Cauliflower ear - a minimally invasive treatment method in a wrestling athlete: a case report

Acute auricular hematoma can be caused by direct blunt trauma or other injury to the external ear. It is typically seen in those who practice full contact sports such as boxing, wrestling, and rugby. “Cauliflower ear” deformity, fibrocartilage formation during scarring, is a common complication of auricular hematomas. Therefore, acute drainage of the hematoma and postprocedural techniques for preventing recurrence are necessary for preventing the deformity. There are many techniques although no superior method of treatment has been found. In this case report, we describe a novel method using needle aspiration followed by the application of a magnet and an adapted disc to the affected area of the auricular. This minimally invasive, simple, and accessible method could potentially facilitate the treatment of cauliflower ear among full contact sports athletes

The development and impact of heterotopic ossification in burns: A review of four decades of research

Introduction: Heterotopic ossification (HO) is the formation of lamellar bone within connective and other tissue where bone should not form and is a rare complication after burn injury. However, it leads to severe pain and distress, marked reduction in joint range of motion (ROM), impaired function and increased hospital length of stay. The pathophysiology, incidence and risk factors of HO remain poorly understood in burns and other traumas and the management, controversial. The aim of this comprehensive review, therefore, was to synthesise the available evidence on the development and treatment of HO after acute burn injury. Methods: The review was based on a systematic search of five electronic databases PubMed, EMBASE, CINAHL, LILACS and Scopus. Results: Synthesis and analysis of the data highlighted that, despite the passage of time, little translatable evidence is available to guide any prevention, screening, diagnostic or pharmacological or physical management protocols. Discussion: Causes of HO remain confounded, therefore prevention is difficult. Although spontaneous resolution is possible, surgical resection remains the recommended treatment when ROM and activities of daily living are severely affected. Conclusion: The findings from this review indicate that multicentre data pooling is needed to understand the optimum pathway to prevention, identification and treatment of HO in acute burn patients

Impact of COVID-19 on global burn care.

Worldwide, different strategies have been chosen to face the COVID-19-patient surge, often affecting access to health care for other patients. This observational study aimed to investigate whether the standard of burn care changed globally during the pandemic, and whether country´s income, geographical location, COVID-19-transmission pattern, and levels of specialization of the burn units affected reallocation of resources and access to burn care. The Burn Care Survey is a questionnaire developed to collect information on the capacity to provide burn care by burn units around the world, before and during the pandemic. The survey was distributed between September and October 2020. McNemar`s test analyzed differences between services provided before and during the pandemic, χ2 or Fisher's exact test differences between groups. Multivariable logistic regression analyzed the independent effect of different factors on keeping the burn units open during the pandemic. The survey was completed by 234 burn units in 43 countries. During the pandemic, presence of burn surgeons did not change (p = 0.06), while that of anesthetists and dedicated nursing staff was reduced (<0.01), and so did the capacity to manage patients in all age groups (p = 0.04). Use of telemedicine was implemented (p < 0.01), collaboration between burn centers was not. Burn units in LMICs and LICs were more likely to be closed, after adjustment for other factors. During the pandemic, most burn units were open, although availability of standard resources diminished worldwide. The use of telemedicine increased, suggesting the implementation of new strategies to manage burns. Low income was independently associated with reduced access to burn care. [Abstract copyright: Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

Standardization of burn patients transfer: Implementation of a transfer request form to Israel\u27s national burn center

Background: Burn injuries are an extreme form of traumatic injury and are a global health issue. The Israeli National Burn Unit at the Sheba Medical Center, a tertiary level 1 trauma center and hence the national referral center, treats burn patients admitted both directly and referred from other medical centers. The transfer and handover of patients is acritical step in patient care. In Israel, to date, there is no standardized and accepted transfer request form for burn patients from one medical facility to another. Objectives: To construct a transfer request form to be used in all future burn patient referrals. Methods: After reviewing publicly available international transfer forms and comparing them to the admission checklist used at our unit, a structured transfer request form was constructed. Results: After a pilot study period, testing the form in various scenarios and adapting it, the first standardized transfer form for burn patients in Israel in both English and Hebrew was implemented beginning May 2020. Conclusions: Implementation of a standardized transfer process will improve communication between healthcare professionals to help maintain a continuum of care. We believe that implementation of a burn transfer form in all future referrals can standardize and assure better care for burn patients, thus improving overall patient care. IMAJ 2020; 22: 700-70

Effect of a tight glycemic control protocol on hypoglycemia and mortality in the burn unit: A case-control study

Background: Burn injury pathophysiology is characterized by severe catabolic state and poor glycemic control. A tight glycemic control protocol using insulin for burn victims has yielded inconsistent mortality and morbidity outcomes. Objectives: To compare the effect of standard and tight glycemic control protocols on mortality and hypoglycemia events in critical care burn patients. Methods: We conducted a case-control study of burn victims admitted to the burn intensive care unit between 2005 and 2011. Patients were assigned to either a standard or a tight glycemic control protocol. Results: Of the 38 burn patients in the study, 28 were under a tight glycemic control protocol. No differences in glucose area-under-the-curve per day levels were observed between the groups (148.3 ± 16 vs. 157.8 ± 16 mg/dl in the standard and tight glycemic control protocol groups respectively, P = 0.12). The hypoglycemic event rate was higher in the tight glycemic control protocol group (46.4% vs. 0%, P = 0.008). No difference in mortality rate was noted (67.9% vs. 50%, P = 0.31). Mortality independent risk factors found on multivariate analysis included total body surface area (adjusted hazard ratio [AHR] 1.039, 95% confidence interval [95%CI] 1.02–1.06, P = 0.001), white blood cell count on admission (AHR 1.048, 95%CI 1.01– 1.09, P = 0.02) and surgery during hospitalization (AHR 0.348, 95%CI 0.13–0.09, P = 0.03). Conclusions: The tight glycemic control protocol in burn patients was associated with higher rates of hypoglycemic events, and no association was found with improved survival in the acute setting of burn trauma care

Conceptual paper: Abdominoplasty and liposuction in systemic sclerosis

Surgical interventions in patients with systemic sclerosis (SSc), in particular plastic procedures, might cause undesired consequences. Notably, liposuction seems to possess greater risk as adipose tissue has been shown to play an important role in treating wounds and ulcers in patients with SSc. While anticentromere antibodies were found to be correlated with vasculopathy in SSc, patients with SSc and anticentromere antibodies might be more vulnerable to surgical wound complications following liposuction. A 46-year-old female patient, who had been diagnosed with SSc at the age of 31 years, had antinuclear as well as anticentromere antibodies. She underwent abdominoplasty with liposuction and developed severe skin necrosis of the abdomen following the procedure and at the site of liposuction. The correlation with anticentromere and the role of liposuction in skin necrosis in SSc are presented. IMAJ 2021; 23: 373–37

A retrospective review of an off-label bromelain-based selective enzymatic debridement (Nexobrid®) in the treatment of deep, partial, and full thickness burns and hard to heal wounds

Background: Rapid and selective bromelain-based enzymatic debridement provides a non-surgical alternative for the eschar removal in deep burns, which allows for early debridement of large surface areas, accurate evaluation of burn and wound depth, and the need for skin grafting. Objectives: To evaluate the efficacy of application of a bromelain-based selective enzymatic debridement (Nexobrid®) beyond the manufacturer’s guidelines for use in burns \u3e 48 hours as well as chemical, electrical, and pediatric burns, land chronic wounds. Methods: This retrospective review included records collected between January 2017 and April 2019, from male and female patients aged 8 months to 99 years with deep burns or wounds treated with bromelain-based selective enzymatic debridement. Results: Of the 33 patients who received the bromelain-based selective enzymatic debridement agent beyond the manufacturer’s guidelines, 25 (76%) were observed to have successful debridement of the eschar, 8 (24%) were observed to have little effect on the burn eschar. Sixteen required further surgery after debridement. Clinical data on the use of bromelain-based selective enzymatic debridement agents are limited, but these results suggest the capacity to effectively debride burns \u3e 48 hours (late presentation burns), use for paediatrics and for chemical and electrical burns, and apply to hard to heal full thickness chronic wounds. Conclusions: Bromelain-based selective enzymatic debridement was found to be an effective treatment modality beyond the recommended guidelines including late presentation burns and chronic wounds. This debridement method warrants further consideration when making clinical decisions concerning burn and wound care. IMAJ 2020, 22: 83-8

Burns sustained from body heating devices: An integrative review

BACKGROUND: Heating devices can provide relief from muscular pain and the cold, however they may result in burn injuries when used inappropriately. OBJECTIVE: This review article synthesizes the incidence, risk factors, outcomes, treatment, and prevention of burns sustained from body heating devices in order to better understand how these burns are sustained. METHODS: PubMed, CINHAL, EMBASE, and Scopus databases were systematically searched from inception up until January 13, 2020, for studies/case reports on burns sustained from body heating devices that were published in the English language. RESULTS: Medical records from 10 retrospective studies yielded 1343 patients with burns, of whom the majority were women (63.4%) with a mean age of 27.7 years (range, 0-92 years). Devices included hot water bottles, hot wheat bags, and heating pads. Sites of injury were predominantly in the lower limbs and feet, with other sites reported (ie, abdomen, pelvis, buttocks, perineum, and upper limbs). Burns sustained typically had low total burn surface area (TBSA) but often involved partial-thickness to full-thickness burn injury. The proportion of patients requiring surgery ranged from 15% to 87.4% for hot water bottle injuries and 91% for wheat bag injuries. Women were predominately represented in the case series/reports. Burns had low TBSA with hot water bottles, and heating pads were the most common mechanism of injury, predominately women following breast reconstructive surgeries. CONCLUSIONS: Burns from body heating devices are often preventable. Community education and improved manufacture labelling on the appropriate use and potential risks should be required. The patient's cognitive ability and physiology must be considered to minimize incidence and severity of injury

People with borderline personality disorder and burns: Some considerations for health professionals

A burn injury can be a tragic event with profound physical and psychological effects on individuals, their family and the broader community. Recovery from a burn can be influenced by a number of factors including premorbid mental health. (Aili Low, Meyer, Willebrand, & Thomas, 2012). In this column, we explore issues related to caring for burns survivors with borderline personality disorder (BPD)