Swallowing impairment in older persons following burn injury: Validation of incidence and predictive factors for dysphagia.

Background: Early retrospective data identify that dysphagia is common in older persons with burn injury, suggesting a rate of 47 %, and that it is associated with medical, burn, and nutritional outcomes.

Aims: To prospectively (1) explore the incidence, (2) describe associations, and (3) evaluate risk factors for dysphagia in patients ≥ 75 years old hospitalised with burn injury.

Methods: All patients > 75 years old admitted to Concord-Repatriation-General-Hospital with burn injury over 4 years (2019-2023) were assessed for dysphagia on presentation and were continually monitored throughout their admission.

Understanding Neural Factors in Burn-related Pruritus and Neuropathic Pain.

Post-burn pruritus and neuropathic pain significantly affect the quality of life of affected individuals in several domains including psychosocial well-being, sleep and general impairment in activities of daily living. Whilst neural mediators involved in itch in the non-burns setting have been well investigated, there remains a lacuna of literature examining the pathophysiological and histological changes unique to burn-related pruritus and neuropathic pain. The aim of our study was to conduct a scoping review into the neural factors that contribute to burn-related pruritus and neuropathic pain.

Skin 11β-hydroxysteroid dehydrogenase type 1 enzyme expression regulates burn wound healing and can be targeted to modify scar characteristics.

Background: Excessive scarring and fibrosis are the most severe and common complications of burn injury. Prolonged exposure to high levels of glucocorticoids detrimentally impacts on skin, leading to skin thinning and impaired wound healing. Skin can generate active glucocorticoids locally through expression and activity of the 11β-hydroxysteroid dehydrogenase type 1 enzyme (11β-HSD1).

Fractional ablative laser therapy for the treatment of severe burn scars: A pilot study of the underlying mechanisms.

Ablative fractional resurfacing is clinically an efficient treatment for burn scar management. The aim of this pilot study was to investigate the poorly understood mechanisms underlying ablative fractional CO2 laser (AFL-CO2) therapy in relation to biomarkers S100 and 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1). S100 stains for Langerhans cells and neuronal cells, potentially representing the pruritus experienced.

Cold burns as a result of cosmetic cryolipolysis: An emerging concern from the NSW Statewide Burn Injury Service.

Cold burns are an uncommon mechanism of burn injury in Australia, where environmental exposure to freezing temperatures is rare. Aetiological research shows that most likely causes are related to intentional injury or industrial accidents Cryolipolysis, a cosmetic technique advertised as 'fat freezing', has recently emerged as a method of fat reduction and body contouring. Whilst perceived as safe, this study presents the world's first case series on cold burns sustained from cryolipolysis.

Alginate Dressings Continuously for 14 Days on Uncontaminated, Superficial, Partial Thickness Burns.

Calcium alginate dressings are commonly used on split-thickness skin donor sites, where they are typically removed after 14 days. Alginates have been used previously on superficial, partial thickness burns, but changed every 3 to 5 days. In this study, alginates were applied to superficial, partial thickness burns on adults within 36 hours of injury, then left intact for up to 14 days.

The importance of biomechanics and the kinetic chains of human movement in the development and treatment of burn scars - A narrative review with illustrative cases.

Background: Burn scars are a major clinical sequelae of severe burn wound healing. To effectively establish a successful treatment plan and achieve durable results, understanding the pathophysiology of scar development is of utmost importance.

Methods: A narrative review of the principles of the kinematic chain of movement and the hypothesised effect on burn scar development based on properties of burn scars was performed.

Management of foot burns with an emphasis on high-risk groups.

Background: Burns injuries are dynamic and evolve over time. Burn injuries to the feet present with seasonal variation, affecting clinical outcomes for certain high-risk groups. Although they affect a very small percentage of the body, burn injuries to the feet can affect mobility, morbidity and rehabilitation, particularly in patients with diabetes.

Effectiveness and safety of ablative fractional CO laser for the treatment of burn scars: A case-control study.

Background: Burn scars are a major clinical challenge. The aim of this study was to determine the effectiveness and safety of one treatment with the ablative fractional CO laser (AFL-CO) compared to standard burn scar treatment.

Method: From December 2014 to October 2018 patients were prospectively recruited and treatment effects analyzed by assessing various outcome parameters from the date of first consultation and after treatment.

Treatment of Partial Thickness Burns: A Prospective, Randomized Controlled Trial Comparing Four Routinely Used Burns Dressings in an Ambulatory Care Setting.

This prospective, randomized controlled trial study compared the effects of four dressings for adult partial thickness burns, focusing on re-epithelialization time and cost effectiveness. Adults with partial thickness burns meeting inclusion criteria were randomized to either Biobrane™, Acticoat™, Mepilex® Ag, or Aquacel® Ag. Primary endpoint for analysis was >95% re-epithelialization.

Foot burns: A comparative analysis of diabetic and non-diabetic patients.

Introduction: Foot burns represent a small part of the body with many challenges. The impact of diabetes on clinical outcomes adds further issues in management that clinicians must consider in their management. These factors have serious implications on morbidity and long term sequelae.

Ventilatory support in Stevens-Johnson syndrome and toxic epidermal necrolysis: a systematic review and meta-analysis.

Introduction: Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are blistering cutaneous disorders that often manifest with epidermal and mucosal necrosis. In extreme cases, the upper or bronchial airways are threatened, necessitating intubation and mechanical ventilation. This systematic review and meta-analysis examines the prevalence of mechanical ventilation (MV) in patients with SJS or TENS, despite maximal medical therapy, and additionally aims to identify the risk factors associated with this requirement.

Ablative fractional resurfacing for burn scar management affects the number and type of elective surgical reconstructive procedures, hospital admission patterns as well as length of stay.

Background: Reconstructive surgery remains the main approach to address burn scar contractures. Ablative fractional resurfacing is an increasingly popular tool for severe burn scar management, but its effect on overall burns reconstructive case-mix, operating time and patterns of hospital admission have not been reported.

Methods: Retrospective analysis of hospital administrative data from September 2013 to June 2017 was performed evaluating these effects of ablative fractional CO laser (CO-AFL).

Ablative fractional resurfacing with laser-facilitated steroid delivery for burn scar management: Does the depth of laser penetration matter?

Background And Objective: To investigate whether the depth of ablative fractional CO laser (CO -AFL) penetration of pathological burn scars influences clinical outcomes.

Study Design/materials And Methods: All patients presenting to the Concord Repatriation General Hospital (CRGH) Scar Clinic received ultrasound measurement at the thickest point of their burn scars. Subsequently, the effect of various CO -AFL settings (energy which correlates to penetration depths) on different outcome parameters was analysed.

Ablative Fractional Resurfacing in Acute Care Management of Facial Burns: A New Approach to Minimize the Need for Acute Surgical Reconstruction.

Current evidence suggests awaiting for scars to fully mature before engaging surgical reconstruction unless acute indications to prevent secondary damage, such as microstomia and eyelid ectropion are apparent. To evaluate the efficacy of ablative fractional CO2 laser intervention early in the acute treatment of panfacial burn injury. A 39-year-old Asian male with 60% TBSA flame burns including panfacial involvement was developing microstomia and upper and lower eyelid ectropion early proceeding epithelialization.

Dysphagia in older persons following severe burns: Burn location is irrelevant to risk of dysphagia and its complications in patients over 75 years.

Background: Management of burns in older persons is complex with evidence indicating advanced age is associated with elevated risk for morbidity and mortality. Dysphagia and its sequelae may further increase this risk.

Aims: (1) Determine the prevalence, and (2) identify risk factors for dysphagia in patients admitted with severe burn injury over 75 years.

Burn injury: Challenges and advances in burn wound healing, infection, pain and scarring.

Severe burn injuries are the most traumatic and physically debilitating injuries affecting nearly every organ system and leading to significant morbidity and mortality. Early burn wound excision and skin grafting are common clinical practices that have significantly improved the outcomes for severe burn injured patients by reducing mortality rate and days of hospital stay. However, slow wound healing, infection, pain, and hypertrophic scarring continue to remain a major challenge in burn research and management.

Laser Modulation of Hypertrophic Scars: Technique and Practice.

In this review, the authors discuss the use of laser photothermolysis and laser resurfacing in the management of hypertrophic burn scars. They provide details regarding preoperative selection, intraoperative decision making, and postoperative care.

Ablative fractional CO laser for burn scar reconstruction: An extensive subjective and objective short-term outcome analysis of a prospective treatment cohort.

Background: The introduction of ablative fractional CO lasers (CO-AFL) for burn scar management shows promising results. Whilst recent studies have focused on objective scar outcomes following CO-AFL treatment, to date no data on patient subjective factors such as quality of life are available.

Methods: A prospective study was initiated to analyze the safety and efficacy of the CO-AFL.

Microbiological findings in burn patients treated in a general versus a designated intensive care unit: Effect on length of stay.

Background: Infection is one of the most common causes of mortality and morbidity in burn patients. The incidence and frequency of microbiological micro-organisms are known to vary across different models of intensive care units. To date, no study has attempted to describe the different findings in burn patients treated in an open, general intensive care unit (GICU) versus a dedicated burns intensive care unit (BICU).

Risk factors for, and the effect of MRSA colonization on the clinical outcomes of severely burnt patients.

Background: MRSA is an on-going problem for burn patients.

Aim: To analyze risk factors for, and the effect of MRSA colonization on burn patients' outcome.

Methods: During 21 months burn patients' details and MRSA isolates were analyzed, and a case-control study performed.