PURPOSE: The aim of this study was to elucidate whether plasma lactate (PL) and base deficit (BD) are useful early parameters to predict the prognosis of burn patients with inhalation injury. In addition, one of the main objectives was to evaluate if PL and its change, BD and its change due to fluid resuscitation, adds additional information. METHODS: A retrospective review was performed on 151 patients admitted to our burn intensive care unit who were suspected to have inhalation burn injury, and then were confirmed by fibreoptic bronchoscopy between 1 Jan 2008 and 31 Dec 2008. All patients received proper fluid and electrolyte resuscitation, pain management, nutritional support, wound care and surgical debridement of dead tissue by burn surgeon. RESULTS: Initial PL, PL1 (24 hours later) and initial BD show statistical differences between survivors group and non-survivors group. A better chance of survival occurs when resuscitation results in normal PL values within 24 h. Moreover, an outcome predictor of shock and effective resuscitation could be defined by evaluating the changes of BD on Day 1. Normalization of the BD within 24 h is associated with a better chance of survival. CONCLUSION: Measuring PL, BD and their changes may help to identify burn patients either for adequacy of treatment, or selection of other therapeutic options. Therefore titration of burn resuscitation to normalize PL and BD levels may be a reasonable method to improve burn mortality.
Bronchoscopy ; Burns ; Burns, Inhalation ; Debridement ; Humans ; Inhalation ; Intensive Care Units ; Lactic Acid ; Nutritional Support ; Pain Management ; Plasma ; Prognosis ; Resuscitation ; Retrospective Studies ; Shock ; Survivors

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection that manifests with a rapid course of inflammation and necrosis of the skin, subcutaneous fat, and fascia. NF commonly follows trauma to the skin, such as a laceration, scratch or insect bite. NF is a surgical emergency and requires both a high index of suspicion for diagnosis and prompt operative intervention. Early aggressive surgical intervention is important for improving survival rates. Mortality and morbidity can be decreased with early diagnosis, adequate and urgent surgical debridement, intensive supportive care, and wound resurfacing. Recently, we experienced a case of NF secondary to a third-degree contact burn on the dorsum of the right foot (1% body area). We report our therapeutic experience in this case, with a review of the literature.
Burns ; Debridement ; Early Diagnosis ; Emergencies ; Fascia ; Fasciitis, Necrotizing ; Foot ; Inflammation ; Insect Bites and Stings ; Lacerations ; Necrosis ; Skin ; Soft Tissue Infections ; Subcutaneous Fat ; Survival Rate

PURPOSE: In major burns, deep vein thrombosis (DVT) is frequently diagnosed as a major complication of burns. But the risk factors and prophylaxis remain controversial. This study was designed to evaluate the incidence and risk factors of DVT in major burn patients. METHOD: We reviewed all major burn patients (>40% of TBSA) admitted to our burn center from June 1998 to August 2003 and assessed each affected patients with an in-hospital diagnosis of DVT for DVT risk factors. RESULT: There were 9 symptomatic DVT detected among 606 severe burn patients (1.45% incidence). Patients diagnosed with DVT had no risk factors of morbid obesity, previous DVT, congestive heart failure or neoplastic disease, except one patient who had a polycythemia vera diagnosed incidentally. In eight of 9 patients, DVT occurred in veins draining burned extremities. All patients had burn wound infections as a complication of burns. Eight of 9 patients had longer hospital stays than patients without DVTs. In all patients, DVT was developed after operations for skin graft. CONCLUSION: DVT should be suspected in patients with delayed wound healing and unresolved edema of extrimites. Wound infection, long bed-ridden state and operations are significant risk factors for DVT formation in major burn patients.
Burn Units ; Burns* ; Diagnosis ; Edema ; Extremities ; Heart Failure ; Humans ; Incidence ; Length of Stay ; Lower Extremity* ; Obesity, Morbid ; Polycythemia Vera ; Risk Factors ; Skin ; Transplants ; Veins ; Venous Thrombosis* ; Wound Healing ; Wound Infection

BACKGROUND: Major burn injury induces an inflammatory response that is accompanied by the release of various cytokines. We investigated the gradual changes in the levels of pro-inflammatory and anti-inflammatory cytokines following burn injury and determined the relationship between these levels and burn size in adult Korean patients with burn injury. METHODS: Blood samples from 9 healthy controls and 60 Korean burn patients were collected on days 1, 3, 7, 14, and 21 after burn injury, and concentrations of interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF)-alpha, and granulocyte-colony stimulating factor (G-CSF) were measured. Burn patients were divided into 3 groups according to burn size (15-30%, 31-50%, >50% total body surface area), and the concentrations of the cytokines were compared between these groups and the control group over 3 weeks. RESULTS: Compared to their levels in controls, IL-6, IL-8, IL-10, TNF-alpha, and G-CSF levels in burn patients were significantly higher during the observation period. Median concentrations of IL-8, IL-10, and G-CSF at each time point increased with burn size, although peak levels and time to peak levels of these cytokines differed from patient to patient. CONCLUSIONS: These findings indicate that IL-6, IL-8, IL-10, TNF-alpha, and G-CSF are important mediators in inflammatory changes after burn injury; however, various factors, including burn size, may influence the concentrations of these cytokines.
Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; Burns/blood/*pathology ; Granulocyte Colony-Stimulating Factor/*blood ; Humans ; Interleukin-10/*blood ; Interleukin-6/*blood ; Interleukin-8/*blood ; Male ; Middle Aged ; Republic of Korea ; Time Factors ; Tumor Necrosis Factor-alpha/*blood ; Young Adult

BACKGROUND: Major burn injury induces an inflammatory response that is accompanied by the release of various cytokines. We investigated the gradual changes in the levels of pro-inflammatory and anti-inflammatory cytokines following burn injury and determined the relationship between these levels and burn size in adult Korean patients with burn injury. METHODS: Blood samples from 9 healthy controls and 60 Korean burn patients were collected on days 1, 3, 7, 14, and 21 after burn injury, and concentrations of interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF)-alpha, and granulocyte-colony stimulating factor (G-CSF) were measured. Burn patients were divided into 3 groups according to burn size (15-30%, 31-50%, >50% total body surface area), and the concentrations of the cytokines were compared between these groups and the control group over 3 weeks. RESULTS: Compared to their levels in controls, IL-6, IL-8, IL-10, TNF-alpha, and G-CSF levels in burn patients were significantly higher during the observation period. Median concentrations of IL-8, IL-10, and G-CSF at each time point increased with burn size, although peak levels and time to peak levels of these cytokines differed from patient to patient. CONCLUSIONS: These findings indicate that IL-6, IL-8, IL-10, TNF-alpha, and G-CSF are important mediators in inflammatory changes after burn injury; however, various factors, including burn size, may influence the concentrations of these cytokines.
Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; Burns/blood/*pathology ; Granulocyte Colony-Stimulating Factor/*blood ; Humans ; Interleukin-10/*blood ; Interleukin-6/*blood ; Interleukin-8/*blood ; Male ; Middle Aged ; Republic of Korea ; Time Factors ; Tumor Necrosis Factor-alpha/*blood ; Young Adult

PURPOSE: To compare the scar formation after laughter therapy in facial burn scar and to make facial burn rehabilitation program. METHODS: In a prospective clinical trial, laughter therapy was done in 12 facial burn injury patients. One group pretest-posttest design was done. After 8 weeks group laughter therapy session, we measured scar condition. Facial burn scar were checked. Scars were assessed with objective measurement tools such as pigmentation, erythema, pliability, transepidermal water loss, thickness and perfusion. RESULTS: Pigmentation value was decreased significantly: 211.6+/-71.9 to 177.8+/-57.1 (p<0.05). Erythema value increased from 432.3+/-62.5 to 451.1+/-49.7 (p>0.05). Transepidermal water loss value changed from 40.7+/-15.9 g/h/m2 to 37.8+/-15.4 g/h/m2 (p>0.05). Microcirculation value was decreased significantly (0.80+/-0.05 volt to 0.43+/-0.19 volt)(p<0.05). Skin elasticity level (R0) was significantly increased (p<0.05). CONCLUSION: Laughter therapy in burn patients could be an alternative treatment to control burn scar contracture. In the future, more studies are needed how laughter therapy may affect the skin condition of the burn injuries.
Burns ; Cicatrix ; Cicatrix, Hypertrophic ; Contracture ; Elasticity ; Erythema ; Humans ; Laughter ; Laughter Therapy ; Microcirculation ; Pigmentation ; Pliability ; Prospective Studies ; Skin

PURPOSE: Burn injury is among the most severe type of trauma that the body can sustain. The major burn increases energy expenditure as the result of its induction of the hypermetabolic and catabolic state. It is well-documented that nutritional support may improve morbidity and mortality after severe burn injury. Therefore, adequate nutritional support is essential in burned patients to prevent the detrimental consequences of overfeeding and underfeeding. The purpose of this study was to analyze the factors influencing resting energy expenditure on major burn patients. METHODS: In 199 patients with > or =20% total body surface area (TBSA) burn were monitored with 403 measurement of resting energy expenditure (REE) from January 2004 to December 2008 in burn center of the Hangang Sacred Heart Hospital. Gender, age, burn size, inhalation injury, ventilator were included in the factors which influence the REE of massive burn patients. RESULTS: The measured REE and REE/basal metabolic rate (BMR) were significantly higher in males (p<0.05). The measured REE and REE/body mass index (BMI) showed significant difference between age groups (p<0.01). The measured REE and REE/BMI showed significant difference between burn size groups (p<0.01). The measured REE, REE/BMR and REE/BMI for patients with inhalation injury were significantly higher than patients without inhalation injury (p<0.01). The measured REE, REE/BMR and REE/BMI for patient needs ventilator were significantly higher than the other group (p<0.01). CONCLUSION: Indirect calorimetry is useful in detecting variations in energy expenditure among individuals and in detecting changes in metabolism. Unlike indirect calorimetry measurements, static formulas may not consider hypermetabolic and catabolic states. Because adequate nutritional support is essential in burned patients, it should be considered the factors influencing resting energy expenditure on major burn patients.
Body Surface Area ; Burn Units ; Burns ; Calorimetry, Indirect ; Energy Metabolism ; Heart ; Humans ; Inhalation ; Male ; Nutritional Support ; Ventilators, Mechanical

PURPOSE: Inhalation injury is one of the most severe morbidity and mortality factors in burn patients. The purpose of this study is to analyze the impact of inhalation injury to the prognosis of burn patients and to investigate the relationship between the inhalation injury assessment and the prognosis of patients. METHODS: Bronchoscopy was performed in 170 patients who had the suspicion of inhalation injury and the patients were reviewed retrospectively from January 2008 to December 2009. Mortality was compared between the factors of brochoscopic findings, age, total body surface area (TBSA) burned, carboxyhemoglobin (COHb) level, PaO2/FiO2 (P/F) ratio. RESULTS: Of 170 patients, 28 patients had no inhalation bronchoscopic finding. 109 patients had mild inhalation, 31 patients had moderate inhalation, only 2 patients had severe inhalation findings. The patients of moderate and severe inhalation findings had higher mortality (48.5%) than mild inhalation patients (31.1%). The larger total burnsurface area in inhalation patients, the greater the mortality. When compared to total admitted burn patients during the same period, inhalation patients showed higher mortality in the patients between 10 to 40% total burn surface area. Inhalation patients whose P/F ratio was below 300 showed higher mortality than above 300. But inhalation patients whose COHb level was below 1.5 had no difference in mortality with patients above 1.5. The COHb level and P/F ratio was the statistically different factors between inhalation patients and non-inhalation group in the mortality. CONCLUSION: Bronchoscopic findings, age, TBSA burned, P/F ratio were related with mortality in inhalation patients. When the international standardization of bronchoscopic classification developed, it can be possible to assess the inhalation patients more objectively and that will lead to the advancement in inhalation treatment and research.
Body Surface Area ; Bronchoscopy ; Burns ; Carboxyhemoglobin ; Humans ; Inhalation ; Prognosis ; Retrospective Studies

PURPOSE: Fiber-optic bronchoscopy is widely used for early diagnosis of inhalation injury. The aim of the study was to ascertain whether a correlation could be shown between bronchoscopic and pathologic grading. METHODS: One hundred seventy patients who underwent bronchoscopy with suspicious inhalation injury were review retrospectively from January 2008 to December 2009. The patients were divided into four groups (normal, mild, moderate, severe) according to bronchoscopic and pathologic findings respectively. RESULTS: Diagnosis of an inhalation burn was confirmed in 142/170 patients, of whom upon initial assessment an inhalation trauma was suspected. Bronchoscopic grading was noted: mild (n=109), 56 ALI (51.4%), 18 ARDS (16.5%); moderate (n=31), 22 ALI (71.0%), 13 ARDS (41.9%); severe (n=2), 2 ALI (100%). Pathologic grading was noted: mild (n=131), 77 ALI (58.8%), 27 ARDS (20.6%); moderate (n=4), 2 ALI (50%), 1 ARDS (25%); severe (n=1), 1 ALI (100%). Consistency of two groups was not significant (P<0.05). CONCLUSION: Any burn patient highly suspicious for inhalation injury should receive an early bronchoscopy for diagnosis and treatment. Fiber-optic bronchoscopy is a safe and effective method for early diagnosis of inhalation injuries. The consensus of classification about inhalation injury will be developed.
Bronchoscopy ; Burns ; Burns, Inhalation ; Consensus ; Early Diagnosis ; Humans ; Inhalation ; Retrospective Studies

PURPOSE: Aim of this study was to assess effects of InsureGraf® (SK-Bioland Co., Korea), an artificial dermis developed by using tissue engineering technology in severe burn patients. METHODS: To examine the clinical effectiveness of InsureGraf®, we transplanted them in patients with severe burns. A total of 14 joint regions in 8 patients received InsureGraf® graft selectively from July to December, 2014. The graft results were determined after confirming the take rate of the transplanted skin graft on top of the InsureGraf®. Take rates were examined twice, at 7 and 14 days after grafting. Photographs of the skin grafts were evaluated individually by two burn surgeon specialists, and the mean values were recorded. RESULTS: The take rate was 99% after day 7 and 100% after day 14 respectively. CONCLUSION: InsureGraf® can be used successfully as an artificial dermis that allows one-stage operation in severe burn patients, exhibiting a successful early-stage graft take rate that is close to 100%.
Burns ; Collagen* ; Dermis ; Humans ; Joints ; Skin ; Specialization ; Tissue Engineering ; Transplants ; Treatment Outcome*