Burn injuries remain a significant cause of morbidity and mortality, particularly among patients requiring intensive care. This retrospective study analyzed 66 burn patients admitted to the Burn ICU at Cipto Mangunkusumo Hospital, Indonesia, from January 2023 to December 2024, aiming to identify the primary causes of death, including sepsis, acute respiratory distress syndrome (ARDS), renal failure, gastrointestinal bleeding, and inhalation injury. The cohort had a mean age of 40.8 years, with a predominance of male patients (65.2%). The average total body surface area (TBSA) burned was 51.1%, and half of the patients sustained full-thickness burns. Inhalation injuries were present in 48.5% of cases. Sepsis emerged as the most common complication (83.1%), followed by ARDS (40.0%) and kidney failure (15.4%). Surgical interventions were performed in 69.7% of patients, with early tangential excision conducted in over half. Despite these efforts, the mortality rate remained high at 69.2%, and the mean abbreviated burn severity index (ABSI) score was 9.58. These findings highlight the critical burden of sepsis in burn-related deaths and underscore the need for enhanced infection control, early surgical management, and comprehensive ICU protocols to improve outcomes in this high-risk population.
Foot burns involve a small total body surface area but may cause significant functional impairment. Deep thermal foot burns often require surgical excision and split-thickness skin grafting, yet the optimal timing of grafting remains debated. Our objective is to describe patient characteristics, surgical management and healing outcomes of isolated deep thermal dorsal foot burns treated at a single burn centre. We conducted a retrospective cohort study including all patients surgically treated for partial- or full-thickness dorsal thermal foot burns at the Burn Centre of the University Hospital of Lille between 2021 and 2023. Two surgical strategies were used: excision followed by delayed grafting and single-stage excision with immediate grafting. Healing times were analyzed per burned foot. Sixty-three patients (75 feet) were included. Patients treated with delayed grafting were older and more frequently had bilateral foot burns. Burn severity was comparable between groups. Post-operative healing time was significantly shorter after single-stage excision and grafting, whereas total healing time from burn injury did not differ significantly. Dermal matrix use was not associated with differences in healing time. In this real-life retrospective cohort, single-stage excision and immediate grafting were associated with faster post-operative healing, while overall healing time remained similar between surgical strategies. Differences between groups reflect clinical decision-making based on patient and wound characteristics rather than a protocol-driven approach.
This retrospective descriptive epidemiological study aimed to investigate the incidence of burns during the cold season compared to other times of the year and to identify associated risk factors and clinical characteristics among hospitalized patients. A total of 402 medical records of patients admitted to the burn unit at the Department of Surgery, Udon Thani Hospital, between January 1, 2022, and December 31, 2024, were reviewed. Descriptive statistics were used to analyze demographic characteristics and incidence. Comparisons between the cold season and other seasons were conducted, and associations between risk factors and clinical outcomes were tested using the Chi-square test. The incidence of burns increased over the three-year period. Incidence during the cold season was 1.65 times higher than in other seasons (OR=1.65). Most patients were elderly females, and the majority of burns occurred due to domestic accidents. Adults were significantly more likely to sustain severe burns than other age groups (χ2=28.45, df=15, p=0.019). Complications were significantly associated with burn severity (χ2=45.78, df=3, p<0.001) and treatment costs (χ2=89.34, df=2, p<0.001). These findings indicate a higher burden of burn injuries during the winter, particularly among the elderly and women. Targeted prevention efforts, such as public safety education and improved first-aid training, are needed. Enhancing treatment protocols and referral systems could further reduce complications and the economic impact of burn injuries.
Indonesia, a country with a high incidence and burden of burn injuries, still faces limited numbers and uneven distribution of burn units, as well as the absence of operational guidelines. This review analyzes global burn unit operational systems to identify best practices that can be adapted for the development and optimization of burn units in Indonesia. A systematic search was conducted in electronic databases, including PubMed, Science Direct, Sage Journals, and MEDLINE. Inclusion criteria comprised studies focusing on managerial aspects of burn units. Literature search was done according to PRISMA guidelines, and included studies were critically appraised. Following screening and eligibility assessment of 1,046 studies, 20 studies were included in the review. A total of 6 guidelines provided recommendations for burn unit operational systems, and 13 studies offered recommendations for developing burn unit operational systems that could be implemented in Indonesia. Indonesia can adopt approaches from international guidelines to establish more burn units in priority areas based on needs, with operational design guidelines aligned with global standards to enhance the quality of care nationwide. Analysis of global burn unit operational systems successfully identified guidelines and recommendations for the development and management of burn units in Indonesia.
Management of burn wounds is challenging. Dressing changes, especially in paediatric burn patients, are a major concern. To address these challenges, numerous methods and advanced dressing materials have been developed. Collagen, a biocompatible material easily derived from natural sources, has emerged as a promising option. The primary goals are early wound healing, reduced pain sensitivity, and fewer dressing changes in the paediatric population. A prospective observational study was conducted among 38 paediatric patients, under 12 years of age, with scald burns. The study was conducted from 1st January 2024 to the end of October 2024. When a patient was admitted with scald burn, the wound was cleaned with normal saline and collagen materials were applied over the wound. This was followed by paraffin impregnated gauze and dry dressing. The first dressing was opened on day 5 and followed by dressing every 3 to 4 days until the wound healed. Thirty-three out of 38 patients (87%) were discharged within 12 days. Infection was found in 5 patients. No adverse reaction due to the application of collagen was observed. Collagen-based dressing is an important dynamic for burn wound management. Frequent change of dressing is avoided, with a significant impact on pain and psychological trauma among the paediatric population.
Burns are a major life altering event affecting the physical well-being of an individual and often resulting in emotional distress amongst the victims. We sought to explore the complex dynamics between social support and adult burn victims, aiming to verify an association between them and explore factors associated with self-esteem and factors predictive of self-esteem. We conducted a retrospective cross-sectional correlational predictive study in the Department of Plastic Reconstructive and Aesthetic Surgery and in the Burns Unit of Habib Bourguiba University Hospital in Sfax between January 2012 to December 2022. Thirty-three patients were included. Their mean age was 37.88 years (range: 19-55 years) with a male predominance (sex ratio=1.576/1). The average self-esteem score was 29.45±4.36, with 51.5% of patients showing low self-esteem. 48.5% of patients received significant social support, primarily from family (63.6%). Low self-esteem seems to be a major hurdle in the path to emotional wellbeing for burn survivors and should be a focal point in medical care.
Enterococcus species are a common cause of nosocomial bacteremia, affecting patients with severe comorbidities. They are often associated with significant morbidity and mortality. A prognostic, observational, mono-centric and retrospective study was conducted in the intensive burn care unit over 4 years, from January 2020 - December 2023. Burn patients who had at least one episode of Enterococcus spp. bacteremia were included. Out of 1,566 admitted patients, 102 developed at least one Enterococcus bacteremia (an incidence of 7.3%), of which 88 patients were retained for analysis. A total of 104 enterococcal bacteremias were observed. The most common species was E. fæcium (58.7%). Twenty-four percent of the strains were resistant to teicoplanin, and 28.8% were resistant to vancomycin. No resistance to tigecycline or linezolid was noted. The median time to the onset of bacteremia was 7 days, and it was complicated by septic shock in 40.4% of cases. Bacteremia was primitive in 96% of cases and polymicrobial in 78,8% of cases. Median ICU length of stay was 22 days. Mortality was 55.7%. Independent factors associated with mortality due to enterococcal bacteremia were: occurrence of ARDS (acute respiratory distress syndrome), acute renal failure, fungal infection, and Enterococcus resistance to vancomycin.
Burn sequelae of the popliteal fossa cause significant functional impairment, with aesthetic and psychological consequences. Flexion contractures are the most frequent, and several therapeutic classifications exist; however, the clinical heterogeneity of these sequelae makes it difficult to establish a consensus. A retrospective study (January 2014 to January 2022) included 20 patients who underwent surgical treatment for major burn sequelae of the popliteal fossa. Functional outcomes were assessed using the Ogawa and Pribaz, and Baux and Mimoun classifications. The median age was 15.5 years, with a male predominance (sex ratio=1.5). Sixty percent of patients were from rural areas, and 55% received initial non-specialized management. Skin contractures were present in 90% of cases, with a severe knee extension deficit in 89%. Reconstruction involved local techniques such as Z-plasties (40%) and locoregional flaps (pedicled transposition or perforator flaps; 45%). These two categories were analyzed separately due to their distinct anatomical and technical considerations. Final functional outcomes were considered good to excellent in 80% of cases after a median follow-up of 1.15 years. Children are particularly susceptible to popliteal fossa burn sequelae, with a risk of recurrence. The quality of initial management influences the severity of sequelae. Surgical intervention is indicated in the presence of ulceration or significant functional impairment. Local flaps demonstrated good results with fewer recurrences. The main limitations of this study include the small sample size, its retrospective nature, and limited follow-up. A management algorithm for retractile sequelae has been proposed and requires prospective validation.
Burn injuries in elderly patients often present complex clinical and psychological challenges, especially when compounded by functional decline, emotional vulnerability, and spiritual distress. This case series illustrated a holistic psychotherapeutic approach implemented in a consultation-liaison psychiatry (CLP) setting for three elderly burn patients, each with unique psychological and spiritual needs. Interventions included supportive psychotherapy to address anxiety and mood disturbances, involvement of family members to enhance emotional security and reduce treatment resistance, spiritual facilitation aligned with patients' religious values, and cognitive reorientation techniques to manage episodes of acute confusion and delirium. These tailored approaches proved effective in improving patients' emotional adjustment, cooperation with care, and treatment adherence. The integration of psychotherapeutic, familial, and spiritual interventions underscores the importance of culturally sensitive and individualized CLP strategies for elderly burn survivors. However, the findings are limited by the small sample size and the qualitative nature of the data, which may restrict generalizability. Nevertheless, these observations highlight the value of interdisciplinary collaboration in optimizing recovery and psychological well-being among older adults in burn units.
A burn is an acute, more or less complete destruction of the skin covering by a thermal, chemical or electrical source. It causes significant morbidity and mortality and requires specialized care that is often very expensive for the people exposed to it. Our objective is to describe the epidemiological characteristics of seriously burned patients admitted to the Army training hospital Omar Bongo Ondimba Burn Center. Our work is a retrospective study of patients admitted for serious burns and who received treatment in the burn center of the Omar Bongo Ondimba Army Training Hospital in Libreville over a period of time of 10 years from January 1, 2012 to December 31, 2022. During the period, 214 patients were admitted with an average frequency of 22 patients per year. The average age was 28 years with the extremes of 1 month and 100 years. The male gender made up 56.5%. Domestic accidents represented 74.3%, work accidents 11.7% and accident on the public highway 5.6% of cases. The burn was thermal in 90.7%, electrical in 11.7%, chemical in 1.4% and immunological in 1.9% of cases. Their depth was mainly second degree, with an average extent of 41.5%. The BAUX index was on average 67.8% and the most common ABSI score was between 6-7. The average length of hospitalization was 11 days. The evolution was favorable in 45.8% of cases with a mortality of 50.9%. Burns pose a public health problem in developing countries. Knowledge of the epidemiological profile makes it possible to put in place means of prevention and adequate care.
Managing extensive pediatric burns is particularly challenging when patients present late with severe systemic complications and when surgical interventions face operational difficulties. Delayed referral increases the risk of sepsis, coagulopathy and metabolic disturbances, while limitations in essential equipment, such as dermatomes and mechanical meshers, further complicate treatment. Alternative techniques are needed to optimize wound coverage and improve outcomes in resource-limited settings. A 2-year-old female patient with 37.5% TBSA deep dermal to third-degree scald burns was referred nine days post-injury in critical condition with sepsis, thrombocytopenia, hypoalbuminemia and significantly elevated D-dimer levels. She underwent serial excisional debridement and multiple skin grafting procedures. Due to operational challenges in standard meshing, the fold-and-cut technique was used, allowing a 4.8-fold expansion of autologous grafts. A living-related allograft from her grandfather was applied as a temporary biological dressing to support epithelialization and reduce grafting needs. The autografts and allograft successfully integrated, leading to epithelialization, systemic stabilization, and functional recovery. At three months post-surgery, she had shown significant improvement, and one year post-discharge she could stand and attend school normally. This case highlights the ability to thrive despite limitations by adapting surgical techniques and leveraging available resources. The fold-and-cut technique and living-related allografts provided a feasible and cost-effective solution, proving that innovation and improvisation can yield favorable outcomes even in the most constrained environments. These findings demonstrate that similar low-resource settings can adopt and modify these techniques to improve burn care where access to advanced technology is limited.
This study aims to identify prognostic factors influencing mortality among work-related burn patients in Northern Vietnam. A retrospective cohort study was conducted on 395 work-related burn patients admitted to the Vietnam National Burn Hospital (VNBH) from January 1 to December 31, 2023. Patient data were extracted from the VNBH electronic database, including demographic characteristics, burn severity, first aid interventions, comorbidities, clinical signs, and blood biomarkers. Univariate and multivariate logistic regression analyses were applied to determine independent predictors of mortality. The study population comprised 310 men (78.5%) and 85 women (21.5%), with a mean age of 36.7±12.9 years. Most patients were workers (87.9%) and resided in rural areas (52.7%). The predominant causes of burns were flames (46.1%) and electrical injuries (34.4%). The majority of patients (74.4%) sustained full-thickness burns, with 50.4% having a total burn surface area (TBSA) <20%. The overall mortality rate was 12.2%. Univariate analysis identified significant associations between mortality and fluid resuscitation (p=0.01), burn shock (p<0.001), facial burns (p<0.05), inhalation injury (p<0.001), full-thickness burns >20% (p<0.001), and complications (p<0.001). Multivariate analysis revealed that incorrect or absent fluid resuscitation (OR=2.3), burn shock (OR=3.7), facial burns (OR=3.5), neuropathy (OR=5.1), respiratory disease (OR=3.3), full-thickness burns (21-49%) (OR=4.2), serum glucose ≥9 mmol/L (OR=3.0), inhalation injury (OR=7.3), and full-thickness burns >50% (OR=6.7) were significant independent predictors of mortality (p<0.05). Work-related burn injuries remain a significant occupational hazard in Northern Vietnam. Factors such as inhalation injury, extensive full-thickness burns, burn shock and hyperglycemia substantially increase mortality risk. Early and appropriate fluid resuscitation, improved first aid measures, and better management of comorbidities are crucial for improving survival rates.
Burning is a major health problem. Surgical management in the acute phase of severe burn injuries remains a challenge for plastic surgeons. There are different means of coverage, including free flaps. The anterolateral flap, due to its multiple advantages, remains an excellent choice. We report three cases of managing severe burns in their acute phase. These were three patients admitted for serious burn and managed with free anterolateral thigh flaps in the acute phase, from February 2010 to August 2016. Reconstruction was performed between the 25th day and 4 months after the burn. Doppler tracking of perforators was performed. All flaps had a single perforator and the vascular anastomoses were end to end. Donor areas were either sutured or grafted. The average operative time was 8 hours. Evolution was favorable, without any complications and with good integration of flaps. Functional and aesthetic results were satisfactory. Surgical treatment of burn injuries in the acute phase must be effective in order to reduce possible after-effects. Free flaps, previously reserved for the management of after-effects, currently constitute an essential element of the therapeutic arsenal in the acute phase. The free anterolateral thigh flap, due to its multiple advantages, constitutes an appropriate choice for covering lesions when other means are proving inadequate.
Experienced burn surgeons correctly assess burn depth in only 60-75% of cases. Various strategies are available to define the degree of burn, ranging from clinical observation (the most common) to biopsy and subsequent histological analysis. Among these, indocyanine green angiography (ICG) is gaining popularity for its potential to improve diagnostic accuracy. This study aims to explore the utility of ICG as a tool for evaluating the extent and severity of burns, thereby enhancing diagnostic accuracy and treatment outcomes in burn care. A systematic review of the literature was conducted using PubMed, Scopus, Embase and the Cochrane Library through February 2025 using the search terms [ICG OR indocyanine green] AND [burn]. Article selection was performed following the PRISMA guidelines. The initial search yielded 201 results, of which 10 articles met inclusion criteria (3 on animal models, 7 on human subjects, involving 122 patients overall). Preclinical studies demonstrated ICG's ability to distinguish between partial- and full-thickness burns with 100% accuracy when compared to histopathology. Clinical studies confirmed improved diagnostic performance over clinical assessment alone. Optimal imaging was reported at five minutes post-injection, with evaluation recommended between days two and three post-injury. Quantitative and qualitative fluorescence analysis enabled discrimination of superficial burns, where dermal vascularization is preserved, from deep burns. This method could reduce waiting times and support early surgical decision-making. A structured clinical algorithm integrating timing, dosing, and interpretation was proposed based on literature. ICG video-angiography has shown to be an effective technique that deserves consideration in the assessment of burn patients. Further studies are needed to increase knowledge and guide its optimal clinical use.
Elderly burn patients represent a vulnerable population with high mortality rates. Despite advances in burn care, age remains a significant predictor of poor outcomes. This study aims to describe the epidemiological and clinical characteristics and factors associated with mortality in elderly burn patients admitted to the dedicated ICU in Tunisia. A retrospective observational study was conducted over 30 months (January 2020 - June 2023). The study included patients aged 65 or older with burn-related ICU admissions. Data on demographics, burn characteristics, co-morbidities, treatment and outcomes were analysed. Univariate and multivariate logistic regression analyses identified predictors of mortality. One hundred out of 1,519 patients (6.5%) were aged over 65 (mean 77 years). Most burns were due to flames (82%), in a domestic setting (96%). The mean total burned surface area (TBSA) was 24% and 45% of the patients required mechanical ventilation. The mortality rate was 46% and significant predictors of death were age ≥69.5 (p = 0.045, Se = 84.8%, Sp = 74%), TBSA ≥19.5% (p <0.001, Se = 74%, Sp = 85%), need for mechanical ventilation (p <0.001), renal failure (p <0.001) and sepsis (p <0.001). Elderly burn patients have a high risk of mortality, particularly those with larger TBSA, requiring ventilation, developing sepsis or renal failure. These findings highlight the need for specialized burn care and prevention strategies tailored to the elderly population, considering their unique clinical challenges and higher susceptibility to severe outcomes.
Colistin is often essential in burn patients presenting infections caused by multidrug-resistant organisms. A retrospective study was conducted in the intensive burn care department in Tunisia over 14 months to assess prevalence and predictive factors of colistin-related acute kidney injury (AKI). Among 70 patients (mean age 34±13 years), 28.6% developed AKI, with onset at 5±2 days. Associated factors included total burned surface area >41% (OR=2.6), UBS score >58 (OR=6.8), metabolic acidosis at admission (OR=28) and contrast agent injection (OR=107). AKI was reversible in 40% of cases. Colistin-associated AKI remains a frequent complication in severely burned patients, and in cases of contrast agent use.
Major burn injury is a cause of disability and death. Burn injuries initiate systemic inflammatory reactions, resulting in the production of burn toxins, free oxygen radicals and tissue peroxidation. One of the substances elaborated in severe burns is c-reactive protein (CRP). The objective of this study is to determine the association between levels of CRP and burn wound severity and outcome in adults with major burns. This was a cross-sectional prospective study. The study was carried out in adult burn patients admitted to the University of Benin Teaching Hospital. Their bio data, percentage surface area burnt, burn depth, C-reactive protein levels, full blood count, electrolyte urea and creatinine were evaluated. All data obtained were recorded in a proforma. Statistical analysis of the data was done to ascertain the correlation of these variables with outcome. Higher levels of CRP were associated with mortality and burn size. There was a statistically significant increase in patients with larger burn size (P=0.041). There was association between patients with inhalation injury and increased CRP. There was a significant increase in level of CRP (P=0.002) in patients with burn wound morbidity. Mortality was 40%. CRP increased with burn severity and high levels were associated with poor outcome.
Burn injury that occurs in pregnancy is considered severe when it affects the functional and/or vital prognosis. The aim of our study was to describe the incidence, the epidemiological, clinical characteristics, and factors associated with mortality of severe burns in pregnant women. A retrospective descriptive study was conducted in the burn intensive care department in Tunisia over a period of 16 years. All burned pregnant women requiring intensive care hospitalization for severe burns were included. Twenty-six pregnant women were included (7.5%). The average age was 28±5 years old. Burns were secondary to a domestic accident in 19 cases and a suicide attempt in 5 cases. Burns were thermal in all cases, caused by flames in 22 cases, occurring at home in 85% of cases (n=22), and occurred mainly in the second and third trimester (n=2). The average total body surface area was 32%±24%. Most patients were transferred from another hospital (n=22, 85%). Eight patients were initially in a hypovolemic shock, and nine patients were under mechanical ventilation. There have been eight fetal deaths (31%), and eight maternal deaths (31%). Total body surface area, prognosis scores, immolation, hypovolemic shock on admission, pulmonary injuries, acute kidney injury, sepsis and acute respiratory distress syndrome were the associated mortality factors. Burns in pregnant women is a rare but serious injury since it affects the fetal and maternal prognosis. Early management in a specialized structure could improve prognosis.
Toxic epidermal necrolysis (TEN) is a life-threatening, rare and severe mucocutaneous disease. Almost all cases are drug-induced. This study aimed to describe the epidemiological, etiological, clinical, therapeutic and evolutionary data of TEN and to determine the predictive factors of mortality. A retrospective and descriptive study was conducted within the intensive burn care department over a period of 15 years, including all hospitalized cases of TEN. During the study period, 81 were included. The sex ratio (M/F) was 0,68. The mean age was 41±15 years. None of the patients had history of drug allergy. Almost 95% of patients had a comorbidity. Self-medication was observed in 27% of cases. The most frequently implicated drugs were anticonvulsants (37%), antibiotics (21%) and hypouricemic agents (18,5%). The mean time to onset after drug administration was 8 days. The median detached skin surface (DSS) was 40% [30-50]. Mucous membrane was affected in all cases. The main principles of symptomatic therapy include treatment of associated organ dysfunctions and local mucocutaneous treatment. Mechanical ventilation was required in 50% of cases. Evolution was favorable in 42 patients (52%). The median hospital stay was 9 [5-14] days and the median duration of mechanical ventilation was 3 [1-8] days. The mortality rate was 48%. In multivariate study, predictive mortality factors were age >43 years, DSS >39%, ICU admission time >5,5 days, mechanical ventilation requirement and infection occurrence.
