The enhanced Total Body Wrap—The new frontier in dressing care for burns

Low, O-Wern; Chong, Si Jack; Tan, Bien‐Keem

doi:10.1016/j.burns.2013.03.010

Cited by 17 publications

(7 citation statements)

References 4 publications

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“…Burn management has improved over the past decades with advances in fluid resuscitation, nutritional support, pulmonary care and infection control practices. This includes improvements in wound care/dressing, such as our previously described enhanced total body wrap technique using negative pressure wound therapy, which protects the wound from micro-organisms and provides an efficient channel to clear excessive exudate while keeping the wounds moist [ 15 ]. This reduces frequency of dressing changes and lowers infection rates through prevention of strikethrough [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…This includes improvements in wound care/dressing, such as our previously described enhanced total body wrap technique using negative pressure wound therapy, which protects the wound from micro-organisms and provides an efficient channel to clear excessive exudate while keeping the wounds moist [ 15 ]. This reduces frequency of dressing changes and lowers infection rates through prevention of strikethrough [ 15 ]. Of note, incidence of burn wound infections in our centre have been reducing over the years, from 50.2% in a 2003–2005 study [ 5 ] to 29.7% in our study.…”

Section: Discussionmentioning

confidence: 99%

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Quantifying the impact of inhalational burns: a prospective study

et al. 2018

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BackgroundInhalational injury is a major cause of morbidity and mortality in burns patients. This study aims to analyse the clinical outcomes, complications and bacteriology of inhalational burn patients.MethodsA prospective study was done on consecutive admissions to Burn Department, Singapore General Hospital over 15 months from January 2015 to March 2016. Presence of inhalational injury, demographics, complications and outcomes was recorded. Diagnosis of inhalational injury was based on history, symptoms and nasoendoscopy. Diagnosis of acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and infective complications were according to the Berlin criteria, acute kidney injury network (AKIN) classification stage 2 and above and the American Burns Association guidelines.ResultsThirty-five patients (17.3%) had inhalational burns out of 202 patients (63.4% male, 57.4% Chinese population). The average age was 43 ± 16.7 years (range 16–86), and percentage of total body surface area (%TBSA) was 12.1 ± 18.0 (range 0–88). In patients with inhalational injury, age was 38.9 ± 17.2 years and %TBSA was 30.3 ± 32.3. In patients without inhalational injury, age was 44.1 ± 12.8 years and %TBSA was 8.3 ± 9.59. Compared to patients with cutaneous injury alone, patients with inhalational burns had more surgeries (3 ± 7.07 vs 1 ± 1.54, p = 0.003), increased length of stay (21 days vs 8 days, p = 0.004) and higher in-hospital mortality rate (17.1% vs 0.6%, p < 0.001). Incidence of ARDS and AKI was 48.6% and 37.1%, respectively, compared to 0.6% and 1.2% in the patients without inhalational injury (p < 0.001). Patients with inhalational injury had increased incidence of bacteraemia (31.4% vs 2.4%, p < 0.001), pneumonia (37.1% vs 1.2%, p < 0.001) and burn wound infection (51.4% vs 25.1%, p = 0.004). Inhalational injury predicted AKI with an adjusted odds ratio (OR) of 17.43 (95% confidence interval (CI) 3.07–98.87, p < 0.001); ARDS, OR = 106.71 (95% CI 12.73–894.53, p < 0.001) and pneumonia, OR = 13.87 (95% CI 2.32–82.94, p = 0.004). Acinetobacter baumannii was the most frequently cultured bacteria in sputum, blood and tissue cultures with inhalational injury. Gram-negative bacteria were predominantly cultured from tissue in patients with inhalational injury, whereas gram-positive bacteria were predominantly cultured from tissue in patients without inhalational injury.ConclusionsInhalational injury accompanying burns significantly increases the length of stay, mortality and complications including AKI, ARDS, infection and sepsis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Quantifying the impact of inhalational burns: a prospective study

et al. 2018

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“…While emergency free flaps used to be the maxim when underlying bone and tendons are exposed (i.e., Tajima 3 defects) [23], recent evidence suggests that NPWT in the form of vacuum assisted closure (VAC) devices may potentially help simplify the final reconstructive option (i.e., STSGs or transposition flaps rather than free tissue transfers) required without compromising on the final clinical outcome promoting granulation tissue formation to prepare the wound bed for definitive closure [5]. Moreover, there are now increasing reports on the use of VAC devices in a circumferential manner in burns [24][25][26] and lower extremity degloving [27,28]. Additionally, VAC dressings have proven utility in helping to secure and improve STSG take [29], and has been used in clinical hand burns to prevent further progression of thermal injury through increased perfusion and reduction of edema [30].…”

Section: Discussionmentioning

confidence: 99%

Soft Tissue Reconstruction of Complete Circumferential Defects of the Upper Extremity

Tan

Lellouch

et al. 2017

Arch Plast Surg

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BackgroundUpper extremity soft tissue defects with complete circumferential involvement are not common. Coupled with the unique anatomy of the upper extremity, the underlying etiology of such circumferential soft tissue defects represent additional reconstructive challenges that require treatment to be tailored to both the patient and the wound. The aim of this study is to review the various options for soft tissue reconstruction of complete circumferential defects in the upper extremity.MethodsA literature review of PubMed and MEDLINE up to December 2016 was performed. The current study focuses on forearm and arm defects from the level at or proximal to the wrist and were assessed based on Tajima's classification (J Trauma 1974). Data reviewed for analysis included patient demographics, causality, defect size, reconstructive technique(s) employed, and postoperative follow-up and functional outcomes (when available).ResultsIn accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 14 unique articles were identified for a total of 50 patients (mean=28.1 years). Underlying etiologies varied from extensive thermal or electrical burns to high impact trauma leading to degloving or avulsion, crush injuries, or even occur iatrogenically after tumor extirpation or extensive debridement. Treatment options ranged from the application of negative pressure wound dressings to the opposite end of the spectrum in hand transplantation.ConclusionsWith the evolution of reconstructive techniques over time, the extent of functional and aesthetic rehabilitation of these complex upper extremity injuries has also improved. The proposed management algorithm comprehensively addresses the inherent challenges associated with these complex cases.

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“…The enhanced total body wrap is a novel technique which was introduced in 2013. By using 3 -4 NPWT devices, long thin foam dressing stripes and covering the whole body in air-tight plastic film this technique was proven to be effective in partial thickness burns with a high percentage of total body surface area (TBSA) [29]. Topical antiseptics such as silver based dressings are ubiquitously used in burn treatment.…”

Section: Npwt In Burn Therapymentioning

confidence: 99%