BackgroundResource limitations in settings such as burn mass casualty incidents (MCIs) present challenges to the judicious fluid resuscitation required for major burns. Previous recommendations for burns care in MCIs have suggested certain adaptations from routine care, such as delaying intravenous (IV) fluid resuscitation until arrival at facility; using a fluid calculation formula that is independent of percentage of total body surface area (%TBSA) burned; or using fluid calculation formula based on time of arrival to first receiving facility rather than from time of injury, thus omitting ‘catch-up’ fluid. ObjectivesTo synthesize and assess certainty of evidence from resource-limited settings on the three adaptations to fluid resuscitation for patients with major burns in MCIs. MethodsPubMed, EMBASE, CINAHL, and Cochrane Library were searched on 8 September 2023 with an update search on 8 July 2024. Primary quantitative studies in resource-limited settings meeting eligibility criteria as assessed by two reviewers were included. Where available, outcome effects for these adaptations compared to routine burns care were calculated. Evidence certainty was determined by GRADE. ResultsTwo eligible studies were identified from 544 search results. One study with 48 participants provided very uncertain evidence that delayed IV fluid resuscitation may increase acute kidney injury compared to prehospital resuscitation (OR 2.48, 95% CI 0.58–10.62). The other study with a cohort of 10 children provided very uncertain evidence that calculating fluid requirements based on time of arrival to first receiving facility, i.e. omitting ‘catch-up’ fluids, may maintain adequate urine output and be associated with no complications of fluid over- or under-resuscitation. There were no studies on use of a simplified %TBSA-independent fluid calculation formula. ConclusionsThere is very limited and uncertain evidence to inform on delayed IV fluid resuscitation, simplified %TBSA-independent formula, and omission of ‘catch up’ fluids for burns care in MCIs. Contextual factors, local values, preferences and feasibility also need to be considered.

IntroductionLaryngotracheal stenosis after inhalation injury can occur not only in the acute period but also in the late period. Stenosis usually develops in only one area and, in some cases, may require intubation or tracheostomy. However, selecting the treatment for extensive laryngotracheal stenosis in patients with severe mental retardation may be difficult. Case presentationA 20-year-old man with severe intellectual disabilities was admitted to our emergency department with burns on the face and lower limbs. Severe inhalation injury was suspected; therefore, intubation was performed. The patient was extubated on day 14; however, extensive laryngeal stenosis from the supraglottic area to the cricothyroid ligament area developed on day 37, resulting in carbon dioxide narcosis requiring cricothyrotomy. We believed that the risk of re-stenosis was high, and his mental retardation would make postoperative management difficult; therefore, we selected conservative therapy. Extensive stenosis persisted over 2 years after injury with a tracheostomy tube. ConclusionGiven the risk of re-stenosis, conservative therapy or laryngotracheal reconstruction is preferred for the treatment of extensive laryngotracheal stenosis after inhalation injury. Conservative therapy is advisable when patients cannot comply with the rest required for the treatment.

BackgroundPre-clinical studies suggest that non-steroidal anti-inflammatory therapy may reduce acute inflammation and modulate scar formation after burn injury. The objective of this trial was to determine if celecoxib administered soon after acute burn improved scar quality. MethodsA single centre, parallel group, placebo-controlled, randomised, superiority trial. Adults with non-major acute burn injury were eligible for recruitment. Participants within 48 h of admission for acute burn injury received either six weeks of celecoxib 200 mg twice daily or identically packaged placebo capsules. The primary outcome was participant-reported Patient Observer Scar Assessment Scale (POSAS) at day 42 following burn injury. The best possible score using this assessment is 7 and the worst 70. Key safety outcomes included study drug side effects. ResultsRestrictions imposed during the COVID-19 pandemic resulted in slow recruitment and early termination after 59 of the 150 planned participants were enrolled. The primary outcome was available for 21/30 (70 %) participants in the celecoxib arm and for 23/29 (79 %) who received placebo. There was no significant difference in the primary outcome between treatment groups with a mean POSAS of 33.4 (standard deviation 12.7) in the celecoxib arm and 36.9 (13.7) in the control arm giving a difference of −3.49 (95 % CI [-11.57, 4.59], p =.39). Gastrointestinal symptoms occurred in 3/30 (10 %) allocated celecoxib and in none allocated placebo. Secondary outcomes including graft loss and delayed healing were similar between groups. ConclusionsAnti-inflammatory therapy did not improve scar quality. Due to early trial termination and significant loss to follow up these findings should be interpreted cautiously. To improve generalisability and to attain recruitment targets, future trials should apply different approaches to improve participant retention as well as including patients with larger burn injuries and an older population.Trial registration: ACTRN12618000732280.

Phenol, a corrosive aromatic compound, is used in many polymers and plastics for industrial purposes. It has previously been used as an antiseptic agent. Phenol burns are partially thick and may cause skin hyperpigmentation. Surgical intervention, including debridement, is often unnecessary. We report the case of a resin industrial worker who sustained phenol burns in both lower extremities due to a work accident. The estimated total body surface area (TBSA) was 11 %. His wound showed signs of epithelialization 7 days after the burn injury without debridement or skin grafting, with daily water irrigation and dressing alone. The patient was discharged from the hospital on day 23 after the accident with no residual organ damage or functional impairment. A conservative approach to phenol burns would be of great benefit to patients in terms of functional prognosis.

BackgroundAcute thermal burns can be severe injuries potentially requiring hospitalization and may even lead to limb amputation or permanent disability if not properly addressed. Primary burn reconstruction using flaps has been shown to be an effective method that optimizes tissue preservation, minimizes limb morbidity, and allows for early mobility. Previous studies have demonstrated the dependence of flap survival on several factors such as wound size, location, and specific tissue requirements (weight-bearing vs non-weight-bearing). Proper selection of soft tissue coverage for a wound defect is vital in ensuring adequate healing and recovery. Our objective was to identify whether the choice of flap leads to differences in near-term survival and postoperative complications in patients undergoing burn reconstruction for thermal hand injuries. MethodsRetrospective review was performed of our single institution burn database to identify patients who underwent primary soft tissue reconstruction for thermal hand burns between September 2014 and March 2022. All patients had wound defects with significant depth not amendable to skin grafting alone for coverage. Medical records were reviewed for demographics, injury specifics, treatment details, and post-operative outcomes. ResultsOf all patients admitted to our institution over an 8-year period for burn-related injuries, we identified 17 patients requiring 28 local or regional flaps for reconstruction. All but one flap survived a minimum of two weeks post-operatively with a success rate of 96%. Complications included partial necrosis in 1 flap, full necrosis in the failed flap, dehiscence in 2 flaps, and hematoma in 1 flap. One patient developed a donor site hematoma requiring evacuation, and another developed flap cellulitis treated with IV antibiotics. ConclusionLocal, regional, and distant flaps can reliably be used to salvage exposed tendons and neurovasculature in deep thermal hand burns. Flap success and subsequent outcomes rely heavily on the initial wound and extent of soft tissue injury, with flap type and timing acting as secondary predictors.