DIETARY MANAGEMENT OF 30% TBSA FLAME BURN PATIENT WITH FACIAL BURN WITH T2DM WITH HTN IN A TERTIARY CARE HOSPITAL

In developing countries like India, burn injury is as yet a significant and regular reason for mortality and morbidity. Nutrition therapy aims to provide satisfactory and early nourishment to patients experiencing burn injuries. Metabolic help during increased inflammatory state is essential to make sure adequate treatment of burn patients. Nutritional sustain is a fundamental and indispensable part of consume care that requires an aggressive multifaceted approach. Impeded injury, dysfunction of multiple organs, increased chances of infection, and death are largely prevented by an adequate nutrition care along with proper wound management. In this study we detailed a patient having 30% TBSA flame burn with facial burn with T2DM & HTN and observed all require parameter in dietary management. The patient was suggested with high protein, moderate calorie, and moderate fat diet. As the sugar level of the patient was high i.e. ranges between 250-350 mg/dl, 5 ml Insulin was given to him at 3hr interval. With time, along with regular therapeutic diet the patient was took curd, paneer, chena etc. Albumin, globulin, total protein level of the patient was decreased so he also took coconut water, fruit juices (sugar free), milk, vegetable soups etc. As the sugar level of the patient was high i.e. ranges between 150-250 mg/dl, 3ml Insulin was given to him at 6hr interval. The wounds of the patient were started healing and he was active & fresh. The patient undertook a dietary counseling for 17 days and dietary modification was done according to the patient condition.

Evaluating a theory-based hypothesis against its complement using an AIC-type information criterion with an application to facial burn injury

An information criterion (IC) like the Akaike IC (AIC), can be used to select the best hypothesis from a set of competing theory-based hypotheses. An IC developed to evaluate theory-based order-restricted hypotheses is the GORIC. Like for any IC, the values themselves are not interpretable but only comparable. To improve the interpretation regarding the strength, GORIC weights and related evidence ratios can be computed. However, if the unconstrained hypothesis (the default) is used as competing hypothesis, the evidence ratio is not affected by sample-size nor effect-size in case the hypothesis of interest is (also) in agreement with the data. In practice, this means that in such a case strong support for the order-restricted hypothesis is not reflected by a high evidence ratio. Therefore, we introduce the evaluation of an order-restricted hypothesis against its complement using the GORIC (weights). We show how to compute the GORIC value for the complement, which cannot be achieved by current methods. In a small simulation study, we show that the evidence ratio for the order-restricted hypothesis versus the complement increases for larger samples and/or effect-sizes, while the evidence ratio for the order-restricted hypothesis versus the unconstrained hypothesis remains bounded. An empirical example about facial burn injury illustrates our method and shows that using the complement as competing hypothesis results in much more support for the hypothesis of interest than using the unconstrained hypothesis as competing hypothesis.

Resurfacing in Facial Burn Sequelae Using Parascapular Free Flap: A Long-Term Experience

Background It is difficult to treat large post burn sequelae (scars and defects) over face. Available methods include skin grafts, local flaps, tissue expansion, and free flaps. These surgical options should be chosen wisely, depending upon individual patient requirements and area involved. In patients with large post burn scars and defects in which the surrounding tissue is also involved, use of free tissue transfer is extremely useful. Patients and Methods A retrospective analysis was done between 2011 and 2019 of fifty-two cases with extensive facial burn deformities in whom secondary reconstruction was done with free parascapular flap cover in or department. Outcome was assessed by direct questionnaire. Results There was no complete flap loss in the series. Two cases were re-explored for venous insufficiency and suffered partial marginal necrosis. Twenty patients had to undergo further debulking procedure. Forty-seven patients were satisfied by the final outcome. Conclusion Post burn facial deformities are difficult to treat, in many cases there are no local options and tissue from different regions is to be used for reconstruction. Free parascapular flaps can be used as an effective method in such cases with a high level of patient satisfaction.

The Relationship of Orofacial Pain and Dental Health Status and Oral Health Behaviours in Facial Burn Patients

This study aims to examine the association of orofacial pain and oral health status and oral health behaviours in facial burn patients. The participants in this cross-sectional study were randomly recruited from the Burn Care Center, Institute of Medical Sciences, Islamabad, Pakistan. An intraoral evaluation was carried out to record the DMFT and OHI-S. A self-administered questionnaire was used to collect information on sociodemographic status, brushing frequency, and dental visits. Orofacial pain during mandibular movement was assessed using the Visual Analogue Scale (VAS). Psychological status was assessed using the Generalized Anxiety Disorder Scale and Impact of Events Scale. ANOVA and simple and multiple linear regression tests were used to analyse the data. From the 90 facial burn patients included, the majority were below 34 years of age, female, single or divorced, and unemployed. The mean DMFT was 10.7, and 71% had poor oral hygiene. 56% of the participants had moderate-to-severe anxiety, and 68% had posttraumatic stress disorder. 53% of the participants had moderate-to-severe pain during mouth opening or moving the mandible with a mean score of 41.5. Analyses showed that orofacial pain was associated with less frequent brushing, irregular dental visits, greater DMFT score, and more plaque accumulation (OHI-S). It was also associated with employment status, the severity of a burn, anxiety, and stress. The treatment and management of dental and oral conditions in burn patients need judicious balance in controlling and accurate assessment of the pain and improving psychological problems in burn patients.

541 72 Facial Burns Treated with Autologous Skin Cell Suspension- A Real World Data Analysis Across 5 U.S. Burn Centers

Introduction Optimal management of facial burn injuries remains a significant challenge in burn care. Acute surgical intervention is often coupled with delayed reconstructive procedures as an essential option for burn care. Experience with new surgical technologies could challenge historic reconstructive ladders. Our goal was to pragmatically assess the rate of successful intervention with autologous skin cell suspension (ASCS) for the treatment of facial burn injuries from real-world data. Methods A retrospective review from five burn centers over a three-year period was performed from deidentified registry data for facial burn injuries initially treated with ASCS. Cases of non-acute thermal burn and burns not involving the face were excluded. Data collection included: date of surgery, last follow-up date, need for grafting (split or full thickness skin graft, STSG or FTSG, respectively) or reapplication of ASCS within the same hospitalization, and reconstruction not including laser procedures due to scarring during the follow-up period. Descriptive statistics were calculated and data are reported as median with interquartile ranges where appropriate. Results A total of 72 burn injuries were treated with ASCS for facial burn injuries. Two burn centers treated 4 patients each, one treated 18, and the remaining two treated 22 and 24 patients. The median follow-up was 199 days (range 9 -1,150 days). Acute failure requiring a second treatment with ASCS or application of a full-thickness or split-thickness autograft occurred in 12 (16%) of the patients with 5 undergoing re-application of ASCS and 7 undergoing FTSG or STSG. reconstruction secondary to scarring during the follow-up period occurred in 10 (14%) of patients. Reconstruction was required in 1 of 5 patients that underwent a second treatment with ASCS as opposed to 4 of 5 patients treated with FTSG or STSG. Conclusions This study represents the largest experience with the use of ASCS for the management of facial burn injury in the reported literature. Use of ASCS from real-world data indicated that ASCS successfully resulted in definitive wound closure in 90% of the patients treated with facial burn injuries, with 10% requiring secondary intervention. This failure rate is below the previously published rate of 33%, indicating the disruptive potential of this technology for the management of facial burn injuries.