Bums (1992) 18, (l), 85-86 Printed in Greal Britain 85

Abstracts

CLINICAL STUDIES

Benefits of delayed surgery for paediatric scalds A prospective controlled study of children with hot water scalds of indeterminate depth soon after injury was undertaken to deter- mine whether early excision at 3 days or conservative treatment ~ any grafting required by the latter group was carried out at least 2 weeks after injury - gave better results, Comparisons were made of the area excised, postbum day of excision, per cent of graft take, operating room time, blood replacement, incidence of infection and length of stay in hospital.

No patient had significant wound infection of systemic sepsis. The delayed surgery patients needed smaller areas of wound exci- sion (because of prior healing) with reductions in operating times and blood loss. Notably only 6 of the 12 patients in the delayed excision group ultimately needed wound excision and grafting. Graft take was comparable for both groups as was length of stay in hospital.

Desai M. H., Rutan R. L. and Herndon D. N. (1991) Conserva- tive treatment of scald burns is superior to early excision, 1. Btirti Cmre Reha6ii. 12, (5), 482-484.

Effects of Interleukin-6 Interleukin-6 is produced in increased amounts in patients with relatively severe burns (mean TBSA, 31 per cent) by activated monocytes and endothelial cells. The increased levels of interleukin-6 persisted for several weeks after injury and correlated with the acute-phase responses, fever, tachycardia, leucocyhosis with an associated left shift, elevation of C reactive protein and alpha-t antitrypsin levels and decreased albumin levels. During the second week after injury the raised interleukin-6 levels corre- lated with peak levels of 1gM and a subsequent prolonged elev- action of IgG. Thrombocyte counts, which were initially decreased soon after injury, rebounded to supranormal levels during the second week, probably under the influence of interleukin-6.

Nijsten M. W. N., Hack C. E., Helle M. et al. (1991) Interleukin-6 and its relation to the humoral immune response and clinical par- ameters in burned patients. Surgey 109, (6), 761-767.

Erythropoietin levels and burn anaemia Erythropoietin levels were measured serially in 27 patients with burns covering between 10 and 85 per cent TBSA using radioim- munoassays. Almost all the patients (25127) had developed a reti- culocytopenic anaemia by the end of the first week after burning. Twenty-three patients remained anaemic throughout the 4 week period of study. The erythropoietin levels increased appropriately as the patients became anaemic. Erythropoietin levels related to the haemoglobin levels in a logarithmic way with a correlation coefficient of - 0.869. The levels of erythropoietin were not related to age or the extent of the burn.

Vasko S. D.. Burdge I. J., Ruberg R. L. et al. (1991) Evaluation of erythropoietin levels in the anemia of thermal injury. 1. Berm Care Rehubil. 12, (5), 437-441.

Repair of depigmented skin areas Depigmented areas of skin following spontaneous or autograft healing of burns has been treated successfully using superficial dermabrasion of the depigmented area followed by trans- plantation of melanocytes via epithelial grafts. Follow-up studies in 11 patients after an average of 14 months showed excellent

(‘ 1992 Butterworth-Heinemann Ltd 030554179/92/OJOO85~02

graft take in all patients, with a cosmetic effect which ranged from good to excellent. No complications have been observed.

Kahn A. M., Cohen M. J. and Kaplan L. (1991) Treatment for depigmentation resulting from bum injuries. J. Bum Care Rehabil. 12, (5), 468-473.

ANIMAL STUDIES

Limited benefits of vitamin E supplements Vitamin E given in a wide range of doses to guinea pigs with deep flame bums covering 30 per cent TBSA did not modify the weights of the body, the carcass, the gastrocnemius muscle, the liver and the spleen. All resting metabolic rates measured after injury were comparable. No significant differences in ear thickness (after 2-4 dinitrofluoro-benzene) or lymphocyte proliferative responses to PHA were found. However the degree of anaemia was significantly greater and the mucosal weight and protein con- tent of the animals receiving the smallest amount of vitamin E (IRDA) were significantly less than found in the animals receiving large supplements of vitamin E.

Kuroiwa K., Nelson J. L. and Boyce S. T. (1991) Metabolic and immune effect of vitamin E supplementation after bums. 1. Parent. Enter. Mdr. 15, (l), 22-26.

Benefits of flurbiprofen cream on burn wounds Twelve burned sheep (15 per cent TBSA deep burns) and 6 control non-burned sheep were studied to determine the effects of a single application of 5 per cent flurbiprofen cream placed on the bum wound. Compared with the controls and the preburn values there was an approximately 30 per cent increase in oxygen consump- tion on day 3 in the burned animals. Application of the flur- biprofen cream to the wounds of six of the 12 burned sheep after the oxygen consumption studies returned the oxygen usage to almost normal values.

Lung and liver lipid peroxidation (measured as malondial- dehyde) was markedly increased in the burned non-treated sheep but not increased in the burned treated sheep. Protein-rich bum lymph flow remained four-fold increased in both groups, indica- ting a persistent increase in the vascular permeability of the burn tissue, not modified by flurbiprofen. All animals showed limited burn wound infections (biopsies with less than lo4 organisms per gram of tissue).

Lalonde C., Knox J., Daryani R. et al. (1991) Topical flurbiprofen decreases burn wound induced hypermetabolism and systemic lipid peroxidation. Stcrgey 109, (5). 645-651.

Bums, sepsis and bacterial translocation Studies in rats with wounds infected with Ps. neruginosa, with or without additional fluid resuscitation, or pretreatment with allo- purinol or treatment with azapropazone indicated that chronic gut barrier dysfunction leading to bacterial translocation associated with sepsis after 30 per cent TBSA bums occurs independently of continuing intestinal ischaemia.

Jones W. G., Barber A. E., Minei J. P. et al. (1991) Differential pathophysiology of bacterial translocation after thermal injury and sepsis. Ann. Surg. 214, (I), 24-30.