Eur. Burn J., Volume 5, Issue 1 (March 2024) – 5 articles

Burns are commonly encountered in the battlefield environment; however, the availability of burn expertise and specialized supplies is variable. Initial burn care should remain focused on cooling the burn, preventing hypothermia, basic wound cleansing, and evacuation. Key ongoing burn wound management principles include wound debridement, accurate burn size and depth estimation, wound care, ongoing wound evaluation, and treatment of suspected Gram-negative wound infection. Operative management should be limited to urgent procedures, and definitive burn management should be performed only after evacuation to a higher level of care. Flexibility, creativity, and the ability to adapt care to the tactical environment are key to the successful management of burn injuries in battlefield and austere settings. Full article

Descriptive clinical tools for characterizing burn scars are limited by between-user variability and unknown sensitivity to change over time. We previously described preclinical assessment of stereophotogrammetry as a valid measure of burn-related scars. Here, we compared the estimated vs. instrumented measurements of maximum height and total positive volume of 26 burn scars. The burn scars were imaged with the QuantifiCare LifeViz Micro 3D camera. Three experienced wound care therapists first estimated, then measured using 3D Track software, the imaged scars’ height and volume. Two-factor analysis without replication was performed to calculate intraclass correlation coefficients (ICCs) between assessors’ estimated scar height and volume, and measured height and volume. Two-sided Wilcoxon tests were performed comparing the mean estimated height and volume with the estimated and measured outputs. The estimated scar height’s ICC was 0.595, and for volume, it was 0.531. The measured scar height’s ICC was 0.933 and for volume, it was 0.890. The estimated and measured volume were significantly different (z = −2.87, p = 0.041), while the estimated and measured height were not (z = −1.39, p = 0.161). Stereophotogrammic measurement of scar height and volume is more reliable than clinical photograph assessment. Stereophotogrammetry should be utilized when assessing burn scar height and volume, rather than subjective estimates from clinical scar tools. Full article

Burn injuries are a constant threat in war. Aspects of the modern battlefield increase the risk of burn injuries and pose challenges for early treatment. The initial resuscitation of a severely burn-injured patient often exceeds the resources available in front-line medical facilities. This stems mostly from the weight and volume of the intravenous fluids required. One promising solution to this problem is enteral resuscitation with an oral rehydration solution. In addition to being logistically easier to manage, enteral resuscitation may be able to mitigate secondary injuries to the gut related to burn shock and systemic immunoinflammatory activation. This has been previously studied in burn patients, primarily using electrolyte solutions, with promising results. Modern ORS containing sodium, potassium, and glucose in ratios that maximize gut absorption may provide additional benefits as a resuscitation strategy, both in terms of plasma volume expansion and protection of the barrier and immune functions of the gut mucosa. While enteral resuscitation is promising and should be used when other options are not available, further research is needed to refine an optimal implementation strategy. Full article

Occupational therapy has been integral to the holistic recovery of soldiers since its origin. The positive psychosocial and physiological effects of occupation-based interventions, fundamental to the profession, have long justified its relevance to the military. As such, occupational therapy has been written into US Army doctrine as an integral component of the Combat and Operational Stress Control (COSC) program. The focus of a COSC unit is to prevent, identify, reduce, and manage combat and operational stress reactions resulting from physical and mental stressors in a combat environment. COSC centers around the recognition and resolution of functional problems and the development of enhanced coping skills. Recognizing that burn patients are, like combatants, also at high risk of stress-related illness, we applied COSC concepts to peacetime burn care. In this paper we describe the theoretical basis for COSC in a burn center. The COSC model supports holistic, functional recovery of the burn casualty and can augment psychosocial recovery, particularly in times of limited resources. Full article

Outside the United States, bromelain-based enzymatic debridement (BBED) has become an effective tool for the removal of burn eschar. A primary concern with BBED is that it is a painful procedure requiring appropriate analgesia. The purpose of this study was to describe our experience using NexoBrid^® (NXB), with a particular focus on pain management. We performed a retrospective review on all 32 adult burn patients enrolled at our institution as part of a multicenter phase 3 clinical trial (DETECT) or the expanded access treatment protocol (NEXT). All patients underwent BBED with NXB of acute deep partial- and full-thickness thermal burn wounds at a major burn center between November 2016 and February 2023. Thirty-two patients with an average age of 42.1 years (SD = 17.4, range 18–72) and an average TBSA of 6.3% (SD = 5.9, range 1–24.5) underwent a total of 33 BBED procedures. Only one patient required an additional NXB treatment, and all patients achieved >95% eschar removal. For pain control during debridement, seven patients required a local block (LB), nine a regional block (RB), and thirteen conscious sedation (CS). Three patients were intubated (INTB) for their burn injury prior to the procedure. There was no statistical difference in Numerical Pain Rating Scale (NPRS) scores during vs. before treatment or after vs. before treatment for all patients or when subdivided by BMI, race, TBSA, total area treated, and anesthetic type (LB, RB, and CS). With appropriate analgesia, the pain associated with BBED of acute deep partial- and full-thickness thermal burns is well tolerated. Full article