Wound Healing Southern Africa - Volume 6, Issue 2, 2013
Volume 6, Issue 2, 2013
Author Nikki AllortoSource: Wound Healing Southern Africa 6 (2013)More Less
Burn injury remains one of the neglected epidemics in South Africa. Funding to specialised units, which are hopelessly small in number, is shamefully inadequate, as resources are channeled to the more politically sensitive HIV and TB crises. The labour intensive and very unglamorous nature of burns management does not attract health care practitioners, nurses and therapists to the field. High morbidity and mortality rates, difficult and extensive wounds, disfigured patients, distraught relatives, all contribute to the emotional strain on dedicated Burn Unit care givers, who are already greatly under-resourced and in desperately short supply.
New insights in the pathophysiology of burns : implications for the prevention of wound progression : SA Burn Society CongressAuthor D. Den HollanderSource: Wound Healing Southern Africa 6, pp 50 –53 (2013)More Less
Traditionally burn shock has been considered a form of hypovolaemic shock. Medical students used to be taught that the burn patient developed shock because large amounts of fluid and proteins leaked out through the burn wound. This has now been proven to be a much too simplistic picture. For instance, the amount of fluid leaking out through the burn wound is less with deeper burns than with superficial burns, as in the former most of the skin vessels have been thrombosed and therefore cannot leak. Yet the shock is more profound in deep burns. Indeed, most of the fluid loss in large, deep burns does not occur in the burn wound, but through leaky capillaries in the non-burned areas of the body. On the other hand, at the end of the first week after a major burn, most of the burn oedema is resorbed, despite a fall in albumin levels.
Author A.D. RogersSource: Wound Healing Southern Africa 6, pp 54 –55 (2013)More Less
Best outcomes are achieved with the application of early excision and grafting, but availability limits this in the major burn. Cadaver skin is undoubtedly the best alternative to autograft, but ready supply is unreliable, and legislative and cultural restrictions have significantly influenced availability. This review summarises the indications for cadaver skin in burn surgery and complex wound care. The South African Burn Society prioritises the establishment of a deceased donor skin bank in South Africa, whose mandate it would be to procure and store allograft for distribution to burns units when required.
Telemedicine, mobile phones and burn wound assessment and management : a valid resource for South Africa? : SA Burn Society CongressAuthor M.G.C. Giaquinto-CilliersSource: Wound Healing Southern Africa 6, pp 56 –59 (2013)More Less
Access to specialist care in the management of burn injuries may be possible through the use of telemedicine. The burned area extent and depth are mainly visual, allowing the transmission of digital images from remote areas in rural South Africa to higher levels of care, such as burn units. Regulations to keep patient's confidentiality and safe transmission and use of the images must be achieved through a proper discussion of the medico-legal issues with the official statutory body.
Source: Wound Healing Southern Africa 6, pp 63 –77 (2013)More Less
Author A.D. WidgerowSource: Wound Healing Southern Africa 6, pp 79 –86 (2013)More Less
Burn injury outcome has improved significantly in recent years in relation to survival and patient rehabilitation. However, scarring and its accompanying aesthetic and functional sequelae still remain a major problem. The burn injury is characterized by unique differences in the nature of tissue trauma, the pathophysiologic response to that trauma and the molecular events that impact on the evolution of scar formation in these injuries. Some nuances in the burn injury profile have direct influence on scar outcome but have not been concentrated on in the past when designing treatment regimens for scar control. These include the exposed nerve endings, stimulation of neuropeptide mediators, neurogenic inflammation, pruritis, mechanotension signaling and hydration. A composite device for scar control in burn injuries should involve a multimodal approach that incorporates strategies for control of these contributing factors. A protective, hydrative, tension relieving device is predominant among the requirements, with substance impregnation being a secondary possibility in future renditions.
Author A. PrinsSource: Wound Healing Southern Africa 6, pp 87 –93 (2013)More Less
The incidence of burn injuries is on the increase in Africa due to migration to urban areas and the development of slum areas, but there is a paucity of such data on the African continent. The South African Medical Research Council has indicated that 3.2% of the South African population is burned annually, with 50% of individuals who suffer burns being younger than 20 years. The Red Cross Children's Hospital admits 650 to 900 children with burn injuries annually.
Burn injury, the most severe type of injury from a metabolic point of view, is characterised by the most profound alterations in basal metabolic rate and urinary nitrogen excretion. In addition, requirements for and/or metabolism of macro- and micronutrients are altered or increased. The major improvement in burn survival can be attributed to many factors, one being the development and implementation of improved methods of nutritional support that optimise host defences, enhance wound healing and support the metabolic response to stress. The greatest threats to survival from burns are still infection/sepsis, with burn wound sepsis and nosocomial pneumonia, including ventilator-associated pneumonia (VAP), being the leading causes of death. Effective medical nutrition therapy in patients with burn injuries requires an understanding of the physiologic and metabolic alterations that accompany the burn injury, alterations in the immune system and the role of reactive oxygen species (ROS).
The use of Acticoat® and Pin Sealer® to reduce the rate of pin-site sepsis with external fixators of the tibia : original researchSource: Wound Healing Southern Africa 6, pp 94 –97 (2013)More Less
A prospective randomised trial was performed to compare Acticoat® dressings with or without Pin Sealer, to plain gauze soaked with Betadine® ointment with or without Pin Sealer, as a dressing for the pin sites of external fixators. Twenty-five patients with 224 pin sites on open tibial fractures were followed-up for weekly observation for six weeks. The pin sites were graded from 1-6 in increasing order of severity and the dressings changed weekly. The average pin site grading of Acticoat® with Pin Sealer was 1.399, Acticoat® without Pin Sealer 1.452, Betadine® without Pin Sealer 1.646 and Betadine® with Pin Sealer 1.805. Statistical analysis showed that Acticoat® with Pin Sealer had a lower pin site grading than Betadine® with Pin Sealer.
Author Alan RogersSource: Wound Healing Southern Africa 6 (2013)More Less