, Marienhospital Stuttgart, GERMANY1)

Clinic for Oral and Maxillofacial Surgery, Marienhospital Stuttgart, GERMANY2)

Maastricht Science Program, Maastricht University, NETHERLANDS3)

Background:Due to a limited amount of available split skin donor sites, complete wound closure of large-area burned wounds with split skin often can be carried out only step by step and delayed.With the Meek technique, small and unfavourably located donor sites can be harvested. Split skin coverage of huge burned areas can be achieved faster, more efficiently with desired expansion ratio. The overlying nylon plisses can be removed after 7-10 days. The Meek isles are covered with a wound dressing afterwards. Healing of the confluent Meek isles should be supported by the applied wound dressing.Material and methods: The nylon plisses are removed about 7-10 days after the Meek grafts are applied. Wound areas are covered with Suprathel® afterwards. Suprathel® can be left on the confluent Meek isles until wound healing.Results:Suprathel® supports faster healing due to numerous effects as an activator of wound healing and reduces the rate of wound infections. Meek isles can achieve protected growth and confluence and thus achieve good and faster wound healing.Conclusion:After removing the nylon plisses, two-step covering of Meek Isles with Suprathel® is a good method of protecting the latter and achieving good wound healing.


Our time tested technique of full thickness skin graft immobilisation over mobile regions of face

Nishanth SADHANALA, Vinita PURI

Department of plastic surgery, KEM HOSPITAL, SETH G S MEDICAL COLLEGE, INDIA

We share our practice of immobilising full thickness grafts (FTSG) on the face using medium density polyurethane solid foam and stainless steel mesh which we found comfortable over the past three decades. After suturing the FTSG to edges of defect a layer of petrolatum gauge is placed. Sterilised foam of half an inch and stainless steel mesh is cut according to the shape of FTSG using the template of the defect. Next foam is placed onto the petrolatum gauge and fixed with sutures to the FTSG edges. This will exert gentle firm pressure over the FTSG. To maintain pressure an additional layer of stainless steel mesh is fixed with sutures on top of foam. Sutures are passed through the mesh, foam and surrounding skin and brought back and knotted on top of the mesh. Addition of mesh over the foam maintains the pressure as steel is unyielding unlike the foam. This technique gives adequate immobilisation to prevent shearing and also exerts gentle firm pressure over the FTSG to avoid hematoma or seroma formation and also absorbs if any. This technique is useful especially for mobile areas on the face like cheeks, eyelids and lips.

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Comparison of Morbidity and Mortality in Burn Patients with Multi-Drug Resistant Organisms (MDRO) and Non-MDRO Bacteria in Sanglah Hospital Bali

Gede Wara SAMSARGA1), I Made Suka ADNYANA1), I Gusti Putu Hendra SANJAYA1), Agus Roy Rusly Hariantana HAMID1), Anak Agung Gede Ngurah ASMARAJAYA1), Ni Nyoman Sri BUDAYANTI2)

Division of Plastic and Reconstructive Surgery, Faculty of Medicine Udayana University, Sanglah General Hospital, INDONESIA1)

Department of Clinical Microbiology, Faculty of Medicine Udayana University, Sanglah General Hospital, INDONESIA2)

ObjectiveResearch related to the effect of Multi-drug Resistant Organism (MDRO) infection on morbidity and mortality in burns is still limited. Based on this reason, the researcher investigate the effect of MDRO bacteria on the morbidity and mortality of burn patients at Sanglah Hospital, Bali.MethodsThis study is a retrospective cohort study taking 70 samples of burn patients from the medical records in Burn Unit at Sanglah General Hospital from 2018-2020. The sample was divided into two groups, MDRO and non-MDRO groups and traced the occurrence of morbidity and incidence of mortality.ResultsMDRO infection was found to be associated with the risk of sepsis and pneumonia with odds ratio (OR 13,90 (CI 95% 2,88 - 67,10) and 12,67 (CI 95% 3,26 - 49,23), respectively. The OR for mortality was 9.75 (95% CI 2.00 - 47.50). Multivariate analysis found that two variables were significantly and independently associated with the risk of mortality, namely MDRO infection (OR 57.09 (95% CI 1.41 - 2318.87)) and burn area (OR 1.13 (95% CI 1.04 - 1.22)).ConclusionMDRO infection in burns increases the risk of sepsis, pneumonia and mortality compared to burn patients with non MDRO infection in Sanglah Hospital Bali.


Early diagnosis of sepsis in severe burn patients

Mitsuhide HAMAGUCHI, Tomohide MATSUSHIMA, Kohei ICHINOHASHI, Atsushi URASE, Ryuto FUKUDA, Hiroshi IWAMOTO, Yoshinori MURAO

Department of Emergency & Critical Care Medicine Kindai University Faculty of Medicine, JAPAN

PurposePatients experienced infectious complication in most cases with 20-40% of total body surface area (TBSA). Sepsis occurred in all cases when over 40% of TBSA. Based on this observation, early diagnosis of sepsis is crucial. Thus, we retrospectively conducted a study on quick sequential organ failure assessment (qSOFA), sequential organ failure assessment (SOFA) and burn sepsis criteria for early diagnosis for sepsis during the treatment of burn patients.SubjectWe retrospectively conducted a study for sepsis in patients aged 20 or older with diagnosis of over 20% burn who were admitted during 2007 to 2016. ResultThere were 20 cases diagnosed as sepsis, and all these cases indicated positive for qSOFA. In addition, we also had 9 positive cases (45%) on the day before diagnosed with sepsis. In terms of body temperature, patients had a temperature increase of 1 degree or higher on the day of diagnosis with sepsis compared to the day before diagnosed with sepsis.ConclusionFor early prediction of sepsis, it is important to observe the evaluation items of qSOFA such as respiration, consciousness, and blood pressure in addition to an increase in body temperature.

135

APBC



Preventive Effect of The First Epidermal Growth Factor Motif of Coagulation Factor 9 on Keloid and Hypertrophic Scar

Tsutomu KASHIMURA, Takashi SUGAWARA, Yukari MATSUDA, Ayako MIYASHITA, Kotoku YOSHIDA, Yuji KIKUCHI, Kazutaka SOEJIMA

Department of Plastic and Reconstructive Surgery, Nihon University School of Medicine, JAPAN

Purpose:Capsule contracture shows abnormal collagenous fiber growth around the implant and is classified as a fibroproliferative disease like keloid and hypertrophic scars. We have found that the epidermal growth factor (EGF) derived from coagulation factor 9 (EGF-F9) has an antifibrotic effect, among other functions. The purpose of this study was to investigate the effect of EGF-F9 on capsular formation in a rat implant insertion model.Methods:Implants were inserted into the back of rat subcutaneous pockets and following two groups were established; preventive administration group and treatment administration group. The preventive administration group to administer phosphate buffered saline (PBS) or EGF-F9 from the time of insertion of the implant and the treatment administration group to begin administration from 4 weeks after implant insertion were created. After 4 weeks administration, tissues were collected and examined histologically. Results:The mean thickness of the capsule in preventive administration, the PBS group(n=8) and EGF-F9 group(n=8) was 95.3 μm and 48.1 μm, respectively. The capsule was significantly thinner in the EGF-F9 group of preventive administration. However, there was no difference in the treatment administration groups.Conclusions:It was suggested that EGF has a preventive effect on post burn keloids and hypertrophic scars.


Placental-based allografts in complex limb salvage: a pilot study

Marc R. MATTHEWS1), William H TETTELBACH2)

The Arizona Burn Center, Phoenix AZ / Department of Surgery, Valleywise Health Medical Center, USA1)

Duke University School of Medicine / MiMedx Group Inc., Marietta, Georgia / Western University of Health Sciences / Western Peaks Specialty Hospital, USA2)

Objective:Human placental-derived allografts have been successfully used as protective barriers for wounds and diabetic ulcers. Wounds with exposed bone or tendon generally are addressed with surgical flaps or amputations. This study evaluated if dehydrated human amnion/chorion membrane (dHACM) allografts with decellularized human collagen matrix (dHCM) could be used to salvage injured human extremities.Method:Prospectively treated 17 patients with complex wounds who were marked for amputation by an attending physician. End points of the retrospective analysis included: complete wound closure, a major amputation or death. dHACM/dHCM were topically applied on to the wound after debridement. Negative pressure wound therapy (NPWT) was concurrently initiated, for bolstering purposes. Approximately every 7-days the wounds were reevaluated.Results:Seventeen patients (26 extremities) were treated for fourteen burn injuries and three necrotizing soft tissue infections (NSTI). Patients who received dHACM/dHCM as a barrier and placental-derived connective tissue matrix over exposed deep tissue structures demonstrated limb preservation in 24 of 26 (92%) extremities (eleven legs, twelve feet, and two hand and forearms).Conclusion:In select limb salvage cases, dHACM and dHCM was observed as a promising alternative to amputations, tissue transfer flaps or other techniques for secondary intention resolution of extremity wounds with bone/tendon exposure.

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The synthetic, resorbable, temporary, epidermal skin substitute Suprathel® for the treatment of burns, burn-like-syndromes and donor sites





The polylactide membrane Suprathel® is a fully synthetic, resorbable, temporary, epidermal skin substitute.The material choice is based on degradation and full resorption from polylactides to lactide acid and its salts. Hence, the structure and morphology of the physical, biological and degradation properties were selected to increase the angiogenetic abilities, fibroblasts and extracellular matrix generation. As the membrane remains on the wound until it has healed completely, analgesia and undisturbed regeneration of the damaged epithelium are enabled. Additionally, it prevents bacterial infections and iatrogenic compromises of the wound when the dressings are changed.Therefore, Suprathel® is considered a versatile dressing for the treatment of burns and numerous other indications. Not only is it used as an epithelial skin substitute for split-thickness skin donor sites, but for superficial and partial-thickness burns, partial-thickness burns with small full-thickness burns, burn-like syndromes and other blistering diseases of the skin.In fact, many years of clinical experience show numerous material-based benefits; pain reduction, reduction in oxidative stress and the systemic inflammatory response, reduction in the need for skin transplantations and consecutive donor wounds, support for more efficient wound healing, low infection rate, good cosmetic results and scar quality, reduction in workload and economic efficiency.


Identification of biologically relevant laminins to culture keratinocytes for potential treatment of burns

Alvin CHUA1), Monica TJIN2), Bien-Keem TAN1), Karl TRYGGVASON2)

Singapore General Hospital / Duke-NUS Medical School, SINGAPORE1)

Duke-NUS Medical School, SINGAPORE2)

Objectives:Expansion of autologous human keratinocytes (HKCs) to treat severe/extensive burns still relies on murine feeder layer (3T3-J2) and calf serum for optimal cell growth and stem cell maintenance. However, the presence of undefined xenogeneic components in this culture system still poses safety concerns to many regulators. Herein, we examined if specialized laminins could replace murine feeder layer and provide robust culture of HKCs.Methods:We analyzed laminin components of the human skin basement membrane and 3T3-J2 using immunochemistry and RNA sequencing. The laminin components identified were further screened for their performances on HKC cultures (compared to the standard 3T3 co-culture method) by assessing their growth potential, colony forming efficiency, expression of basal and differentiation markers by qPCR, immunostaining, FACS, organotypic culture functional assay and grafting using a flap model on nude mice.Results:We identified two biologically relevant recombinant laminins - LN-511 and LN-421- as potential candidates to replace murine feeder layer for HKC culture.Conclusion:As the laminin-based culture system is xeno-free and defined, this method will not only provide safer skin epithelial cell therapy for severe burns, but also open up more applications for smaller burns and chronic wounds.

137

APBC



Clinical application of autologous dermal keratinocytes for chronic, diabetic, difficult-to-heal wounds

Niann-Tzyy DAI

Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, TAIWAN

Objective:The main purpose of this study is to evaluate the effect of transplantation of autologous keratinocytes to assist in the treatment of chronic and difficult-to-heal wounds in diabetic patients without affecting the conventional wound management process.Methods:Seven diabetic patients with grade two or higher diabetic foot ulcers unhealed for over four weeks are recruited. Subjects are randomly assigned to experimental group with conventional wound management assisted by autologous keratinocyte transplantation once a week for twelve times and control group with conventional wound management only.Results:There is no serious infection for wounds in all subjects before and after treatment. Three of the four subjects for experimental group have their wounds completely healed within the treatment period of twelve weeks, while only one of the three subjects’ wound for control group is healed. Wounds in all subjects are healed before the end of one-year follow-up period.Conclusions:Subjects transplanted with autologous keratinocytes can heal their wounds more efficiently than conventional treatment procedures without cell therapy.


Evaluation of pre-vascularized 3D skin substitutes in full-thickness skin defects

Hiromi MIYAZAKI1), Yasuyuki TSUNOI2), Takami AKAGI3), Shunichi SATO2), Mitsuru AKASHI3), Daizoh SAITOH1)

Division of Traumatology, Research Institute, National Defense Medical College, JAPAN1)

Division of Bioinformation and Therapeutic Systems, Research Institute, National Defense Medical College, JAPAN2)

Graduate School of Frontier Biosciences, Osaka University, JAPAN3)

A number of alternative treatments are already in use to treat large burns. Despite intense efforts to develop tissue-engineered skin, delayed or absent vascularization is one of the major reasons for tissue-engineered skin engraftment failure. To overcome these problems, we developed a 3-dimensional (3D) skin substitute containing vascular networks that combine dermal fibroblasts, endothelial cells, and epidermal keratinocytes based on our layer-by-layer cell coating technique.We transplanted the pre-vascularized 3D skin substitutes onto full-thickness skin defects on severe combined immunodeficiency mice to assess their integration with the host tissue and effects on wound healing. We used non-vascularized 3D skin substitutes as a control.Histological examinations revealed that, as early as 7 days after grafting, the wounds treated with the pre-vascularized substitutes contained blood-perfused vessels, whereas the wounds treated with non-vascularized control and artificial dermal substitutes did not contain perfused vessels. Moreover, the pre-vascularized 3D skin substitutes had high graft survival.We propose that a novel dermo-epidermal 3D skin substitute containing blood vessels can promote efficient reconstruction of full-thickness skin defects.

138



Simple and effective technique for calculating burn wound surface area and its applications

Nishanth SADHANALA, Vinita PURI

Department of plastic surgery, KEM HOSPITAL, SETH G S MEDICAL COLLEGE, INDIA

Quantification of burn area is an important aspect in assessing the requirements of costlier dressing materials or dermal regeneration templates(DRT), allografts. The technique which we employ uses simple commercially available dressing materials like petrolatum gauze sheets which are available in standard dimensions like 10*10cm, 10*30cm etc. during the initial dressings and will note the number of sheets used separately for different regions. Whenever feasible we use the dressing sheets of the same dimensions to calculate while we are procuring DRT, costlier dressing materials or allografts of similar dimensions. This eliminates the mathematical exercise of calculating the area in square centimetres but serves the purpose. It has the added benefit (considering the wastage of DRT or allografts) that these sheets of perfect geometric shapes are placed on to the geographically shaped burn wound. Application of this technique saves time and the wounds are not kept exposed for longer periods as in other techniques. In this method the act of dressing the wounds itself is utilised to calculate the burn wound area.


Vacuum sealing drainage with instillation in treatment of necrotizing soft-tissue infection: a retrospective analysis

Hongjie DUAN, Yang CHANG, Jiling HU, Hailiang BAI

Department of Burns and Plastic Surgery, the Fourth Medical Center of PLA General Hospital, CHINA

Objective:Necrotising soft-tissue infection is a rare but life-threatening infectious disease with high morbidity and mortality. It is typically caused by toxin-producing bacteria and characterized clinically by a very rapid progression of the disease with significant local tissue destruction. In this study, we intend to explore effective wound management to control the invasive infection and to decrease the high mortality. Methods:This retrospective analysis explored the wound management and mortality in patients with necrotising soft-tissue infection. Extensive debridement, vacuum sealing drainage (VSD) with normal saline instillation combined with broad-spectrum or sensitive antibiotics, and supportive therapies were used.Results:All 17 patients included in the analysis survived. The microbiology of 11 patients was found to be polymicrobial. Of the patients, 14 were discharged with completely healed wounds and three were transferred to a local hospital after the systemic and invasive wound infection was controlled.Conclusion:Our experiences revealed the outstanding effect of VSD with instillation in removing the debris of necrotising tissue on the wound bed, in the continual and complete drainage of wound exudates, and in prompting wound healing.

139

APBC



Combination of 3 different NPWT application and free ALT flap for open elbow joint injury with extensive burn

Junya OSHIMA1), Kaoru SASAKI1), Yukiko AIHARA1), Masahiro SASAKI1), Yoichiro SHIBUYA1), Yoshiaki INOUE2), Mitsuru SEKIDO1)

Department of Plastic and Reconstructive Surgery, University of Tsukuba, JAPAN1)

Department of Emergency and Critical Care Medicine, University of Tsukuba, JAPAN2)

ObjectiveFlap surgery is necessary for treating burns with exposed joints, but when extensive burns are involved, it is difficult to select the time of surgery, wound management, and flap. In recent years, negative pressure wound therapy (NPWT) has been used not only in chronic wounds but also in various fields, and its applications are diversifying.MethodsThe patient was a 53-year-old woman who was injured by burning herself. The injured sites were the anterior neck, from the wrists on both sides to the chest and back（40％ TBSA）. The left arms was deeply injured, and the elbow joint cavity was opened during treatment. ResultsFirst, NPWT was performed on the entire upper left limb for ① Wound Bed Preparation. After that, skin grafting was performed on left arm except the joint open part, and NPWT was performed to ② fix the skin graft. Although it took some ingenuity to seal the wound, NPWT was achieved. After subsequent flap surgery, exudate was prolonged from the flap margin, so NPWT was performed ③ above the flap. The exudate disappeared in about a week.ConclusionsNPWT is effective in the perioperative period of flap surgery for extensive burn patients.


Tideglusib Promotes Wound Healing in Aged Skin by Up-regulating Epidermal Growth Factor Receptors

Jiachen SUN, Chuanan SHEN, Xinzhu LIU


Objectives:EGF plays a role in promoting wound healing by regulating cell proliferation and apoptosis via EGFR, but its effect on wounds of different ages as well as the underlying molecular mechanism are unclear.Methods:The efficacy of EGF in wound healing, the changes in the EGF/EGFR/PI3K/Akt signaling pathway, and the levels of cell proliferation and apoptosis in vivo were assessed in vivo. The mechanism of Tideglusib affecting EGFR expression was explored through knockdown and overexpression experiments.Results:Decreased EGFR impaired the activity of the PI3K/Akt/mTOR pathway in aged skin and in ESCs, thereby slowing wound healing and impeding the efficacy of EGF. Tideglusib, a small molecule drug, could increase the expression of EGFR via the GSK-3β/β-Catenin/MMP9 with proliferation accelerated and apoptosis inhibited in ESCs, and thus accelerate wound healing in aged rats.The efficacy of Tideglusib was better than EGF in aged skin. Notably, in the presence of Tideglusib, EGF could elicit moresustained EGFR signaling, and the combined use of Tideglusib and EGF could promote wound healing more effectively.Conclusions:The declined expression of EGFR in aged skin which diminishes the efficacy of EGF can be restored by Tideglusib through apositive feedback.

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NLRP3 Activation Induced by Neutrophil Extracellular Traps Sustains Inflammatory Response in the Diabetic Wound

Dan LIU, Peilang YANG, Min GAO, Yan LIU

Burn Department, Ruijin Hospital, Shanghai Jiaotong University, CHINA

Persistent inflammatory response in the diabetic wound impairs the healing process. Mounting evidence indicates that the activation of Nod-like receptor protein (NLRP) 3 inflammasome in macrophages contributes it. However, the main trigger of NLRP3 inflammasome in the wounds is not known. Neutrophils, as sentinels of the innate immune system and key stimulators of macrophage, play the main role in the early phase of healing. Neutrophils release extracellular traps (NETs) have been detected in the diabetic wound and implicated in the impaired healing process, but the mechanism of NETs suspend wound healing and inflammatory dysregulation are elusive. Here, we report that NLRP3 and NETs production are elevated in human and rat diabetic wounds. NETs triggered NLRP3 inflammasome activation and IL-1β release in macrophage. NETs up-regulated NLRP3 and pro-IL-1β levels via the TLR-4/TLR-9/NF-κB signalling pathway. The generation of ROS facilitated the association between NLRP3 and TXNIP, and activated the NLRP3 inflammasome. In addition, NET digestion by DNase I alleviated the activation of NLRP3 inflammasome, regulated the immune cell infiltration, and accelerated wound healing in diabetic rat model. These findings illustrate a new mechanism by which NETs contribute to the activation of NLRP3 inflammasome and sustained inflammatory response in the diabetic wound.


The practice of negative pressure wound therapy with ostomy paste, as a skin graft bolster dressing.

Kazuki MATSUMURA, Ryo YAMAMOTO, Yukio SATO, Junichi SASAKI


Introduction:Negative-pressure-wound-therapy (NPWT) has been shown to reduce the infection rate and to accelerate wound healing by promoting re-epithelialization in burn patients. Although NPWT has been also used as a skin graft bolster dressing, maintaining seal integrity to keep negative pressure is difficult with large wounds. While various methods have been reported, such as double layers, staples, and running sutures, we used ostomy paste expecting its sealing efficacy. Case:The patient was a 57-year-old male, who was suffered from a flame burn and presented with 75% total body surface area (%TBSA) full-thickness burns to the face, neck, trunk, extremities, and groin. After several surgical debridement, we performed 1:6 meshed split-thickness skin graft (STSG) implantation on the left upper extremity. As NPWT dressing, RENASYS-G Gauze Dressing (Smith and Nephew, Hull, England) was used on a silicone contact layer, and ostomy paste (Skin Barrier [Hollister, Illinois, USA]) was applied directly on the wounds at the border of STSG, where surface transparent film was attached. The negative pressure of 80 mmHg was maintained for 5 days without changing the NPWT dressing. Conclusion:The use of Skin Barrier can be an option to keep seal integrity in NPWT.

141

APBC



Experience with silver-containing dressings for burn wounds

Shimpei NARA1), Rei OGAWA2)

Plastic surgery, Towa Hospital, JAPAN1)

Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, JAPAN2)

IntroductionWe have used silver-containing materials for various processes in burn wounds, and have obtained good results not only for the original indication of second-degree burn wounds but also for the perioperative period of third-degree burn wounds.Based on various experiences, we discussed the usage and indication of the material.MethodWe used silver-containing dressings in the process of treating second-degree and third-degree burns. The treatment performed every 2 to 3 days, and we switched to topical therapy when it worsened,ResultWe were able to obtain good epithelialization with superficial dermal burns. Almost no infection occurred during perioperative use. But burn depth worsened in some deep dermal burns.DiscussionThe silver-containing dressing could be used without problems for second-degree burns. The time to epithelialization was almost the same as that of treatment with topical therapy. The use of silver-containing dressings reduces the number of treatments, patient pain, and treatment effort. Careful consideration should be taken for deep dermal burns in the elderly patients as the depth of burns may worsen.


A case of burn ulcer with bone exposure successfully treated using PELNAC Gplus® without invasive procedures

Yosuke OJIMA, Norihito ITO, Yuma HIRAOKA, Takuma OZONE, Sayo NEI, Hajime MATSUMURA

Department of Plastic & Reconstructive Surgery, Tokyo Medical University Hospital, JAPAN

Artificial Dermis(AD) is useful for regenerating dermis-like tissues in the treatment of full-thickness skin defect. Basic fibroblast growth factor (bFGF) is also effective for chronic wounds. PELNAC Gplus® AD with 10% gelatin, was launched in the Japanese market in 2019. It is characterized by sustained release of bFGF and recently, its usefulness for wound healing has been reported. We experienced the case with refractory burn ulcer that was effectively treated with PELNAC Gplus®.The patient was 49-year-old man with electronic injury. He suffered 19% total body surface area electrical and flame burn. An electric current seemed to flow from his left thumb to left elbow. The deepest ulcers with bone exposure were seen on his left thumb and elbow. After applying PELNAC Gplus® to the ulcers, his proximal phalange of thumb and ulna were covered with good granulation tissues and the wounds were finally epithelized without invasive surgical procedures.AD impregnated with bFGF can lead early wound healing, and it will be used as a convenient regenerative device more and more in the future.

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Investigation and management of the heat-press injury to the hands

Norio FUKUDA, Takeshi KAN, Akiko YANO, Kimikazu YOKOI, Shohei NISHIDUKA

Plastic and Reconstructive Surgery, Yamagata University Hospital, JAPAN

PurposeThe heat-press injury is deep-seated, and is likely to become more severe than normal burn. Especially the heat-press injury to the hands often causes a high degree of functional and morphological impairment. We report the cases that we have experienced and discuss the management of heat-press injury.Subject and MethodBetween January 2006 and December 2020, there were 7 cases of heat-press injuries to the hands treated at our department and related facilities.For these cases, problems and points in treatment / surgery were discussed.ResultsOne patient underwent debridement and flap transplantation on the same day, three patients underwent two-stage flap covering after debridement, and one patient underwent full-thickness skin grafting in two stages. One patient received conservative treatment. The remaining one required amputation of the finger due to progressive necrosis.DiscussionHeat press injuries to the hands often injure tendons, bones, and joints over time, so debridement and flap surgery is desirable as soon as possible. In surgery, it is important to accurately identify the damaged tissue and to design the flap in consideration of the area on the side of the finger and web space.


The treatment of toxic epidermal necrolysis (TEN) with Suprathel® - the Stuttgart treatment concept





Introduction:Toxic Epidermal Necrolysis (TEN) is a life-threatening event with lethality of 40-60%. Such large-scale skin defects require early and permanent wound closure, which can be ideally achieved with Suprathel® as a hydrolytic epithelial substitute.Additional administration of immunoglobulin-G or Cyclosporine A in the treatment of TEN is controversial.Material and method:After blunt debridement, open areas of skin are covered with Suprathel® and dressings with mafenide acetate are applied prophylactically to avoid infections with pseudomonas aeruginosa. A total of 18 Patients received from 07/2012-06/2018 IgG 0.4 g/kg body weight/day for 5 days and since 07/2018 Cyclosporin A 1.5 mg/kg body weight/day 1-0-1 for 10 days orally.Result:Notably, the epithelial substitute Suprathel® remains on the wound until it has healed completely. Not only does it enable both analgesia and undisturbed regeneration of the damaged epithelium, but it prevents bacterial infections and iatrogenic compromises of the wound when the dressings are changed.Conclusion:Thus, our concept of treating TEN with the use of Suprathel® as a hydrolytic epithelial substitute and the initial intravenous administration of IgG respectively Cyclosporin A has proven in the treatment of toxic epidermal necrolysis. As a result, mortality could be reduced to 0% in the CysA-group.

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APBC



Efficacy of acetic acid for wound management

Raghav MAGO, Kapil. S. AGGARWAL, Anup VIDHYADAR, Vinita PURI

Department of Plastic & Reconstructive Surgery, K.E.M Hospital, INDIA

Introduction:There is no consensus on which agent or dressing is optimal for burn wound coverage to prevent or control infection or to enhance wound healing. In this study, we have evaluated the use of acetic acid for burn wounds.Materials and Methods:A total of 100 patients with wounds were treated with topical application of 1% acetic acid. Specimen of wound swab was collected before first application and further on days 3, 7, 10 and 14. Daily dressings of wounds were done. Minimum inhibitory concentration of acetic acid against various organisms isolated was determined.Results:The patients treated ranged between 9 and 60 years, with the mean age 33 years. Various microorganisms isolated include Pseudomonas aeruginosa, Staphylococcus aureus , Acinetobacter, Escherichia Coli, Proteus mirabilis, Klebsiella, methicillin-resistant S. aureus. About 28%, 64% and 8% of patients isolated no growth on culture after 7, 14 and 21 days, respectively. MIC of all isolatedorganisms was ≤ 0.5%.Conclusion:Acetic acid is non-toxic, inexpensive, easily available and efficient topical agent for effective elimination of burn wound infectionscaused due to multi-drug resistant, large variety of bacteria and fungus.


EFFECT OF TOPICAL CORTICOSTEROID TIME OF APPLICATION ON FIBROBLAST AND TYPE III COLLAGEN EXPRESSION ON DEEP DERMAL BURN WOUND (BEST TIME TO START TOPICAL CORTICOSTEROID APPLICATION IN PREVENTING HYPERTROPHIC SCAR)

Loelita LUMINTANG1), I Made Suka ADNYANA1), Agus Roy HAMID1), Hendra SANJAYA1), Nyoman GOLDEN2), Putu ASTAWA3), Made DARMAJAYA4), I Wayan Juli SUMADI5)

Department of Surgery, Division of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia1)

Department of Surgery, Neurosurgery Division, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia2)

Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia3)

Department of Surgery, Pediatric Surgery Division, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia4)

Department of Anatomical Pathology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia5)

The role of topical corticosteroids in suppressing inflammation and hypergranulation had widely demonstrated in the previous studies. However, there is no study related to the application of topical corticosteroids as prevention of hypertrophic scars identified. This study aimed to examine the effects of topical corticosteroid in decreasing fibroblasts and type III collagen expression and the best time to start its application. This randomized experimental post-test involved 54 deep dermal burn wounds on the ventral ear of female Oryctolagus cuniculus that distributed into three groups (control dan treatment). Corticosteroid topical application on the first (inflammatory), second (proliferation), and third group (remodeling) was started on day 3, on day 10, and day 21, respectively. The number of fibroblasts significantly decreased in the second group (p =0.001) and followed by the first group (p = 0.016). The type III collagen decreased significantly in the second group (p = 0.000) and followed by the third group (p = 0.019). No significant decrease of fibroblast and type III collagen found in the third group and controls. Topical corticosteroids was effective in reducing fibroblasts and type III collagen number without healing disruption. The proliferation phase found to be the best time to start the application.

Oﬃcial Congress of Asia Paciﬁc Burn Association

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Transcript of Oﬃcial Congress of Asia Paciﬁc Burn Association