Management Strategies of Major Burns and Learning Curve
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Abstract
Large total body surface area burns can have a substantial impact on morbidity and mortality, but with early management and intervention by a skilled surgical team, outcomes can be favorable. The purpose of our study is to discuss the management of extensive burns and review the experience at our center. A review of patients admitted to this hospital in the previous two years, with burns greater that 50% was done. From July 2022 to July 2024, 43 patients with burn sizes more than 50% TBSA were admitted. Female: male ratio was 1.047:1 and with average age of 28.674 ± 9.37 years (range 9 to 58 years). There was an average delay of 2.053±2.19 days between the burn and arrival at our centre (Range of 3 hours to 9 days). Esharotomies and fasciotomy was done in 20 and 8 patients, respectively. All patients expired in the hospital except one, who went LAMA. 20 patients survived for 2 to 5 days. Major cause of death in most of the patients was Sepsis. The two most significant risk variables affecting a burn victim's survival and clinical outcome are burn size and depth. Because donor sites are insufficient for the necessary grafting procedures, burns with a size greater than 80% of the total body surface area (TBSA) provide daunting surgical obstacles. Comfort care may be the best choice when clinical predictors indicate no likelihood of success.
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References
Hermans MH. An introduction to burn care. Advances in skin & wound care. 2019 Jan 1;32(1):9-18.
AlAlwan MA, Almomin HA, Shringarpure SD et.al. Survival from ninety-five percent total body surface area burn: a case report and literature review. Cureus. 2022 Feb 4;14(2).
Woods JF, Quinlan CS, Shelley OP. Predicting mortality in severe burns—what is the score?: evaluation and comparison of 4 mortality prediction scores in an Irish population. Plastic and reconstructive surgery Global open. 2016 Jan;4(1).
Khadra C, Ballard A, Paquin D et al. . Effects of a projector-based hybrid virtual reality on pain in young children with burn injuries during hydrotherapy sessions: A within-subject randomized crossover trial. Burns. 2020 Nov 1;46(7):1571-84.
Hussain A, Choukairi F, Dunn K. Predicting survival in thermal injury: a systematic review of methodology of composite prediction models. Burns. 2013 Aug 1;39(5):835-50.
AlAlwan MA, Almomin HA, Shringarpure SD et al.. Survival from ninety-five percent total body surface area burn: a case report and literature review. Cureus. 2022 Feb 4;14(2).
ISBI Practice Guidelines for Burn Care, ISBI Practice Guidelines Committee, 2016
Robenpour M, Teman J, Tamir G et al. Successful treatment of a 95 per cent body surface area burn. Burns. 1990 Dec 1;16(6):462-6.
Naves LB, Dhand C, Almeida L et al.. In vitro skin models and tissue engineering protocols for skin graft applications. Essays in Biochemistry. 2016 Nov 30;60(4):357-69.
Burd A, Chiu T. Allogenic skin in the treatment of burns. Clinics in dermatology. 2005 Jul 1;23(4):376-87.
Phillips TJ, Bhawan J, Leigh IM et.al.. Cultured epidermal autografts and allografts: a study of differentiation and allograft survival. Journal of the American Academy of Dermatology. 1990 Aug 1;23(2):189-98.
Wardhan R, Fahy B. Regional Anesthesia and Acute Pain Management for Adult Patients with Burns. Journal of Burn Care & Research. 2023 May 16:irad069.
Steinvall I, Elmasry M, Abdelrahman I et al.. Addition of admission lactate levels to Baux score improves mortality prediction in severe burns. Scientific reports. 2021 Sep 10;11(1):18038.
Raff T, Germann G, Barthold U. Factors influencing the early prediction of outcome from burns. Acta chirurgiae plasticae. 1996 Jan 1;38(4):122-7.
Barajas‐Nava LA, López‐Alcalde J, i Figuls MR et al.. Antibiotic prophylaxis for preventing burn wound infection. Cochrane Database of Systematic Reviews. 2013(6).
Saffle JR, Graves C, Cochran A et.al. Nutritional support of the burned patient. Total burn care. London: WB Saunders. 2012 Jan 1:333-53.
Herndon d, Stein md, Rutan TC et al.. Failure of TPN supplementation to improve liver function, immunity, and mortality in thermally injured patients. Journal of Trauma and Acute Care Surgery. 1987 Feb 1;27(2):195-204.
Mehta K, Arega H, Smith NL et al.. Gender-based disparities in burn injuries, care and outcomes: A World Health Organization (WHO) Global Burn Registry cohort study. The American Journal of Surgery. 2022 Jan 1;223(1):157-63.
Čapek KD, Culnan DM, Desai MH et al.. 50 Years of Burn Care at Shriners Hospitals for Children, Galveston. Annals of plastic surgery. 2018 Mar;80(3 Suppl 2):S90.
Guo F, Chen XL, Wang YJ et al.. Management of burns of over 80% of total body surface area: a comparative study. Burns. 2009 Mar 1;35(2):210-4.
Hahn H. Recovery from an eighty-percent total body surface area burn injury sustained at work.. 2012 Jun 15;63(2):223-5.
Thomson PD, Bowden ML, McDonald K et al.. Survival of an infant with massive thermal injury: a case report. Burns. 1989 Jun 1;15(3):171-4.
Robenpour M, Teman J, Tamir G et al.. Successful treatment of a 95 per cent body surface area burn. Burns. 1990 Dec 1;16(6):462-6.
Chai JK, Zheng QY, Li LG, et al.: [Analysis on treatment of eight extremely severe burn patients in August 2nd Kunshan factory aluminum dust explosion accident]. Zhonghua Shao Shang Za Zhi. 2018, 34:332-8. 10.3760/cma.j.issn.1009-2587.2018.06.004
Li HY, Xiao SC, Zhu SH et al.. Successful treatment of a patient with an extraordinarily large deep burn. Medical science monitor: international medical journal of experimental and clinical research. 2011;17(4):CS47.