Characteristics, Treatments and Outcomes in Patients with Severe Burn Wounds; a 10 Year Cohort Study on Acute and Reconstructive Treatment

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2024 Nov 22

PMID 39576769

Authors

Lucindi Smit

Anouk Pijpe

Cindy Nguyen

Tara Hartsuiker

Matthea Stoop

Anouk van Heel

Eelke Bosma

Cornelis H van der Vlies

Paul P M van Zuijlen

Margriet E van Baar

Esther Middelkoop

Affiliations

Soon will be listed here.

Abstract

Reports on treatment characteristics and long term outcomes for severe burns are scarce, while the need to compare outcomes of novel treatment modalities to standard of care is increasing. Our national database on burn treatment enabled analysis of patient as well as treatment characteristics during acute treatment and following reconstructive procedures. Furthermore, outcome data of longitudinal scar assessments were analysed from a single burn centre database. Acute and reconstructive data were analysed for patients admitted to the three Dutch burn centres with total body surface area burned of ≥ 20% TBSA. Long term outcome was analysed from a single centre scar database, both for a period of 2009-2019. Treatment characteristics from 396 surviving acute burn patients were analysed. Surgical treatment was required in 89.6% of these patients and 110 patients (27.8%) needed reconstructive surgery in the years after the burn incident, with a mean of 4.4 reconstructive procedures per patient. Main indications were contractures (70.5%) and arms (45.0%) and head and neck region (41.2%) were most frequently affected. Techniques used for reconstructive corrections were predominantly excision, release and flaps (54.7%), followed by skin transplants (32.4%). Scar quality was significantly worse in patients with more severe burns compared to those with TBSA < 20% during prolonged times. These data provide insight into health care utilization, treatment characteristics and outcomes in severely burned patients. These real-world data can guide future development of improved treatment strategies for at risk patients as well as anatomical locations.

References

Oosterwijk A, Mouton L, Schouten H, Disseldorp L, van der Schans C, Nieuwenhuis M . Prevalence of scar contractures after burn: A systematic review. Burns. 2016; 43(1):41-49. DOI: 10.1016/j.burns.2016.08.002. View

Buta M, Donelan M . Evolution of Burn Care: Past, Present, and Future. Clin Plast Surg. 2024; 51(2):191-204. DOI: 10.1016/j.cps.2023.10.002. View

Zavlin D, Chegireddy V, Boukovalas S, Nia A, Branski L, Friedman J . Multi-institutional analysis of independent predictors for burn mortality in the United States. Burns Trauma. 2018; 6:24. PMC: 6103989. DOI: 10.1186/s41038-018-0127-y. View

van der Wal M, Vloemans J, Tuinebreijer W, van de Ven P, van Unen E, van Zuijlen P . Outcome after burns: an observational study on burn scar maturation and predictors for severe scarring. Wound Repair Regen. 2012; 20(5):676-87. DOI: 10.1111/j.1524-475X.2012.00820.x. View

Bottcher-Haberzeth S, Biedermann T, Reichmann E . Tissue engineering of skin. Burns. 2009; 36(4):450-60. DOI: 10.1016/j.burns.2009.08.016. View

Spronk I, Polinder S, Van Loey N, van der Vlies C, Pijpe A, Haagsma J . Health related quality of life 5-7 years after minor and severe burn injuries: a multicentre cross-sectional study. Burns. 2019; 45(6):1291-1299. DOI: 10.1016/j.burns.2019.03.017. View

Cartotto R, Johnson L, Savetamal A, Greenhalgh D, Kubasiak J, Pham T . American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. J Burn Care Res. 2023; 45(3):565-589. DOI: 10.1093/jbcr/irad125. View

Tapking C, Panayi A, Haug V, Palackic A, Houschyar K, Claes K . Use of the modified meek technique for the coverage of extensive burn wounds. Burns. 2024; 50(4):1003-1010. DOI: 10.1016/j.burns.2024.01.005. View

Kruger E, Kowal S, Bilir S, Han E, Foster K . Relationship Between Patient Characteristics and Number of Procedures as well as Length of Stay for Patients Surviving Severe Burn Injuries: Analysis of the American Burn Association National Burn Repository. J Burn Care Res. 2020; 41(5):1037-1044. PMC: 7510847. DOI: 10.1093/jbcr/iraa040. View

10.

Hoogewerf C, van Baar M, Middelkoop E, Van Loey N . Patient reported facial scar assessment: directions for the professional. Burns. 2013; 40(2):347-53. DOI: 10.1016/j.burns.2013.07.015. View

11.

Wallace H, Fear M, Crowe M, Martin L, Wood F . Identification of factors predicting scar outcome after burn injury in children: a prospective case-control study. Burns Trauma. 2017; 5:19. PMC: 5494810. DOI: 10.1186/s41038-017-0084-x. View

12.

Kenny E, Lagziel T, Hultman C, Egro F . Skin Substitutes and Autograft Techniques: Temporary and Permanent Coverage Solutions. Clin Plast Surg. 2024; 51(2):241-254. DOI: 10.1016/j.cps.2023.12.001. View

13.

Lisiecki J, Buta M, Taylor S, Tait M, Farina N, Levin J . Efficacy of Mepliex Ag Versus Xeroform As A Split-Thickness Skin Graft Donor Site Dressing: Bad Habits Die Hard. Ann Burns Fire Disasters. 2024; 36(3):243-250. PMC: 11041881. View

14.

da Costa P, Echevarria-Guanilo M, Goncalves N, Girondi J, Goncalves A . Subjective Tools for Burn Scar Assessment: An Integrative Review. Adv Skin Wound Care. 2021; 34(6):1-10. DOI: 10.1097/01.ASW.0000749732.09228.a9. View

15.

Golinski P, Menke H, Hofmann M, Valesky E, Butting M, Kippenberger S . Development and Characterization of an Engraftable Tissue-Cultured Skin Autograft: Alternative Treatment for Severe Electrical Injuries. Cells Tissues Organs. 2015; 200(3-4):227-39. DOI: 10.1159/000433519. View

16.

Meuli M, Hartmann-Fritsch F, Huging M, Marino D, Saglini M, Hynes S . A Cultured Autologous Dermo-epidermal Skin Substitute for Full-Thickness Skin Defects: A Phase I, Open, Prospective Clinical Trial in Children. Plast Reconstr Surg. 2019; 144(1):188-198. DOI: 10.1097/PRS.0000000000005746. View

17.

Hop M, Langenberg L, Hiddingh J, Stekelenburg C, van der Wal M, Hoogewerf C . Reconstructive surgery after burns: a 10-year follow-up study. Burns. 2014; 40(8):1544-51. DOI: 10.1016/j.burns.2014.04.014. View

18.

Draaijers L, Tempelman F, Botman Y, Tuinebreijer W, Middelkoop E, Kreis R . The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg. 2004; 113(7):1960-5. DOI: 10.1097/01.prs.0000122207.28773.56. View

19.

Dokter J, Vloemans A, Beerthuizen G, van der Vlies C, Boxma H, Breederveld R . Epidemiology and trends in severe burns in the Netherlands. Burns. 2014; 40(7):1406-14. DOI: 10.1016/j.burns.2014.03.003. View

20.

Rijpma D, Claes K, Hoeksema H, De Decker I, Verbelen J, Monstrey S . The Meek micrograft technique for burns; review on its outcomes: Searching for the superior skin grafting technique. Burns. 2022; 48(6):1287-1300. DOI: 10.1016/j.burns.2022.05.011. View