Eur. Burn J., Volume 3, Issue 4 (December 2022) – 7 articles

Background: Procedural pain in burn patients continues to be a major problem. Frequently used analgesics, such as opioids, may have various side effects, including respiratory depression, nausea, and vomiting. Inhaled methoxyflurane has been used in the pre-hospital setting for trauma-related pain. This pilot study aimed to investigate the feasibility of using methoxyflurane for pain relief during dressings changes for burns in the hospital setting. Methods: In this investigator-initiated pilot study, we included burn patients undergoing dressing changes in the burn ward. The primary outcome was the maximal pain level experienced by the patient during the procedure on a verbal rating scale of 0 to 100. Furthermore, patient satisfaction and the nurse’s assessment of the patient’s pain were reported. We also reported the presence of nausea, vomiting, coughing, and headache, along with changes in the pulse rate, oxygen saturation, and arterial blood pressure. Results: We included 12 patients in the period of June 2021 to July 2022. The median patient-reported maximal procedural pain was 60 (interquartile range (IQR), 37–80), which corresponded well with the nurse’s rating of a median of 57 (IQR 28–67). The patients were satisfied with methoxyflurane as an analgesic, with a median score of 96 (IQR 96–100). One patient reported coughing after the procedure, and another patient experienced nausea one week after the procedure. No clinically important haemodynamic changes during administration were detected. Conclusions: Methoxyflurane was found to be feasible for pain relief in burn patients undergoing dressing changes in the burn ward. Full article

NovoSorb^® Biodegradable Temporising Matrix (BTM) is a synthetic matrix used as an adjunct in the reconstruction of certain complex wounds. We present a gentleman who sustained severe full-thickness lower limb burns as a child which were treated with split-thickness skin grafts. In later life, he went on to develop bilateral non-healing ulcers, resulting in a left above-knee amputation and a giant circumferential right lower limb squamous cell carcinoma (SCC) encompassing the majority of the lower leg. Surgical resection and salvage of the single remaining limb was achieved with the successful application of a BTM. BTM has proven to be successful in reconstructing a small number of SCC wounds; however, to the best of our knowledge, we are the first authors to test its application in the reconstruction of a circumferential defect associated with a giant lower limb Marjolin’s ulcer. Full article

Early management of burns is an essential component of achieving desirable patient outcomes. One of the earliest points of patient management in the case of burn injuries is in the prehospital setting. Unlike first aid, which can be provided by a non-healthcare worker, fluid resuscitation can be provided in the prehospital setting by emergency medical services personnel. This systematic review aims to investigate whether burn patients are receiving accurate fluid resuscitation in the prehospital setting. In addition, it will investigate if existing inaccuracies could impact patient outcomes negatively. This systematic review was completed in accordance with the guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search for eligible studies started by searching relevant databases (PubMed, Embase, Medline, and Google Scholar). The selected studies were screened, and data were extracted and analyzed using a narrative synthesis approach. Seven studies met the inclusion criteria of this review, with a total of 961 patients. All seven studies included in this review reported that the volume of fluids for resuscitation purposes received by burn patients in the prehospital setting was inaccurate. However, most reported that the patient outcomes were not affected. Most of the studies were rated as “good,” however, and further high-quality randomized control studies are required before strong recommendations can be made. Full article

Cellular therapies for burn wound healing, including the administration of mesenchymal stem or stromal cells (MSCs), have shown promising results. This review aims to provide an overview of the current administration methods in preclinical and clinical studies of bone-marrow-, adipose-tissue-, and umbilical-cord-derived MSCs for treating burn wounds. Relevant studies were identified through a literature search in PubMed and Embase and subjected to inclusion and exclusion criteria for eligibility. Additional relevant studies were identified through a manual search of reference lists. A total of sixty-nine studies were included in this review. Of the included studies, only five had clinical data from patients, one was a prospective case–control, three were case reports, and one was a case series. Administration methods used were local injection (41% in preclinical and 40% in clinical studies), cell-seeded scaffolds (35% and 20%), topical application (17% and 60%), and systemic injection (1% and 0%). There was great heterogeneity between the studies regarding experimental models, administration methods, and cell dosages. Local injection was the most common administration method in animal studies, while topical application was used in most clinical reports. The best delivery method of MSCs in burn wounds is yet to be identified. Although the potential of MSC treatment for burn wounds is promising, future research should focus on examining the effect and scalability of such therapy in clinical trials. Full article

A burn injury affects a person’s health-related quality of life (HRQoL) in different ways and might influence their daily life for months and years afterward. The aim of this study was to examine how activity performance and subjective scar estimation relate to self-rated health and whether this changes in the first year post-burn. Fifty consecutive patients who were scheduled for follow-up at the Burn Center’s outpatient clinic in Uppsala were included. Assessments of HRQoL (EQ-5D), activity performance (DASH), and subjective scar evaluation (POSAS) were conducted at 6 and 12 months post-burn. The results show a statistically significant correlation between self-rated HRQoL and activity performance (p = 0.001) and between self-rated HRQoL and subjective scar estimation (p = 0.000) at 6 but not at 12 months post-burn. A possible explanation of the lack of correlation at one year post-burn might be the patient´s expectations of his or her recovery. In future research, it would be interesting to investigate the long-term correlations between quality of life and activity performance. Full article

Background: The incidence of sunburn injuries continues to rise despite increased awareness of the risks of sun exposure and availability of sun protection. Whilst not a significant burden on burns care services, patients remain exposed to associated risks for future development of skin malignancies. The aims of this study were to determine the burden and severity of sunburn injury presentations to the Manchester adult and children’s burns services. Methods: A 10-year retrospective review was performed of patients with sunburn injuries, presenting to the Manchester burn services between 2010 and 2019 (inclusive). Data were collected from the International Burn Injury Database (iBID), electronic patient record (EPR) and local data collection systems. The data extracted included patient demographics, sunburn characteristics and management of the burn injury including need for admission and any documented surgical interventions. Temporal correlation was determined by linear regression analysis. Results: In total, 131 paediatric and 228 adult patients with sunburn injuries were managed by the Manchester burns services over the 10-year period. Mean % total body surface area burned was low (2.00% and 2.12% in adult and paediatric patients, respectively), with the majority of injuries either superficial or superficial partial thickness. Thirty percent (30.2%) of adult and 40.5% of paediatric patients were admitted with a mean length of stay of 3.51 and 1.11 days, respectively. The presentation of sunburn injuries progressively increased over the study period with a peak in 2017 (n = 58). Similar trends in patient demographics, burn size and depth and temporal trends were observed in national data from the same period for both adult and paediatric patients. Conclusion: This 10-year retrospective cohort study demonstrates an increasing trend of sunburn injury presentations to the Manchester specialist burns services; a pattern replicated in national data from England and Wales. The majority of sunburn injuries do not present to specialist burn services; therefore, these reported injuries reflect only a fraction of the true burden of sunburn nationwide. Despite increased awareness, an obvious need for enhanced public awareness campaigns regarding sun protection is therefore needed to address this trend. The educational and preventative role of burns care services is a key component in tackling both consequences of burn injuries themselves and associated risks such as future skin cancer development. Full article