bluuebunny/crossref_metadata_2025_split huggingface dataset:
122 In Patients with Lower Extremity Burns and Osteomyelitis, Diabetes Mellitus Increases Amputation Rate
Authors: Iles Kathleen A , Chrisco Lori , Heisler Stephen , King Booker , Williams Felicia N , Nizamani Rabia 
Published: April 2021

Abstract

Introduction
Diabetes mellitus (DM) is a critical comorbidity with burn injury due to the disrupted healing process. Previous reports have confirmed the increased rate of osteomyelitis (OM) and subsequent amputation in this cohort, however this has yet to be studied in comparison to non-diabetic patients. In this retrospective analysis, we investigate OM and amputation in both the diabetic and non-diabetic lower extremity burn populations to determine the impact of DM on these outcomes.

Methods
The burn registry was used to identify all patients admitted to our tertiary burn center from January 1, 2014 to December 31, 2018. Only patients with lower extremity burns (foot and/or ankle) were included. Patients with burns to additional body areas were excluded. Amputations were categorized by time from injury. Statistical analysis was performed using Student’s t test, chi-squared test, and Fischer’s exact test.

Results
Of the 315 patients identified, 103 had a known diagnosis of DM and 212 did not. Scald injury was the most common mechanism and average TBSA was similar. Differences were observed in average length of stay (LOS) and admission cost, with diabetics demonstrating both a higher LOS (13.7 days vs 9.2 days, p-value= 0.0016) and cost ($72,883 vs $50,500, p-value= 0.0058) (Table 1).
In total, 17 patients were found to have radiologically confirmed OM within three months of the burn injury. Fifteen of these patients had a history of DM and two had no history of DM (p-value= &lt; 0.001) (Table 2). The DM OM patients were found to have a higher blood glucose level on admission (219 mg/dL vs 110 mg/dL, p-value= 0.0452). No significant difference was seen in Hgb A1c in diabetics with or without OM (9.26% vs 8.81%, p= 0.2743). Notably, when non-diabetics were diagnosed with OM, significant differences were observed in both LOS and cost in comparison to their counterparts without OM (36 days vs 9 days; p= 0.0003; $226,289 vs $48,818, p=0.0001). Of the 11 patients who required an amputation, 10 (90.9%) of these patients had comorbid DM.

Conclusions
DM patients with lower extremity burns are more likely to develop OM than their non-diabetic counterparts. When radiologically confirmed OM is present, DM patients have an increased rate of amputation. OM incurs significant healthcare utilization and cost in both the diabetic and non-diabetic populations.
135 Vital, Porcine Skin Xenotransplants Provide Safe and Efficacious Temporary Wound Closure of Severe Burns in a First-in-Human Phase I Clinical Trial
Authors: Chang Elizabeth J , Goverman Jeremy 
Published: April 2021

Abstract

Introduction
Temporary wound closure with human allograft skin is considered the gold standard after early excision of a large burn injury. Limitations of allograft include availability, cost, and safety; thus, an alternative that provides the same quality with enhanced safety would be a valuable surgical adjunct to the clinical options currently available to treat severe and extensive full thickness burn wounds.
A live cell skin xenotransplant from a clinical grade porcine donor is one candidate. Advantages of this alternative include retention of 70% or more of the innate metabolic activity following cryopreservation, vascularly favorable dermal thickness, and genetic modifications that eliminate hyperacute graft rejection. Combined, these result in pliability, strength, survivability, and function that far exceed those of conventional xenografts and mirror those of human allograft.

Methods
Split-thickness skin xenotransplants containing vital dermal and epidermal cells were aseptically procured from alpha-galactosyltransferase knockout porcine donors from a closed, Designated Pathogen Free, colony. They were then processed to achieve both sterility and cellular viability and cryopreserved for long term storage.
In 2018, the FDA authorized a first-in-human Phase I clinical trial to evaluate the safety and tolerability of a genetically modified skin xenotransplant to treat severe and extensive burn wounds. A two cohort, open-label, dose-escalation study evaluated 6 consenting patients with severe burns requiring allograft. Each received surgical grafting with a skin xenotransplant and human allograft skin in a side-by-side, in-situ comparison.

Results
The skin xenotransplant was well tolerated by all patients, resulting in zero adverse events or safety issues, and without zoonotic disease transmission. In all cases, the skin xenotransplant appeared indistinguishable from the human allograft comparator and at the time of autografting, both were vascularized and fully adherent. These findings build upon the series of preclinical studies reported by these authors and presented at the ABA in 2019.

Conclusions
These highly promising patient outcomes demonstrate a potential treatment for complicated burns, especially when human allograft skin is unavailable. Further study of the efficacy of the porcine skin xenotransplants is warranted. As such, a multi-center, Phase II efficacy trial is planned for 2021.
532 Intravenous Supplementation of Micronutrients in Patients with Severe Burns
Authors: Arnold Olivia M , Shields Beth A , Kieffer Adam J , Cole Renee E , Vega Saul J , Aden James K , Williams Alicia M , Cancio Leopoldo C 
Published: April 2021

Abstract

Introduction
Pneumonia is a prominent cause of morbidity and mortality in burn patients. The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends supplementing with intravenous copper, selenium, and zinc, as a randomized controlled trials on burn patients in Switzerland showed decreased pneumonia rates. The purpose of this performance improvement project was to determine whether the intravenous supplementation of copper, selenium, and zinc had an association with the incidence of pneumonia in patients with total body surface area (TBSA) burns over 20% in order to determine if this practice should be re-initiated.

Methods
Based on available randomized controlled trial evidence, we began the clinical practice of providing intravenous trace elements to our patients with burns over 20% TBSA who were admitted to the burn intensive care unit and who had a central line. This clinical practice ended after 2 years when there was a national shortage of these intravenous trace elements. We performed a retrospective evaluation on patients admitted for initial burn care to our intensive care unit who received an intravenous solution containing 4 mg copper, 500 mcg selenium, and 40 mg zinc daily for a goal duration of 14 days in patients with 20–40% TBSA burns and 21 days in patients with over 40% TBSA burns. Patients who survived less than two days were excluded. In order to compare the incidence of pneumonia within the first 30 hospital days in patients who received intravenous trace element supplementation to those who did not, we matched patients based on age, burn size, and gender. Matched subjects were admitted either before or after the time period of intravenous trace element supplementation and these subjects received oral zinc supplementation. Descriptive statistics and Chi-Square were performed using JMP. Significance was set at p&lt; 0.05.

Results
Pneumonia within the first 30 hospital days occurred in 63% of the 52 included patients with the following characteristics: 71% male, 52 ± 18 years old, 43 ± 15% TBSA burn, 29 ± 25 mechanical ventilator days, and 44% mortality. A significant difference in the incidence of pneumonia during the first 30 hospital days was not found between groups (intravenous trace element group: 70%; comparison group: 56%, p=0.28).

Conclusions
Supplementation of intravenous copper, selenium, and zinc was not significantly associated with incidence of pneumonia in our severely burned patients, contrary to previous research findings.
539 If Seeing Was Believing - A Retrospective Analysis of Potential Reduced Treatment Delays with a Novel Burn Wound Assessment Device.
Authors: Huson Henry B , Phelan Herbert , G’Sell David , Smith Sydney , Carter Jeffrey E 
Published: April 2021

Abstract

Introduction
Burn care (BC) remains a highly specialized and resource intensive specialty with only 2% of hospitals featuring a burn center and less than 1% of graduating general surgery and plastic surgery residents pursing a burn fellowship each year. Access to specialized care is further complicated by burn wound assessment (BWA) which is commonly performed visually without adjunctive devices. To help clinicians make more accurate assessments and potentially reduce delays in transfer or treatment, a new non-invasive imaging device for BWA is being developed using visible and non-visible wavelengths of light with machine learning algorithms. Our goal was to assess the potential reduced treatment delay (RTD) and associated financial savings by implementing such a device using our burn center’s historical data.

Methods
The study was an IRB-approved, retrospective review of admissions from 07/01/2018 through 06/30/2019. Inclusion criteria: thermal, chemical, contact, or electrical mechanism of injury, &gt;15 years of age requiring excision, and length of stay &gt;72 hours. Inclusion data included: presence/absence of concomitant trauma, day of surgery, day of admission, day of electronic order entry for case request, and length of stay per percent total body surface area (LOS%TBSA). RTD was defined starting &gt;48 hours after injury daily until electronic order entry for surgical case request. Reduced costs were calculated per day from prior studies ranging $3,000 to $5,100/day.

Results
A total of 109 patients were included. 29 patients had case requests placed within 48 hours of admission. Of the remaining 80 patients, a potential of 398 days would have been saved had a novel BWA adjunctive imaging devices aided surgeon to requests earlier surgical intervention. Overall savings from reduced length of stay range from $1,194,000 to $2,029,800 dollars.

Conclusions
Our study demonstrates that should a BWA technology with accuracy 48 hours after injury be developed, even burn centers with 24-hour access to operating rooms can reduce treatment delays. The study does not look at additional cost savings offered by reduced emergent transfers or admissions which offer additional intrigue and promise.
543 Escharotomy Incisions in the Burn Foot and Toe with Compartment Syndrome
Authors: Lifferth Greg S , Roth Bryan J , Lardizabal Marisse , Kowal-Vern Areta , Foster Kevin N , Matthews Marc R 
Published: April 2021

Abstract

Introduction
Patients with burn injuries are at risk for lower extremity compartment syndrome, especially if the injury is circumferential. The hypothesis was that two dorsal escharotomy incisions to release foot and toe compartment syndrome would be most efficacious in the prevention of lower extremity amputations.

Methods
This was a retrospective chart review of foot compartment syndrome in burn patients between January 2001 and May 2019.

Results
The study consisted of 59 feet from 32 patients who had been admitted to the Burn Center for thermal injury. The patient age was a mean±sd of 29±30 years, and 41±29 as the % total body surface area (%TBSA); there were 19 males and 13 females. All patients had received fluid resuscitation on admission. Twenty-one (66%) of the patients did not require amputations after undergoing a median of two incisions (range 1–5); 6 of 59 (11%) required fasciotomies. Compared to medial or dorsal or multiple echarotomies, the majority of patients who underwent two dorsal foot escharotomies did not require amputations, p = .0001. Significantly more patients were alive with no amputation 15 (50%) compared to 4 (13%) (dead with amputations), p = .02. Survivors were significantly younger than the non-survivors (median 20 and range1-69) compared to the non-survivors (48, 12–59), p =.04. The survivors also had significantly less severe %TBSA median 22 (range 2–75) versus 83 (35–95) %TBSA, p &lt; .0002. Dorsal/Lateral incisions had the highest number of amputations.

Conclusions
Foot dorsal compartment release is the most effective site for escharotomies in the treatment of burn-induced compartment syndrome. It does not require more than two incisions at the skin/fat level and over the second and fourth metatarsal bones on the dorsal part of the foot to decrease the lower extremity amputation rate in the majority of cases.
547 Face Escharotomy in an Acute Deep Facial Burn
Authors: Ozkan Burak , Uysal Cagri A , Ertas Nilgun Markal , Haberal Mehmet 
Published: April 2021

Abstract

Introduction
Escharotomy is the relaxation of the eschar through longitudinal or horizontal incisions in order to protect the region’s deep perfusion. The pressure that it will create in the peripheral areas such as hard eschar limb, trunk, and neck causes the circulatory disorder in the limb and the risk of limb loss, inadequate thoracic expansion in the thorax and vital perfusion and oxygenation problems in the neck. It is one of the most basic rules of burn surgery to perform the determined escharotomy incisions very quickly and without hesitation to prevent complications. In this report, a case of facial subunit principles based escharotomy is presented.

Methods
42-year-old man felt into hot sand while working in an iron and steel factory. Patient was transferred to our burn unit for corresponding 35% of the total body surface burns on the face, neck and upper extremities. The patient was consulted to plastic surgery after the initiation of fluid replacement therapy, insertion of a chest tube for hemothorax, and tracheostomy. The patient had massive edema in the face and neck (Figure 1). There was no capillary fill in the facial skin. Doppler ultrasound examination showed bilateral weak facial artery, temporal superficial artery, supraorbital and trochlear artery flow.

Results
A decision was made to perform escharotomy to relieve arterial traces at 10th hour of the injury. Bilateral nasolabial, infraorbital rim, superior glabellar, temporal incisions were performed from eschar to subcutaneous fat layer in accordance with aesthetic subunits (Figure 2). Relief of the base perfusion during escharotomy was observed and bleeding was observed at the base of the incision. Doppler examination was repeated after escharotomy. The facial edema rapidly regressed. Deepitelization and reepithelization was observed in the areas with hair roots within 10 days and the patient was operated on the 15th day of hospitalization for debridement and skin grafting. Eschars were debrided and covered with split thickness skin grafts according to aesthetic subunit principles. Post-operative image of the patient seen (Figure 3).

Conclusions
Face is not an area in which eschar formation commonly seen because of its robust vascular supply and protection reflex of the patients. Although descriptive drawings and guides for facial escharotomy has not been published yet, relaxation of axial arteries in terms of compression due to eschar formation may be needed. In this report, a case of facial subunit principles based escharotomy is presented and acceptable results were achieved.
568 Ethical Challenges in the Pregnant Burn Patient
Authors: Khandelwal Anjay , Gerrek Monica L 
Published: April 2021

Abstract

Introduction
Classically, ethics in pregnancy have revolved around abortion. However, there are numerous issues that require attention including the fetus as a patient, the mother’s autonomy and medical treatment of the pregnant patient amongst others. These are further complicated when the pregnant patient has sustained a traumatic or burn injury. Although there are numerous case reports of managing the pregnant burn patient, there is a paucity of literature that focuses on the ethical challenges in the pregnant patient.

Methods
We report the case of an 18-year-old engaged female who sustained 60% total body surface area full-thickness burns. She was found to be 6 weeks pregnant with a viable fetus on ultrasound. The pregnancy was not planned, but desired. During the early portion of the hospitalization, she was found to lack capacity for both complex medical decision making and assigning of a surrogate decision maker. Furthermore, her mother only intermittently had custody of the patient when she was a minor, complicating whether she would be the best surrogate decision maker. Medical treatments that would significantly decrease morbidity and mortality would have had a negative impact on the viability of the fetus. Morning sickness compromised the nutrition care of the patient. Ethical issues that arose included capacity for complex medical decision making, the mother’s autonomy, surrogate decision making and whether a surrogate decision maker can make decisions regarding the fetus, the fetus as a patient, and medical interventions of the pregnant patient. Later on in the hospitalization, the patient was refusing many aspects of her care, raising the issue of paternalism in the burn center.

Results
The patient was later deemed to have capacity for assigning a surrogate decision maker, but not for complex medical decision making. She assigned her fiancée as the surrogate decision maker, although he initially refused. Medical treatments that would significantly decrease morbidly and mortality were instituted even though some were “contraindicated” in pregnancy. A gastrostomy tube was placed through burnt tissue for direct enteral access even though the patient was alert, oriented, and could tolerate oral intake in order to enhance her nutritional status. The burn center adopted a practice of “benevolent parentalism” as a means to overcome the patient’s resistance of medical care and treatments.

Conclusions
Pregnancy in the burn patient represents a deeply ethically challenging situation which have not been discussed in previous case reports. Ethical guidelines for the management of the pregnant burn patient should be established. Guidelines for surrogate decision making must be followed. In addition, the concept of “benevolent parentalism” must be elucidated and should replace the notion that burn centers are paternalistic.
571 Palliative Care Utilization in Burn Patients
Authors: Geffre Marcus , Endorf Frederick W , Nygaard Rachel M 
Published: April 2021

Abstract

Introduction
The morbidity and mortality of the severely burned patient can be affected by multiple variables. Many of these variables are also associated with an increased likelihood of withdrawal of care. Palliative care services can aid families in difficult decision making during this time and improve the process of transition to comfort cares. Despite this, palliative care services may be underutilized. The aim of our study is to assess factors associated with palliative care consultation in the setting of severe burns.

Methods
We analyzed 191 patients with a burn TBSA of ≥30% at our institution from 2007 to 2019. Univariate and multivariate analysis was performed to identify factors associated with consultation to palliative care.

Results
17 of the 191 (8.9%) patients received a palliative care consultation. The average time to consultation was 10.3 days. On univariate analysis, age, inhalation injury, multiple comorbid conditions, and code status were associated with consultation to palliative care. Independent predictors of palliative care consult included inhalation injury, non-white race, code status, and ventilator days.

Conclusions
Palliative care consultation appears to be seldomly requested at our facility. The presence of an inhalation injury and comorbidities increase the likelihood of consultation. These factors correspond to the same factors that increase likelihood of transition to comfort care. Consult to palliative care on patients with these factors can help improve patient and family care.
592 Medwatch: A Public Service Media Outlet Promoting Burn Prevention and Survivor Awareness
Authors: Henry Shana M , Kopari Nicole M 
Published: April 2021

Abstract

Introduction
The American Burn Association estimates 486,000 burn injuries occur each year. Inability to receive specialized treatment from a verified burn center can negatively impact long term outcomes and survival rates for burn survivors. The burn team has a multidisciplinary approach to meeting the physical and emotional needs of burn patients and their families. Ongoing education and outreach programs are key elements in preventing fire tragedies. We identified an opportunity to incorporate burn and fire prevention education as well as burn survivor testimonies into a pre-existing media platform.

Methods
We identified burn injury trends, at an American Burn Associated Verified Burn Center, via the burn registry and determined the most common etiologies of injuries treated at our center. We utilized an established relationship with burn prevention community partners, our hospitals communication department, and local news station. Our aftercare and burn prevention coordinator partnered with these established relationships to produce 10-minute television segments on burn and fire safety topics. The interactive television sessions were aired during the local news. Within each segment, viewers were provided with safety tips, preventative strategies, and/or burn survivor testimony.

Results
30 news segments over the past 3 years have been produced reaching an average of 58,000 people per year spanning 7 local counties. This health and wellness tool has provided education regarding pet fire safety, scald/contact burn prevention, outdoor/BBQ burn/fire prevention, car fire safety, honey oil explosion education, and holiday burn prevention. We have also had segments focusing on smoke alarm awareness/education and home/fire escape planning to make our communities safer. We have been able to promote our successful aftercare programs by highlighting our support groups, burn survivor activities, and grateful patient stories sharing burn survivor testimony.

Conclusions
We identified burn prevention topics as well as grateful patients to spread awareness of burns within our community. We partnered with the hospital communications department and local news stations to produce directed educational television segments. These segments were designed to educate the community as well as highlight our successful multidisciplinary approach to managing burn patients. This media platform is one component of our burn centers ongoing burn prevention and outreach program.