Mextra Superabsorbent as a New Skin Graft Donor Site Dressing

Dr Devlin Elliott1

1Greenslopes Plastics Department, Greenslopes, Brisbane, Australia

Abstract:

Introduction:There are a variety of products on the market that can be used for donor site dressing. Mextra Superabsorbent is a dressing with high retention and absorption capacity that reduces the risk of leakage and maceration. The fluid-repellent backing material, and polyacrylate superabsorbent particles reduce strike through resulting in fewer dressing changes. The dressing is soft and comfortable which makes it easy to apply. Applications include highly exuding wounds, such as venous leg ulcers, diabetic foot ulcers or skin graft donor sites.

Results:Our preliminary findings with Mextra Superabsorbent are positive. We’ve noticed we are able to leave the dressing on for the full two weeks until the wound has healed without the need for reinforcement or replacement. The dressing allows for excellent healing and maintains its structure and integrity without becoming bulky upon exudate absorption.

Discussion:Mextra Superabsorbent as a donor site dressing has many added benefits. Patients report that the dressing is comfortable and there is reduced pain on removal in comparison to conventional dressings. Reduced dressing changes and leakage have resulted in lower costs and better patient satisfaction.

Conclusions: Mextra Superabsorbant is an effective option for a donor site dressing with several significant benefits. Increased absorptive capacity allows for reduced dressing changes, avoids maceration and promotes effective wound healing.


Biography:

Otago University Graduate

PGY4

Current Plastics PHO Greenslopes Hospital

Improving Skin Graft Donor Site Scarring with Mepilex Transfer Ag

Dr Devlin  Elliott1

1Greenslopes Plastics Department, Greenslopes , Brisbane, Australia

Abstract:

Introduction:Skin graft donor site scarring can be problematic in selective patients. Donor sites require optimum conditions free from excessive exudate and infection to maximize healing potential and final cosmesis. Mepilex Transfer Ag utilizes silver sulfate to reduce infection, has foam technology to absorb exudate and transfer to a second layer and Safetac technology supporting less painful healing.

Results:Our preliminary findings with Mepilex Transfer Ag suggest better wound healing with reduced scarring. A no backing film allows us to leave the dressing on for two weeks even if an outer layer needs to be replaced. We found patients reported minimal pain and trauma with dressing changes and had more optimum conditions for healing resulting in better scarring long-term.

Discussion:Mepilex Transfer Ag is an effective dressing to enhance donor site healing. Soft silicone adhesive technology means less pain and tissue trauma with dressing changes and improves scarring. The dressing is thin and highly comfortable for difficult to dress wounds.

Conclusions:Skin graft donor site scarring can be optimized with Mepilex Transfer Ag. This dressing only needs to be applied once, and optimizes the environment for tissue healing as well as reducing any further tissue trauma with removal.


Biography:
Otago University Graduate
PGY4
Current Plastics PHO Greenslopes Hospital

Improving Graft Take to Burns on the Hand with Acticoat Flex 3

Dr Devlin Elliott1

1Greenslopes Plastics Department, Greenslopes, Brisbane, Australia

Abstract:

Introduction:Full thickness burns on the hand require debridement and skin grafting. Negative pressure wound therapy (NPWT) can be used to help with graft stability and take with a variety of non-adhesive interface dressings being used. Prior interface dressings in our unit displayed signs of maceration and graft instability. Acticoat Flex 3 contours to maintain contact with the wound surface, has broad spectrum antimicrobial activity and allows exudate transport through the dressing.

Case:A 22 year-old male had a full thickness friction type burn to the dorsum of his dominant hand when it was caught in the conveyor belt at work. The ring and little finger were involved as well as the fourth web space. A split skin graft was taken from the thigh, inset and then Acticoat Flex 3 was used under a VACC negative pressure dressing.

Results:Day three post procedure, the patient had excellent graft take, nil signs of infection and minimal exudate. The graft was very secure and stable with no signs of shearing damage or graft loss. A thermoplastic splint was used and the patient healed well and is currently working with the hand therapists. Our unit has noticed increased graft take and less macerated graft beds since using Acticoat flex 3 under NPWT.

Conclusions: Acticoat Flex 3 is an effective interface dressing when using NPWT and helps to increase graft take, stability and reduce infection in burn patients.


Biography:

Otago University Graduate
PGY4
Current Plastics PHO Greenslopes Hospital

Neonatal Burn at the Women’s and Children’s Hospital, South Australia.

HP Chong1, E Gibson1, L Quinn1R Cooksey1,D Molony1,A Jeeves1, M Lodge1,B Carney1

1Women’s And Children’s Hospital, North Adelaide, Australia

Abstract:

Introduction: Neonatal burns are rare and challenging. Thermal injuries in neonates are iatrogenic in nature and can have devastating results due to their immature physical and physiological development. We present our unit’s experience with neonatal burns, with particular attention to epidemiology, etiology, management approaches and complications.

Methods: This is a single-site, retrospective study of inpatient and outpatient burn injuries managed in patients less than 29 days-old from 1995 to 2017 at Women’s and Children’s Unit, South Australia. Information was extracted from the local burns database and from individual case notes.

Conclusion: Neonatal burn injuries constitute an important cause of paediatric morbidity in our population.Scald burns are the commonest causes of neonatal burns in the study environment. Burn injuries in this age group are associated with prolonged morbidity and high mortality rate. Neonatal burn injuries emanate from largely preventable causes and health education, highlighting methods of prevention should be undertaken in the community


Biography:

HP Chong is the Burns Fellow at WCH and previous unaccredited Plastics and Reconstructive Surgery Registrar at Flinders Medical Centre.

Major burn in a 10 week old baby: A Case Report

HP Chong1, E Gibson1, L Quinn1R Cooksey1,D Molony1,A Jeeves1, M Lodge1,B Carney1

1Women’s And Children’s Hospital, North Adelaide, Australia

Abstract:

Scald burns injuries are the most common cause of thermal injuries in children under 4 years of age. We discuss our experience with a 10-week-old-baby who sustained deep partial thickness burns from a spilled jug containing freshly boiled hot water. Although this patient is by definition an infant (a neonate is children age 29 days or less), the relative thinness and immaturity in their skin were considerably similar.
Neonates differ from older children and adults on many counts. Because of their smaller size, thinner skin, larger surface area to weight ratio, larger evaporative fluid losses, immaturity of renal and immune systems, different resuscitative requirements due to their large maintenance fluid requirements per kg body weight, neonatal burns management poses challenging dilemmas. The management protocols for burns in older children have been established for a long time, however there are no clear guidelines concerning the care of neonatal burns victims. We report the challenges faced, reconstructive outcomes and lessons learnt with managing an infant burn of this age.


Biography:

HP Chong is the Burns Fellow at WCH and previous unaccredited Plastic and Reconstructive Registrar at Flinders Medical Centre.

Inhalation injury and the upper airway: a case of severe laryngeal scarring, glottis stenosis and dysphagia

Mrs Miriam Voortman1, Mrs Gulsen Ellul1, Ms  Heather Cleland1, Ms Amanda Richards2

1Victorian Adult Burns Service, Melbourne, Australia, 2Epworth Healthcare, East Melbourne, Australia

Abstract:

Long term outcome post inhalation injury to the upper airway is not well reported in the literature. This single case study will explore the long term outcome of a patient with 28% deep dermal burns and severe inhalation injury due to building fire resulting in laryngeal stenosis and airway compromise.
On admission the patient had 3 failed attempts at intubation due to epiglottic oedema and required cricothoracotomy then surgical tracheostomy to secure the airway.
Speech pathology management of upper airway burns included tracheostomy weaning, perceptual voice assessment, Videofluoroscopic Swallowing Study (VFSS) and Fibreoptic Endoscopic Evaluation of Swallowing (FEES).
After decannulation the patient was severely dysphonic and FEES demonstrated nasal adhesions, reduced laryngeal sensation, copious secretions and a patent upper airway. The patient was unable to commence oral intake due to severe dysphagia and a Percutaneous Endoscopic Gastrostomy was inserted.
10 weeks post initial injury the patient developed stridor and exertional dyspnoea while at inpatient rehabilitation. He was seen as an outpatient and was immediately admitted for emergency tracheostomy insertion due to severe subglottic stenosis and posterior glottic stenosis. 12 months post injury the patient continues to have a permanent tracheostomy and is being considered for laryngotracheal reconstructive surgery. He remains severely dysphonic however has resumed regular oral intake.
Key learnings from this case included that close monitoring by speech pathology and ENT is beneficial in identifying early upper airway stenosis. A guideline for airway surveillance will be developed in future to identify patients at risk of laryngeal scarring. Laryngeal scarring will result in persisting dysphonia however severe dysphagia may resolve long term.


Biography:

Miriam is a Senior Speech Pathologist at The Victorian Adult Burns Service and has worked extensively in the field of voice and dysphagia management.

75 years on from the Coconut Grove nightclub fire: The birth of modern burns care

Dr Steven Cook1, Dr Bernard Carney1

1Women’s And Children’s Hospital, Adelaide, Norwood, Australia

Abstract:

75 years ago on the 28th of November 1942, the incredibly popular Coconut Grove nightclub in Boston, Massachusetts was transformed into an uncontrolled inferno. In what is estimated to be less than 20 minutes from the first sighting of smoke, 492 people were dead and another 166 injured in what is still to this day the 2nd deadliest nightclub fire worldwide.
The burn victims flooded into Massachusetts General Hospital and Boston City Hospital which provided the first real world test of the burns research commenced at Massachusetts general in the wake of the Pearl Harbour attack the year earlier. Lead by Dr Francis Daniels Moore and Dr Oliver Cope new techniques of burns care were implemented including doing away with tannic acid paint dressings used in World War I and instead dressing the burns in petroleum jelly coated guaze with the aim of keeping the patients as sterile as possible. Fluid resuscitation was trialled and the newly developed blood bank was used. The burns patients were also among the first humans to be treated with the new antibiotic of the time, penicillin. Shortly after the Coconut Grove fire 32 litres of the antibiotic in the form of culture liquid in which the Penicillium mold were sent to the two hospitals from the Merck company. Penicillin played a pivotal role in the 100% survival rate at Massachusetts General via combating staphylococcus bacteria, which typically infect skin grafts.


Biography:

Steven Cook is an unaccredited registrar in Plastics and reconstructive surgery at the Women’s and Children’s Hospital and Queen Elizabeth Hospital in Adelaide. He has a keen interest in Burns surgery and Paediatric patients.

The Cause of Death among Patients with Burn Injuries in Burn Unit of Cipto Mangunkusumo Hospital

Aditya Wardhana1,2, Lara Aristya2, Claudio Agustino2, Radhianie Djan1, Zainul Halim1

1 Burn Unit, Cipto Mangunkusumo National General Hospital, Jalan Pangeran Diponegoro No. 71, Jakarta, 10430

2 Faculty of Medicine, Universitas Indonesia, Jalan Salemba Raya No. 6, Jakarta, 10430

Abstract:

Background: Burn injuries are highly associated with disability and mortality worldwide. Although the current advancement of therapy had improved the outcome, there are still many death cases among burn patients.

Objectives: This study aims to investigate the cause of death among patients with burn injuries in order to evaluate our burn unit as the basis in improving standards through a greater depth of understanding the trends of mortality in our burn unit service.

Method: We conducted a retrospective study. The data of burn patients died between January 2016 and December 2017 in Burn Unit of Cipto Mangunkusumo Hospital were collected. Subsequently, several literatures were reviewed to compare the data collected with studies conducted in other burn units.

Result: Eighty-six patients (27,4%) were died during hospitalization, 54 of whom were male (62,8%). The average age was 38,8. Eighty-three patients (96,5%) had burn extent over 20% TBSA and the average length of stay was 11,4 days. The most common cause of death was flame (n=67; 78%). The majority cause of death was multiple organ failure (n=76; 88,4%). Pseudomonas aeruginosa was the most common organism isolated among the death patients (n=30; 27,8%).

Discussion: The major cause of death among patients with burn injuries in our unit was multiple organ failure, triggered primarily by sepsis, which accorded with the literatures reviewed.

 

Keywords: burn, cause of death, mortality


Biography:

Lara Aristya is a medical student of Faculty of Medicine Universitas Indonesia. She has high interest in science and research field. She had participated several research competitions and conferences, both national and international. Lara has done a publication about fluid resuscitation and vasoactive usage for septic shock patient in Cipto Mangunkusumo National General Hospital Intensive Care Unit. She also has been actively participating in several national and international symposiums and workshops about medical field.

Retrospective Case Series of Keragel or Biobrane on Paediatric Facial Burns

Mrs Herni Lutfiah Hussein1, Mrs Nurazlin Azman1, Ms Joanne Jovina SH Cheng1

1Kk Women’s And Children’s Hospital, Sengkang, Singapore

Abstract:

Background:KK Women’s and Children’s Hospital is the referring paediatric hospital in Singapore for a wide variation of burns. The Department of Plastic, Reconstructive and Aesthetic Surgery consults an average of 23 paediatric burns a month, of which facial burns is common and a challenging area for dressing coverage.
Keragel is a thick hydrogel consisting of keratin protein which provides a moisture rich environment. It delivers Replicine™ Functional Keratin® which aids in epithelialisation of a wound. Application of Keragel is advise to apply twice a day to cover the entire wound surface without the need for dressing coverage.
Biobrane is a biosynthetic dressing extract from porcine dermal collagen secured to a silicone membrane. Application of Biobrane requires a sterile environment in the operating theatre as the dressing need to be secured with stitches/staples or securement tapes.

Aim:The aim of this case series is to evaluate the healing rate of using Keragel or Biobrane on pediatric facial burn. The cost of care and pain management will be explore too.

Method: Retrospective data of 4 paediatric patients with partial to deep partial thickness burns to the face were selected. All patients are within the age group of >6months of age to 16 years of age. 2 patients had application of Keragel dressing on their burns while the other 2 patients had Biobrane dressing.

Conclusion: Keragel took an average of 7-14 days to heal completely, while Biobrane dressing took more than 7 days of expected healing time as it converted to deeper burns. The cost of care on Keragel was reduced as it can be managed in an outpatient setting whereas Biobrane dressing required admission for application in the operating theatre. There was also reduce pain experienced in Keragel application as it is easy to clean and re-apply with minimal pain. As compared to Biobrane dressing, the removal of stitches/staples or securement tapes is done in the clinic with pre-medications given.
Keragel is easy to use by parents at the home settings as it does not require hospital admission. It minimizes trauma and requires less visit to the clinic for dressing change.


Biography:

I have been working for 14 years in KK Women’s and Children’s Hospital. I worked in a surgical ward for 7 years before transferring out to the Department of Plastic Reconstructive and Aesthetics Surgery. I am a nurse clinician and WOCN nurse too. I worked in an outpatient setting where burns cases is one of the common wound dressing I do in my daily job.

Honey dressing versus foam dressing on paediatric burns: Comparison of healing rate

Mrs Nurazlin  Mohd Azman1, Mrs Herni Lutfiah Hussein1, Mrs Joanne Jovina SH Cheng1

1Kk Women’s And Children’s Hospital, Singapore, Singapore

Abstract:

Background:KK Women’s and Children’s Hospital is the referring paediatric hospital in Singapore for a wide variation of paediatric burns. The Department of Plastic, Reconstructive and Aesthetic Surgery consults an average of thirty-five paediatric burns a month, of which most patients require some form of dressing coverage. Burns dressing has been shown to be painful and traumatizing, and the average recovery time for deep partial thickness burn is around four to six weeks using foam dressing. People with burn wounds have a higher chance of having wound infection, especially with Singapore’s humid climate.
Honey had been used since ancient times as a recommended treatment for healing wounds. It is known to accelerate wound healing, debriding action with antibacterial, anti-inflammatory and antioxidant properties. Recent Cochrane review in 2017 showed a moderate to high certainty that honey accelerates wound healing compared to those with non-bacterial treatment.

Aim:The aim of this review is to compare the healing rate of burn wound using of honey dressing versus plain foam dressing. Other variables such as burn wound infection and pain score will be looked into.

Method: Retrospective data from (Jan 2016 – Jan 2018) of 20 paediatric patients with a total burn surface area (TBSA) between 5 – 10% with partial thickness burns to deep partial thickness were selected. The age group was within >6months of age to 16 years of age. 10 patients were treated with honey-dressing while the 10 patients were treated with foam dressing.

Results: Patients with honey dressing took an average of 3-4 weeks to heal, while foam dressing took an average of 4-6 weeks to heal completely. There was an increased chance of hypergranulation with patients on foam dressing, while no incidence of hypergranulation occurred in the honey dressing group. Findings of increased pain occur in honey dressing with a pain score ranging from 6-10.


Biography:

Working At KK Women’s and Children’s Hospital for 6 years in the Department of Plastics, Reconstructive and Aesthetics.

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About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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