Burn Disaster-Management Planning: A Preparedness Tool Kit

It is vital that preburn center emergency providers have the knowledge and equipment needed to treat burn-injured patients should there be an extended delay in transporting the patients to a burn center as may be the case during a mass-casualty incident or weather-related emergency. Since 2007 a collaborative effort has been underway to build an emergency-response tool kit that provides to and draws from local, state, and federal resources. This tool kit is designed to fill knowledge deficits regarding burn treatment as well as address gaps in stockpiled treatment materials. This tool kit was implemented in four modules: provide equipment, provide guidance, provide education, and provide drill. Module one ensures that equipment needed for treating burn injuries is available to emergency providers. Module two ensures that policies and procedures congruent with the practice of the regional burn center are in place. Module three ensures that preburn center providers are provided education on modern burn care. Module four is to drill. The sum of the effort by the authors is the establishment of a tool kit that enhances the capabilities of preburn center emergency providers. Implementation has led to improved collaborative relationships, increased the awareness of available resources, and reduced knowledge deficit regarding burn care among preburn center providers. This tool kit provides greater continuity of care for all burn patients affected by a delay in transport to a burn center, and its modular structure makes it adaptable to other regions as a whole or in part

Epidermal-cell-based therapy as an adjunct to healing second degree burns-A randomized controlled pilot study.

BACKGROUND: Healing of partial-thickness (2a and 2b) burns is notoriously unpredictable as far as healing time, scarring and (hypo)pigmentation is concerned. Epidermal blister grafting is an autologous grafting technique involving transfer of epidermal islands without dermal elements. Cellutome™ is an FDA-acknowledged epidermal harvesting device. This proof-of-concept study evaluates whether blister grafting of partial-thickness burns results in improved healing compared to standard acellular treatment. METHODS: This is a randomized controlled trial with 8 patients in which each patient received both treatments randomized to different burn sites. Healing was assessed at regular intervals. Twelve months after treatment, outcomes were measured with the Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), photography, spectrometry, Semmes-Weinstein Filaments, cutometry and high-resolution ultrasound. RESULTS: Areas treated with epidermal blister grafting healed slightly faster than acellular treatment. Epidermal treatment yielded healing with less erythema, closer to that of surrounding normal skin (p = 0.0404). Donor sites were not visible and not measurably different than normal skin. CONCLUSIONS: Results favor cellular over acellular technique for the treatment of partial-thickness (2a and 2b) burns. Significant improvement in erythema implies a higher quality healing process. Further studies should look primarily at larger areas of treatment, and larger sample size

Prospective Evaluation of Fractional CO2 Laser Treatment of Mature Burn Scars.

The authors conducted a prospective study of fractional CO2 laser treatment of mature burn scars, comparing objective and subjective scar measurements evaluating at least one treatment and one control scar on the same patient pre- and post treatments. After institutional review board approval, burn survivors with mature blatant burn scars were invited to enter the study. A series of three fractional CO2 laser treatments was performed in an office setting, using topical anesthetic cream, at 40 to 90 mJ, 100 to 150 spots per cm. Subjective and objective measurements of scar physiology and appearance were performed before and at least 1 month after the treatment series on both the treated and the control scar. A total of 80 scars, 48 treatment and 32 control scars, were included in the study. Treatment pain score averaged at 4.7/10 during and at 2.4/10 5 minutes after the treatment. All treated scars showed improvement. Objectively measured thickness, sensation, erythema, and pigmentation improved significantly in the treated scars (P = .001, .001, .004, and .001). Elasticity improved, but without statistical significance. Vancouver scar scale assessments by an independent observer improved from 8 to 6; patient self-reported pain and pruritus remained unchanged in both groups. Fractional CO2 laser treatment is a promising entity in the treatment of burn scars. Our study results show significant differences in objective measurements between the treated scars and the untreated control scars over the same time period. In scar treatment studies, the patient/observer and Vancouver scar scales may not be sensitive enough to detect outcome differences

A bio-degradable synthetic membrane to treat superficial and deep second degree burn wounds in adults and children - 4 year experience.

INTRODUCTION: A new bio-degradable synthetic membrane was recently introduced to treat second degree burns in adults and pediatric patients. OBJECTIVE: To assess complications and outcomes using this absorbable synthetic membrane to treat second degree burns. METHODS: 229 burn patients, 138 pediatric, with superficial and deep second -degree wounds, treated with the absorbable synthetic membrane (Suprathel®, Polymedics, Denkendorf, Germany) were included in this study. Patients were treated under anesthesia or moderate sedation. The wound bed was prepared by using either rough debridement or dermabrasion excision. After hemostasis, the membrane was applied to the wound with an outer layer dressing of fatty gauze, bridal veil, absorptive gauze and an ACE® wrap. The outer dressing was removed every one to four days, depending on exudate, in order to closely follow the wound through the translucent membrane and fatty gauze layers. After complete epithelialization, the dressing separated and could be removed. The study focused on the need for subsequent grafting, healing time, patient pain level, hypertrophic scarring and rate of infection. RESULTS: All wounds in this study that were treated with Suprathel® healed without grafting. The average TBSA (Total Body Surface Area) was 8.9% (1%-60%). Average time to healing was 13.7 days for ≥ 90% epithelialization with 11.9 days for pediatric patients versus 14.7 days for adults. Throughout the treatment period, the average pain level was 1.9 on a 10-point scale. 27 patients developed hypertrophic scarring in some areas (11.7%). Average Length of stay (LOS) was 6.9 days. The rate of infection was 3.8% (8/229). Failure or progression to full thickness in part of the wounds was 5.2% (12/229). CONCLUSION: In treating second degree burn wounds, this membrane provides a simple, effective solution alternative with good outcomes and less pain than conventional and previously studied treatment options in the same institution. Fewer dressing changes and easier overall management of the wounds contribute to its favorable profile