Biodegradable Temporising Matrix (BTM) for neck contracture release. A case presentation from the nursing perspective

Hana Menzies1

Victorian Adult Burns Service, Alfred Health, Prahan, Vic, Australia

Abstract:

As with all aspects of burns care, collaboration of the multidisciplinary team is paramount to optimise best outcomes. The nursing care of patients receiving such surgical treatments is pivotal in supporting the whole patient during their care.
Biodegradable Temporising Matrix (BTM) is a relatively new dermal substitute technology that burns clinicians are becoming more familiar and confident with managing.
This case presentation follows the patient journey from preadmission, stage 1 and 2 BTM application and grafting and on to scar management.
This case shall be used as an opportunity to share and build knowledge amongst nurses to support the future care of patients receiving BTM.

Biography:

To come

 

New technology to light the way in wound debridement

Mrs Kristen Storey1,2, Ms Alicia Miers1, Mrs Aoife Rice1, Professor Roy Kimble1,2,3,4

1Queensland Children’s Hospital, Sth Brisbane, Australia, 2Queensland University of Technology, Brisbane, Australia, 3Centre for Children’s Burns and Trauma Research, Sth Brisbane, Australia, 4University of Queensland, Brisbane, Australia

Abstract:

Wound debridement is required to remove dead, damaged or infected tissue within a wound to promote healthy tissue growth. While in some wounds slough and necrotic tissue are easily identified, others may seem ‘clean’ to the human eye, however, delays in wound healing suggest possibility of infection within the wound bed. The ability to identify bacteria within a wound allows for targeted wound debridement to ensure healthy tissue remains undamaged, targeted sampling of wounds, and effective use of antibiotics.

The MolecuLight i:X is a non-contact, safe and portable hand-held device allowing real time identification of bioburden within a wound bed. It allows clinicians to quickly visualise and identify bacterial presence within a wound bed or surrounding tissue. The MolecuLight i:X emits an ultraviolet light that identifies bacterial load of ≥10⁴ CFU/g within a wound by fluorescing red or cyan depending on bacteria identified.

The use of the Moleculight i:X within the Pegg Leditschke Children’s Burns Centre has allowed us to identify infections within a wound, provide targeted non- excisional wound debridement to wounds, identify effectiveness of wound debridement and provide accurate pathology testing. This technology has also been used pre skin grafts to ensure absence of bacteria within a wound.

Surgical needling for management of hypertrophic scars following burns injuries at Queensland Children’s Hospital

Dr Holly Campbell1,2,3, Dr Victoria Tan4, Kristen Storey1,2,3, Professor Roy Kimble1,2,3

1Queensland Children’s Hospital, Brisbane, Australia, 2Centre for Children’s Burns and Trauma Research, Brisbane, Australia, 3University of Queensland, Brisbane, Australia, 4Bundaberg Hospital, Bundaberg, Australia

Abstract:

The aim of this study is to determine the effectiveness of surgical needling in reducing hypertrophic scars in children who have sustained burns injuries. Hypertrophic scarring following a burns injury is common and there is currently very little evidence demonstrating effectiveness of surgical interventions, especially in a Paediatric population.

This project hopes to demonstrate that surgical needling significantly reduces hypertrophic scar thickness in Paediatric burns patients and will act as a pilot study for our upcoming RCT comparing traditional scar management techniques (silicon) to both surgical needling and to CO2 fractional laser therapy.

A retrospective chart review of all patients who had surgical needling for scar management through the Department of Paediatric Surgery at Queensland Children’s Hospital from July 2017 – March 2019 was conducted.  The review identified 41 patients who had 96 surgical needling procedures in total. All needling procedures were performed under general anaesthetic and a patient protocol was followed that included use of a standard surgical needling device, no use of antibiotics and dressing with Sorbact gel for one night following the procedure before normal silicon applications were resumed. Ultrasounds were performed on the day of surgical needling as well as two months following the surgical needling and scar thickness measurements were compared for each site. The results revealed a mean hypertrophic scar thickness of 46mm pre-needling (range 20-115mm) and 38mm post-needling (11-87mm). These results represent a mean decrease in scar thickness of 17.4% two months following a surgical needling procedure.


Biography:

Holly is a Senior House Officer at Queensland Children’s Hospital working in Paediatric Surgery, Urology and Burns.

Presence of adipose tissue after autologous fat transplantation in patients with adherent scars, a pilot study

Mr Roy Zuidema1, Dr. Sandra Jongen1, Dr. Marianne Nieuwenhuis1, Mrs.  Ina van Ingen Schenau1, Drs. Leense Wagenaar1

1Martini Hospital, Groningen, Netherlands

Abstract:

Objectives

A substantial number of  burn survivors develop an adherent scar because the subcutis had to be excised. The important functions of the subcutis are therefore missing, as well as the functional sliding layer itself. These patients suffer from pain, itching and soft tissue or joint stiffness. Autologous fat transplantation (AFT) is an upcoming technique for the reconstruction of the subcutis in adherent scars. Recent studies have shown a beneficial effect of AFT on the aforementioned symptoms. However, it is still not proven whether the transplanted adipose tissue is present and functional after a period of time, because not all adipose tissue might survive the grafting process due to for example surgical trauma. This study aims to assess the presence of subcutaneous adipose tissue after AFT.

Methods

A prospective uncontrolled trial was carried out. Five patients with a total of seven adherent scars due to burns, necrotizing fasciitis or degloving injuries, undergoing AFT using the LipiVage method, were included. A subcutaneous ultrasonography was made preoperatively and at 3-months follow-up. These ultrasounds were assessed by a single, experienced anesthesiologist.

Results

In five of the seven scars there was an increase in subcutaneous tissue visible. In one scar the result was inconclusive due to differences in ultrasonography angles and in one scar no increase in subcutaneous tissue was seen.

Conclusion

This study shows that adipose tissue is still present at 3 months follow-up after AFT and its presence supports the hypothesis that adipose tissue is instrumental in the treatment of adherent scars.


Biography:

Plastic surgeon Martini Hospital Groningen

Equipping Parents to Cope With Their Child’s Injuries: A Systematic Review

Miss Jo Butler1,2, Professor Justin Kenardy1,2, Dr Alexandra De Young1,2, Dr Zephanie Tyack1,

1Centre for Children’s Burns and Trauma Research, South Brisbane, Australia, 2School of Psychology, University of Queensland, St Lucia, Australia

Abstract:

Introduction: The period following a child’s accidental injury can be traumatic for both children and parents. Parents have an important role in the way children process these events and are an important target for interventions aimed at improving psychosocial outcomes.

Methods: PubMed, Cochrane, CINAHL, PsycINFO, Web of Science, and Embase were searched for randomised control trials (RCTs) examining acute interventions for parents of children with accidental injuries. The effectiveness of these interventions at improving various psychosocial outcomes was examined. Two independent reviewers screened studies, extracted data, and completed the Cochrane Risk of Bias tool.

Results: Nine RCTs were identified for inclusion, including populations with brain injuries (n = 4), general accidental injury (n = 3), burns and road traffic accidents (n = 1), and facial trauma (n = 1). A narrative synthesis of results was completed. Interventions varied, including aspects such as discharge support, counselling, and psychoeducation. Eight studies had a high risk of bias in at least two areas, with the ninth study having an unclear risk of bias. The RCT in burns found reductions in internalising problems (e.g. anxiety, depression, and social withdrawal), and the studies on general accidental injury found a range of unreplicated reductions in anxiety, posttraumatic stress, and depression. No effects were found in brain injury populations.

Conclusions: Some individual interventions show promise at reducing negative psychosocial outcomes, but results should be interpreted cautiously due to the high risk of bias. Factors relating to why these interventions may not have been successful will be discussed.


Biography:

Jo Butler is a PhD Candidate with the UQ School of Psychology and the Centre for Children’s Burns and Trauma Research. Her current research is investigating ways we can improve psychosocial outcomes for children and their parents following a burn injury.

The effect of parent, child, and clinician interactions on the development of trauma responses in families

Miss Jo Butler1,2, Dr Zephanie Tyack1, Professor Justin Kenardy1,2, Dr Alexandra De Young1,2, Professor Roy Kimble1,4, Dr Megan Simons1,3

1Centre for Children’s Burns and Trauma Research, South Brisbane, Australia, 2School of Psychology, University of Queensland, St Lucia, Australia, 3Occupational Therapy Department, Queensland Children’s Hospital, South Brisbane, Australia, 4Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, South Brisbane, Australia

Abstract:

Introduction: Paediatric burn injuries can be traumatic for both parents and children as a result of the initial event and subsequent treatment. Whilst there has been research on the relationship between trauma and interactions between parents and children, or between parents and clinicians in a burns context, there has been far less examining how these three parties influence each other. By failing to examine parent, child, and clinician interactions together, we lack a full understanding of the development of trauma responses in children and parents secondary to healthcare experiences.

Methods: Qualitative semi-structured interviews were conducted with parents whose children were receiving acute treatment in an Australian outpatient burns clinic. Interview questions explored parent perceptions of how interactions with both clinicians and children influenced the ways they relate to each other. The impact of these interactions on how both the parents and children were able to cope with the trauma of a burn injury was also examined. Interviews were transcribed and thematic analysis completed.

Results: Data collection is currently underway.

Conclusions: Understanding interactions between healthcare staff, parents, and children following burn injuries will help to improve care, particularly in relation to traumatic injuries.  Examining parental perceptions of these interactions will offer a unique insight into the development of both trauma responses and coping strategies following a child’s burn.


Biography:

Jo Butler is a PhD Candidate with the UQ School of Psychology and the Centre for Children’s Burns and Trauma Research. Her current research is investigating ways we can improve psychosocial outcomes for children and their parents following a burn injury.

The effect of sedation and inotropic support on the achievement of verticality in burns patients admitted to ICU. A retrospective observational cohort study.

Lauren Bright1, Lisa van der Lee2,3, Dana Hince7, Fiona Wood4,6, Dale Edgar2,4,5,6

1 The University of Notre Dame Australia, Fremantle Western Australia, Australia

2 Physiotherapy Department, Fiona Stanley Hospital, Murdoch Western Australia, Australia

3 Intensive Care Unit, Fiona Stanley Hospital, Murdoch Western Australia, Australia

4 State Adult Burn Unit, Fiona Stanley Hospital, Murdoch Western Australia, Australia

5 Burn Injury Research Node, The University of Notre Dame Australia, Fremantle Western Australia, Australia

6 Fiona Wood Foundation, Murdoch Western Australia, Australia

7 Institute for Health Research, The University of Notre Dame Australia, Fremantle Western Australia, Australia

 

Introduction

Early rehabilitation for severe burns survivors is arguably more challenging than the general intensive care population. Early achievement of verticality has the potential to address the detrimental effects of immobility identified in ICU patients and reduce healthcare costs. However, achieving functional verticality is influenced by acute skin reconstruction, sedation practices and cardiovascular stability during the acute intensive care period.

 

Objectives/Aims

The aim of this study was to identify the impact of sedation and inotropic support on cessation of bed rest in burns patients admitted to ICU.

 

Methods

A retrospective observational cohort study was conducted. The digital medical records were reviewed to explore episodes of functional verticality and the impact of inotrope and sedation practices and mechanical ventilation. Logistic regression was used to examine the association between inotropic support and sedation levels on the achievement of verticality for patients who survived ICU admission.

 

Results

Data for 64 subjects indicated that daily maximum noradrenaline dose increases of 1mL/hr are associated with a 14% reduction in odds of achieving verticality. When sedation is within recommended limits, odds of achieving verticality milestones increase 20.83 times compared to periods outside those limits.

 

Discussion and Conclusion

High sedation scores, sedative infusion and inotropic support pose significant limitation on early and frequent mobilisation in burns patients admitted to ICU. Additional barriers are mechanical ventilation and burns surgery. The challenge for clinicians moving forward is to determine which of these factors are modifiable in order to increase early mobilisation of burn patients in ICU.

 

e-Poster References

[1]        Tipping CJ, Harrold M, Holland A, Romero L, Nisbet T, Hodgson CL. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med. 2017;2:171-83.

[2]        Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults 2014.

[3]        Ely EW, Truman B, Shintani A, Thomason JWW, Wheeler AP, Gordon S, et al. Monitoring Sedation Status Over Time in ICU Patients: Reliability and Validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 2003;22:2983-91.


Biography:

Lauren Bright is a Physiotherapist and recent graduate from The University of Notre Dame Australia, Fremantle.

Psychosocial Practice in the Changing Context of the Larger Burns Survivor – Maximising psychosocial recovery through reintegrating towards a new reality

Ms Rochelle Kurmis1, Ms Jenny Edge1, Ms Madeline Rowell1, Ms Kathryn Heath1, Prof. John E. Greenwood1

1Royal Adelaide Hospital, Adult Burns Service, Adelaide, Australia

Abstract:

Severe burns are a traumatic experience with recovery not only being physical, but psychosocial. The challenge for the large burn injury survivor is one of reintegrating a new identity and sense of place from their previous social environment.

After World War II, traumatised soldiers were advised to not mention their ordeal, and families advised to ‘change the subject’ if the topic arose, resulting in high levels of post-traumatic stress disorder and other negative psychological outcomes. Understanding trauma survival and response has changed considerably since then and applies to all types of trauma. It is now recognised that all involved with care of the burns survivor can support psychosocial recovery towards integration back to a new ‘normal’.

The aim of this study is to identify the various ways to support a patient towards hope for a future beyond the hospital room, and a belief that they can reintegrate towards a social world with a reformed identity.

A literature review of psychosocial theory in the context of its application to support burns survivors was conducted. This demonstrated that from the initial admission when working with families in crisis, throughout the subsequent phases of recovery for survivors, there are multiple approaches and understandings that can support the recovery process. Phases of recovery from admission through to rehabilitation include critical care, grief, anger, loss and adjustment.

A summary of identified theories and examples of the application of trauma-informed principles into the care of severe burns survivors on our unit will be presented


Biography:

Jenny Edge is the Social Worker for the Adult Burns Service at the RAH. With previous experience with wound care as a nurse, she found her passion was for assisting people with their psychosocial as well as their physical wellbeing, leading her to a change in career. Jenny has bought this passion and experience with her to the RAH burns team.

The Matching Assessment using Photographs with Scars (MAPS) App: Reliability testing

Ms Tanja Klotz1, Ms Rochelle Kurmis1

1Royal Adelaide Hospital, Adult Burns Service, Adelaide, Australia

Abstract:

The Matching Assessment using Photographs with Scars (MAPS) scar assessment tool was developed in 2005. MAPS was recommended in a systematic review as a preferred scar assessment tool for enabling accurate relocation for reassessment of scars. It is used across Australia, however, distribution was hampered by the A4 paper manual format.

In addition to the MAPS, the Modified Vancouver Scar Scale (mVSS) and a Patient Reported Outcomes questionnaire was incorporated into a new App to produce a comprehensive scar assessment package: ClinMAPS™Pro. At the time of development no other scar assessment Apps were available, making this the first of its kind.

To ensure the digitised MAPS is a reliable scar assessment, a reliability study was required.

The digitised MAPS module within ClinMAPS™Pro was used for intra- and inter-rater reliability testing. Convenience sampling was utilised to recruit burns patients representing 42 scars, based on pre-determined power calculations. Three therapists, one experienced and two novice, acted as the assessors. Each therapist assessed pre-selected scars with the digitised MAPS. Re-assessment of the same scar sites occurred 3-7 days later.

Inter-rater reliability testing scores showed fair to moderate agreement (combined Fleiss Kappa=0.38-0.49, P<0.0001). Intra-rater reliability scores between initial and repeat measures showed moderate to almost perfect agreement (Cohen’s Kappa=0.43-0.90, P<0.0001).

The digitisation of this scar assessment manual ensures that MAPS within the ClinMAPS™Pro App is now readily available for clinicians and researchers internationally, with electronic or paper reporting options. Results of the reliability testing of the MAPS component confirm its intra- and inter-rater reliability.


Biography:

Rochelle Kurmis has been the Allied Health Project Manager at the Royal Adelaide Hospital, Adult Burns Service since 2010. Her role incorporates supporting all multi-disciplinary staff in quality management, quality improvement, and research related activities across the continuum of care. She is a current ANZBA member and contributes to the BRANZ steering committee. She also co-chairs the Joanna Briggs Institute Burns Node.

Positive blood cultures in a burn cohort: Findings from the Burns Registry of Australia & New Zealand.

Heather Cleland1,2, Belinda Gabbe1, Alex Padiglione2, Tracey Perret4, Edward Raby3, Miss Yvonne Singer1,2, Lincoln Tracy1, Fiona Wood3

1Victorian Adult Burn Service, The Alfred, , , 2School of Public Health and Preventive Medicine, Monash University , , , 3State Adult Burn Service, Fiona Stanley Hospital, , , 4National Burn Service, Middlemore Hospital, ,

Abstract:

Effects of bacteraemia and sepsis on morbidity and mortality following burn injury remain significant. Blood culture is essential for diagnosis of blood stream infection, identification of causative pathogens, and susceptibility testing to guide antibiotic therapy. The aim of this study was to examine the incidence of positive blood cultures and effects on length of stay (LOS) in patients ≥16 years old admitted to Australian and New Zealand Burn Centres between July 2016 and December 2018.

Preliminary analysis of 12 months of data (July 2016 -June 2017) from the Burn Registry of Australia and New Zealand (BRANZ) identified 2,286 eligible patients ≥16 years old. Six hundred and thirty-two patients (27.7%) had blood cultures taken, and of these, 27 patients (4.3%) had positive blood cultures. Sixty-five percent of positive blood culture pathogens were gram positive micro-organisms, and 35% were multi-resistant micro-organisms. Only 38% of patients were already receiving appropriate antibiotics at the time of the first positive blood culture result. Inhalation injury and increased % Body Surface Area were risk factors for positive blood cultures. Bacteraemic patients were more likely to have surgery and had a longer LOS. Although clinically significant, the small sample size limited statistical analysis; however, the addition of another 18 months of data will make our findings more robust.


Biography:

Bio to come

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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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