Bacterial and fungal colonization of burn wounds

A prospective study of fungal and bacterial flora of burn wounds was carried out from February 2004 to February 2005 at the Burns Unit of Hospital Regional da Asa Norte, Brasília, Brazil. During the period of the study, 203 patients were treated at the Burns Unit. Wound swab cultures were assessed at weekly intervals for four weeks. Three hundred and fifty four sampling procedures (surface swabs) were performed from the burn wounds. The study revealed that bacterial colonization reached 86.6% within the first week. Although the gram-negative organisms, as a group, were more predominant, Staphylococcus aureus (28.4%) was the most prevalent organism in the first week. It was however surpassed by Pseudomonas aeruginosa form third week onwards. For S. aureus and P. aeruginosa vancomycin and polymyxin were found to be the most effective drugs. Most of the isolates showed high level resistance to antimicrobial agents. Fungi were found to colonize the burn wound late during the second week postburn, with a peak incidence during the third and fourth weeks. Species identification of fungi revealed that Candida tropicalis was the most predominant, followed by Candida parapsilosis. It is crucial for every burn institution to determine the specific pattern of burn wound microbial colonization, the time-related changes in the dominant flora, and the antimicrobial sensitivity profiles. This would enable early treatment of imminent septic episodes with proper empirical systemic antibiotics, without waiting for culture results, thus improving the overall infection-related morbidity and mortality

Sepse em pacientes queimados

Um estudo prospectivo foi realizado de junho de 2001 a maio de 2002, na Unidade de Queimados do Hospital Regional da Asa Norte, Brasília, Brasil. Durante o período do estudo, 252 pacientes foram tratados na Unidade de Queimados, 49 (19,4%) desenvolveram sepse clinicamente e microbiologicamente provada. Vinte e seis (53,1%) eram homens, 23 (46,9%) eram mulheres, com uma média de idade de 22 anos (variação de um a 89 anos) e superfície corporal queimada total de 37,7 ± 18,4% (variação de 7 a 84 %). Quarenta e três pacientes tiveram queimaduras por chama aberta, cinco por escaldamento e um por queimadura elétrica. Esses 49 pacientes tiveram um total de 62 episódios septicêmicos. Quarenta (81,6%) pacientes tiveram somente um episódio de sepse e nove (18,4%) tiveram até três episódios. Trinta (61,2%) pacientes tiveram seu primeiro episódio septicêmico dentro da primeira semana após a queimadura. Dos 62 episódios de sepse, 58 foram bacterianos e quatro por Candida sp. As bactérias mais comumente isoladas das hemoculturas foram Staphylococcus aureus, Staphylococcus coagulase-negativo, Acinetobacter baumannii, Enterobacter cloacae e Klebsiella pneumoniae. Onze (18,9%) episódios foram devido a S. aureus resistentes à oxacilina. A. baumannii era sensível a ampicilina/sulbactam em 71,4% e ao imipenem em 85,7% dos casos. O foco primário da sepse foi a queimadura em 15 (24,2%) episódios. Os achados clínicos mais comuns da sepse foram a febre, dispnéia, hipotensão e oligúria. As alterações laboratoriais mais comuns foram a anemia, leucocitose, hipoabuminemia e trombocitopenia. Doze (24,5%) pacientes morreram. O conhecimento apropriado dos aspectos clínicos, epidemiológicos, laboratoriais e microbiológicos da sepse no paciente queimado favorecem um adequado diagnóstico e tratamento dessa complicação.A prospective study was conducted from June 2001 to May 2002 at the Burns Unit of Hospital Regional da Asa Norte, Brasília, Brazil. During the period of the study, 252 patients were treated at the Burns Unit, 49 (19.4%) developed clinically and microbiologically proven sepsis. Twenty-six (53.1%) were males and 23 (46.9%) females with a mean age of 22 years (range one to 89 years) and mean burned body surface area of 37.7 ± 18.4% (range 7 to 84%). Forty-three patients had flame burns, five a scald and one an electric burn. These 49 patients had a total of 62 septic episodes. Forty (81.6%) patients had only one and nine (18.4%) had up to three episodes of sepsis. Thirty (61.2%) patients had their first septicemic episode either earlier or by one week postburn. Out of 62 septic episodes, 58 were due to bacteria and four due to Candida sp. The most common bacteria isolated from blood culture were Staphylococcus aureus, coagulase-negative Staphylococcus, Acinetobacter baumannii, Enterobacter cloacae and Klebsiella pneumoniae. Eleven (18.9%) episodes were due to oxacillin resistant Staphylococcus aureus. Acinetobacter baumannii was sensitive to ampicillin/sulbactam in 71.4% and to imipenem in 85.7% of the cases. The primary foci of sepsis were the burn wound in 15 ( 24.2% ) episodes. The most common clinical findings of sepsis in these patients were fever, dyspnea, hypotension and oliguria. The most common laboratory findings of these patients were anemia, leukocytosis, hypoalbuminemia and thrombocytopenia. Twelve (24.5%) patients died. The appropriate knowledge of clinical, epidemiological, laboratorial and microbiological aspects of sepsis in burned patients permits an adequate diagnosis and treatment of this complication

Epidemiology of facial trauma of patients admitted to a public hospital emergency department

OBJETIVO: Avaliar os dados epidemiológicos e a localização dos traumas de face de pacientes atendidos no Hospital Regional da Asa Norte (HRAN), Brasília, Distrito Federal. MÉTODO: Trata-se de um estudo retrospectivo, realizado no pronto socorro do HRAN-DF, visando avaliar o perfil epidemiológico dos pacientes atendidos pela equipe da Unidade de Cirurgia Plástica vítimas de trauma de face no período de 1 de janeiro a 31 dezembro de 2004. RESULTADOS: O estudo compreendeu 711 pacientes, destacando-se o sexo masculino (72,8%). Quanto à causa, predominou a agressão física, seguida por acidente com veículos/motos. As quedas foram a causa predominante das lesões em crianças, mas verificou-se a participação cada vez maior da agressão física como mecanismo de trauma facial com o aumento da idade. A relação de homem:mulher foi de 3:1. A faixa etária mais atingida foi de 21 a 30 anos, representando 35,3% dos pacientes. As fraturas foram encontradas em 24,9% das lesões faciais. O nariz foi o local mais acometido nas fraturas de face (76,8%). CONCLUSÃO: A violência interpessoal foi a principal causa de trauma de face. A queda da própria altura mostrou-se como importante mecanismo de trauma nos extremos de idade.BACKGROUND: To evaluate the etiology, age, gender and location of the lesions of facial trauma in patients arriving at our hospital. METHODS: The data were evaluated through retrospective analysis of patient charts from January 1st to December 31st, 2004. RESULTS: The group comprised 711 patients with facial trauma. Blunt assault was the most common cause, followed by motor vehicle crashes. Falls were, by far, the predominant cause of injury in children, but with increasing age, assaults became more common. It was observed a male:female ratio of 3:1. The most frequent age group was the 21-30 years one, with 52%. Facial fractures were found in 24.9% of facial injuries. The most frequent fracture was nasal (76.8%). CONCLUSION: Aggressions or interpersonal violence were the main cause of facial trauma in our population. The causes of facial trauma were directly related to the age

Antimicrobial susceptibility of aerobic bacteria isolated from leishmaniotic ulcers in Corte de Pedra, BA

Um estudo prospectivo, sobre a sensibilidade antimicrobiana da flora bacteriana em úlceras cutâneas leishmanióticas, foi realizado em pacientes portadores de leishmaniose tegumentar, em Corte de Pedra, Bahia. Foram estudados 84 pacientes, principalmente adolescentes e adultos dedicados à lavoura, apresentando lesão cutânea única. Staphylococcus aureus predominou (83%) nas culturas, sendo sensível à maioria dos antibióticos testados. Flora bacteriana mista esteve presente na úlcera em 37 (44,1%) pacientes. Entre as bactérias Gram-negativas isoladas, foram mais freqüentes Enterobacter sp (13,1%), Proteus sp (8,3%), Pseudomonas aeruginosa (7,1%) e Klebsiella sp (7,1%), sendo sensíveis principalmente à ciprofloxacina, aminoglicosídeos, cefalosporinas de terceira geração e carbapenêmicos.A prospective study regarding aspects of antimicrobial susceptibility aspects was realized among patients with tegumentary leishmaniasis in Corte de Pedra, Bahia. Cases were composed mainly of adolescent and adult farmer patients with single lesions. Staphylococcus aureus predominated (83%) in the culteres with susceptibility to the majority of antibiotics. A mixed bacterial flora in ulcers was encountered in 37 (44,1%) patients. Among the gram-negative bacteria isolated, Enterobacter sp (13.1%), Proteus sp (8.3%), Pseudomonas aeruginosa (7.1%) and Klebsiella sp (7.1%) were mainly found with susceptibility to ciprofloxacin, aminoglycosides, third generation cephalosporin and carbapenems

Abdominoplasty in gastric bypass patients: anthropometric profile, comorbidities, and complications

Introduction: Patients who undergo vertical-banded gastroplasty- Roux-en-Y gastric bypass (VBG-RYGB) have significant weight loss, and abdominoplasty (AP) is an effective corrective surgery for removing excess skin. Methods: A prospective study conducted from January 2011 to December 2016 in a public hospital evaluated patients who underwent AP after VBG-RYGB. The analyzed variables were body mass index (BMI) before VBG-RYGB, BMI before AP, weight loss, weight of the excised abdominal flap, comorbidities, and complications. Results: For this study, 107 patients who underwent AP were included. The patients' mean age was 41 years; BMI before AP, 27.6 ± 3.7 kg/m2; and mean weight loss, 47.7 ± 17.3 kg. The maximum BMI before bariatric surgery was 45.5 ± 7.5 kg/m2, and the difference between the maximum BMI before VBG-RYGB and before corrective surgery was 18.6 ± 9.3 kg/m2. The comorbidities observed before VBG-RYGB were arterial hypertension (11.1%), arthropathy (4.6%), diabetes mellitus (5.6%), and metabolic syndrome (5.6%). Fourteen patients (13.1%) underwent herniorrhaphy during AP. The overall complication rate was 31.5%. Weight before VBGRYGB, BMI before VBG-RYGB, mean weight loss, comorbidities, abdominal flap weight, and BMI of >20 kg/m2 were significantly associated with postoperative complications. Conclusions: VBGRYGB was an effective approach to reduce comorbidities in obese patients. Comorbidities, weight before VBG-RYGB, mean weight loss, amount of tissue removed from the abdomen, and BMI of >20 kg/m2 significantly increased the complication rate in the gastric bypass patients who underwent AP. Furthermore, AP is fundamental for the comprehensive care of obese patients and has optimized the results achieved with VBG-RYGB

Retrograde flow medial plantar artery flap reconstruction for defects of the dorsal metatarsophalangeal region

INTRODUCTION: Complex reconstructions of the foot region are planned based on the anatomical subunits affected by the etiological factors of lesions. We have several options for covering defects of the back of the feet, from the simpler ones, such as local graft and local flap at random and locoregional pedicled flaps, to the more complex ones, such as free flaps. Here, we report a case in which an unpublished technique using a retrograde flow medial plantar flap in the reconstruction of dorso-distal structures of the foot was used. Its originality consisted in the passage of the flap of the plant to the back through the first intermetatarsal space. METHODS: The patient was a 20-year-old woman who had a motorcycle accident, wherein she sustained foot trauma with loss of back substance at the first to fifth metatarsal level, with bone and tendon exposure, and retrograde flow medial plantar flap was used, with transposition to the back of the foot. RESULTS: The reconstruction of the distal region of the forefoot and fingers is a challenge. Grafts are not ideal for deep defects and exposure of noble structures. Local flaps are inaccessible for finger defects. Furthermore, the free flaps are well indicated for large defects. The flaps of the medial plantar artery are indicated and consecrated to the forefoot region, and some authors have modified to the dorsum region of the first metatarsal. CONCLUSION: This flap is useful for reconstruction of feet with dorsal lesions through this new technique that is unpublished in the literature, with the originality of the passage of the pedicle from the plant to the back through the first intermetatarsal space

Feridas complexas de membros inferiores por desenluvamento cutâneo pós-traumático raro durante a pandemia da COVID19 no centro-oeste brasileiro: um relato de caso

Background:  Reconstruction of lower limbs (LL) resulting from trauma is one of the greatest challenges in Plastic Surgery1. With the return of activities after the Covid-19 pandemic, it was possible to observe an increase in hospitalization rates due to traffic accidents, also increasing hospitalizations for complex LL wounds5. This study aims to present a rare case of complex LL wounds due to traumatic skin degloving. Case Report: A 29-year-old male patient, with no previous comorbidities, was admitted to the Plastic Surgery Service of the Regional Hospital of Asa Norte for complex injuries in the lower limbs after a motorbike x bus car accident. He underwent optimized clinical treatment and ten surgical and curative debridements, including the vacuum modality. The patient improved with the appearance of the lesion and then underwent two more surgeries for skin autograft. He was discharged from hospital after one hundred and nine days of hospitalization and was referred for interdisciplinary outpatient follow-up. Discussion: Traumatic LL injuries occur mainly in young male adults, victims of accidents involving motorcycles6, between the second and third decades of life. The management of complex wounds requires clinical and/or surgical treatment3. With regard to surgical treatment, there are several techniques, and one should opt, whenever possible, for less complex procedures, such as skin grafts15. Conclusion: This study brought a rare case that occurred in the Brazilian Midwest without a previous similar description, presenting extreme difficulties in clinical and surgical management that were resolved by improving relevant therapeutic techniques.Introdução: a reconstrução de membros inferiores (MMII) decorrente do trauma é um dos maiores desafios da Cirurgia Plástica. Com retorno das atividades após a pandemia da COVID-19, foi possível observar um aumento nas taxas de internação por acidentes de trânsito, aumentando também as internações por feridas complexas de MMII. Este estudo tem como objetivo apresentar um caso raro de feridas complexas de MMII por desenluvamento cutâneo traumático. Relato de Caso: paciente masculino, 29 anos, sem comorbidades prévias, foi admitido no Serviço de Cirurgia Plástica do Hospital Regional da Asa Norte por ferimentos complexos em MMII, após acidente motociclístico no qual houve colisão entre a moto do paciente e um ônibus. Ele foi submetido a tratamento clínico otimizado e a dez desbridamentos cirúrgicos e curativos, incluindo a modalidade a vácuo. O paciente evoluiu com melhora do aspecto da lesão e, em seguida, passou por mais duas cirurgias para autoenxertia de pele. Recebeu alta hospitalar após cento enove dias de internação e foi encaminhado para seguimento ambulatorial interdisciplinar. Discussão: as lesões traumáticas de MMII ocorrem, principalmente, em adultos jovens, do sexo masculino, vítimas de acidentes envolvendo motocicletas, entre a segunda e a terceira décadas de vida. O manejo de feridas complexas requer tratamento clínico e/ou cirúrgico. No que se refere ao tratamento cirúrgico, há diversas técnicas, devendo-se optar, sempre que possível, pelos procedimentos menos complexos, como os enxertos de pele. Conclusão: este estudo trouxe um caso raro, ocorrido no centro-oeste brasileiro sem descrição semelhante prévia, apresentando dificuldades extremas de manejo clínico e cirúrgico que foram resolvidas mediante aprimoramento de técnicas terapêuticas pertinentes