Abstracts from the 12th Asia Pacific Burn Congress

Burns & Trauma 2019, 7(Suppl 1):27https://doi.org/10.1186/s41038-019-0164-1

MEETING ABSTRACTS Open Access

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Abstracts from the 12th Asia Pacific Burn

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Published: 13 August 2019

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Foreword 1Si Jack ChongOrganising Co-chairperson | 12th Asia Pacific Burn CongressPresident | Association for Burn Injuries SingaporePresident | Asia Pacific Burns AssociationAPBC is the official meeting of APBA

Members of the Asia Pacific Burn Association (APBA) have beenmanaging the bulk of the World’s burnload over the years. Gener-ations of burn care professional in the Asia Pacific region have de-voted their life to develop and enhance burn care the burnpatient in the region. They have pioneered many innovations andintroduced many techniques to the world of burn managements.Members have shared their experiences and latest research at thepast Asia Pacific Burn Congresses(APBC) since it was first held inSingapore in 1992.The organising committee of the 12th APBC is pleased to collaboratewith the board and editorial team of Burns & Trauma to select andcollectively publish 132 abstracts as a supplemental issue of Burns &Trauma in Aug 2019 and distributed in conjunction with the 12th

APBC held in Singapore. Among all submissions five excellent paperswill win Burns & Trauma best article awards.Burns & Trauma is the first peer-reviewed Open Access journal de-voted to basic, clinical and translational research related to burnsand traumatic injuries in the region. It is indexed by the PubMed andSCIE, with the Impact Factor of 2.493. The journal offers a fast publi-cation schedule whilst maintaining rigorous peer review. All articlespublished by Burns & Trauma are made freely and permanently ac-cessible online immediately upon publication.I strongly believe that this association between APBC and Burns &Trauma is a win-win relationship. Having their work published inBurns and Trauma will undoubtedly spur and motivate researchers intheir endeavours in the field of burn research. It is also beneficial forBurns & Trauma to engage and build lasting partnership with re-searchers in the Asia Pacfic region.In all, I am pleased to be part of the team effort to launch the inaug-ural supplemental issue for Burns & Trauma. I sincerely hope that theAsia Pacific Burn Care community will embrace this publication.

© The Author(s). 2019 Open Access This articInternational License (http://creativecommonsreproduction in any medium, provided you gthe Creative Commons license, and indicate if(http://creativecommons.org/publicdomain/ze

Foreword 2Gaoxing LuoDirector of Institute of Burn Research, Southwest Hospital, Army Med-ical University, ChinaAssociate EIC, Burns & TraumaGuangping LiangManaging Editor, Burns & TraumaManaging Editor, Chinese Journal of Burns

Burns & Trauma, the official journal of Chinese Burn Association, hasjust got its first impact factor of 2.493 in 20th June, 2019. As thesponsor of the journal, we deeply appreciate the Editor-in Chief, Prof.Jun Wu and his forward-looking to found the journal in 2013. Wealso appreciate the great support by the former Deputy Editor Prof.David Mackie, Naiem Moiemen, and current Deputy Editor Prof. TinaPalmieri, as well as all efforts made by the editorial board. Surely, theeditorial office team should be remembered for their hard work andgreat contribution for the Journal. Through years of development,and active cooperation with various international organizations likeAPBA, Burns & Trauma has become a good academic platform forknowledge and idea exchanges in the fields of burns and trauma.As the only Open Access journal in Asia focusing on burns, all thecontents could be freely read and download in the journal home-page (www.burnstrauma.com). Here, we are happy for the first timeto initiate an abstract supplement for the 12th APBC 2019, and setAPBC - Burns & Trauma best paper awards, aiming to encourageyoung investigators to devote more into clinical and basic burn re-searches. We hope this salutary attempt will be a good start, whichwill not only promote the journal but also enlarge the influence ofAPBC.With the development of new scientific technology, the emphasis ofburn care has transferred gradually from traditional treatment of im-proving the mortality rate into prevention and outcome qualities. Re-searches not only on critical care, but also on scar management,tissue engineering and regeneration, and rehabilitation have beenbecoming hotter and hotter. Burns & Trauma has published severalspecial issues on these hot topics, High quality research papers re-lated to the following special series are warmly welcomed for sub-

le is distributed under the terms of the Creative Commons Attribution 4.0.org/licenses/by/4.0/), which permits unrestricted use, distribution, andive appropriate credit to the original author(s) and the source, provide a link tochanges were made. The Creative Commons Public Domain Dedication waiverro/1.0/) applies to the data made available in this article, unless otherwise stated.

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mission: Facial & Hand burns, Inflammation & Wound healing, Nutri-tion & Metabolism, Scar, Stem cells & Tissue engineering, etc.Moreover, we’d like to give our sincere thanks to the president ofthe 12th APBC, Prof. Chong Si Jack, who is also the editorial boardmember of Burns & Trauma, to provide the opportunity for deepbilateral cooperation between the journal and the congress. Thiswin-win action will help the journal get wider audience, while alsoenlarge APBC influence in China and world-wide.Let every one of us enjoy the grand congress, and have a fruitfulgaining in Singapore.

Foreword 3Jun WuEditor-in-Chief, Burns & Trauma

Since launched in June 2013, Burns & Trauma remains focused onpublishing the latest developments in basic, clinical and translationalresearch related to burns and traumatic injuries. As the official Jour-nal of Chinese Burn Association, Chinese Society for Scar Medicineand Chinese Burns Care & Rehabilitation Association, Burns & Traumais the first peer-reviewed OA journal in the related fields which de-voted to report burn researches. After indexed by the PubMedin2015, the journal was included in the SCIE in 2018 and gained thefirst Impact Factor of 2.493 in 2019.With cooperation with various international associations Burns &Trauma tries to provide a platform for burn researchers and doctorsto present their scientific achievements and exchange their ideas.We have organized 11 special series covering the hot topics in thefield of burns and trauma, such as scar management, cell therapy &skin regeneration, 3D bio-printing, pediatric burns, etc., inviting pres-tigious scholars to review the most advanced technologies and pro-gress in the related fields, which aims to provide new perspectivesand knowledge in the field of burns. Now we are delighted to joinhands with the organizing committee of the 12th Asia Pacific BurnCongress (APBC) to publish 132 abstracts as a supplement of Burns&Trauma, and select best original papers for the possibility to bepublished in the journal.The consociation with Asia Pacific Burn Association (APBA) is a suc-cessful and beneficial attempt for both sides. Publishing the abstractsof the delegates will surely motivate their enthusiasm for further re-searches and make Burns & Trauma better known in Asia Pacificregion.Finally, I wish the 12th APBC a complete success and hope the inaug-ural supplemental issue launched smoothly.
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12th Asia Pacific Burn Congress Scientific CommitteeSi Jack Chong (Chairperson)Alvin Wen Choong Chua (Chairperson)Kala AdaikanHong Ngee ChanKong Yik ChewJasmine Chiat Ling OngMaciej Piotr ChlebickiAnnabelle Soo Ching IpCecilia Sze Nga KwokGale Jue Shuang Lim

Pei Fen SeahAnna Chew Na TanEmily U-Tong TanChai Lian TengSanda Thangarajoo

Speaker presentationAbstract Topic: Burn Care in Pre hospital & AustereEnvironment

S1Actualities and thinking on early management of mass burncasualty disaster in ChinaGuodong Song1,2, Naijun Xin1,21Department of Burns and Plastic Surgery, Jinan Central HospitalAffiliated to Shandong University, Jinan, Shandong, PR China; 2First AidCenter for Burns in Jinan, Jinan, Shandong, PR ChinaCorrespondence: Guodong SongBurns & Trauma 2019, 7(Suppl 1):S1

BackgroundManagement of mass burn casualty disaster (MBCD) is both medicaland social problems. Field first aid, triage transfer and early care isthe critical stage of MBCD management. This paper presents an ana-lysis of the recent experiences and lessons of MBCD managementwith the aim of proposing relevant countermeasures for the prob-lems in several key links in early management of MBCD in China.Materials and MethodsLiterature review including systematic searches of PubMed/Medlineand CBMdisc, representative monographs and landmark articles.ResultsBurns department should be incorporated into medical rescuecontingency plans of local public emergencies, and burn specialtyteam should be organized. Triage and primary triage transfer isthe first link of medical emergency at the disaster scene or atthe emergency room of the first receiving hospital. The disastersite incident headquarters should call the nearest burns depart-ment and the hospital with the necessary care competence ac-cording to the situation of triage and evacuate of casualty. Forthe MBCD that can be not rapidly shunted nearby, especially theseverely burned patients, the headquarters should coordinate andorganize protraction of specialized technical force, and thenorganize to implement the normative early management in localhospital. After spending steadily the shock stage or making upblood volume, the burn patients should be secondarily triagedand transferred to the burn center in soonest possible. Normativefluid resuscitation should be persistently performed in each linksof MBCD triage and transfer. The treatment strategies for exten-sive deep burns wound of early MBCD should aim at stabilizingand controlling patient’s condition firstly, carry out the conceptof damage control operation, and perform tangential excisionand alloskin or xenoskin grafting for temporary coverage andlater on autoskin grafting.ConclusionsRescue contingency plans and early management on MBCD in Chinashould be further improved.

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Abstract Topic: Burn Care in Pre hospital & AustereEnvironment

S2Transport and early treatment of molten Steel Burn in batchesShutang Zhang, Qi LiuDepartment of Burn and Reconstruction surgery, The Affiliated Hospitalof Zhengzhou University, ChinaCorrespondence: Shutang ZhangBurns & Trauma 2019, 7(Suppl 1):S2

BackgroundFurther discussion on the early treatment measures of a batch of se-vere patients burned by explosive molten steel.Materials and MethodsSummarize the body condition, transshipment, treatment processand experience of 13 explosive molten steel burned patients in thesudden explosion in a steel mill, 17th may 2018. Scientific and ra-tional double-echelon management, multi-departments’ and multi-disciplinary comprehensive diagnosis and treatment mode,establishment of a rapid and effective early transport and treatmentsystem, rehydration scheme based on patient treatment responseand early cutting and skin grafting were mainly adopted as the res-cue and early treatment.ResultsThe County Emergency Office and Center immediately organized firstaid for patients after the explosion, and reported to the City HealthPlanning Commission at the same time. They immediately organizedNanshiyoutian Hospital to start ambulances and helicopters to go tothe scene for rescue. About 5 hours after the injury, 13 severeburned patients were transferred to the hospital for treatment. Thesuccess rate of transport was 100%. Two wounded died within 24hours of hospitalization due to traumatic brain injury and deep burnof 100% TBSA. There were 9 especially severely burned and 2 se-verely burned among the remaining 11 patients. Six of the 9 espe-cially severely burned had burn wounds of 80-100% TBSA. The 1-week survival rate was 100%, the 2-week survival rate was 90.9%,and the 1-month survival rate was 72.7%. The hospital discharge rateand survival rate were 54.5% after 4 monthsConclusionsThe effective organization of relevant departments, thejoint transportation of air and land, the seamless connection of trans-shipment and in-hospital consultation, the multi-departments' andmulti-disciplinary collaborative treatment after the batches of burnaccident can significantly improve the prognosis of patients and re-duce the serious consequences caused by explosive damage.

Abstract Topic: Burns Education

S3A look at the effectiveness of burns management in Dhaka, a fast-developing capital.Low Tzuemn Lin1, Chong Xin Ying3, Foong Shyn Yih Hayley3, TanveerAhmed Himon2, Chong Si Jack31Ministry of Health Holdings, Singapore; 2Department of Plastic Surgeryand Burn Unit, Dhaka Medical College and Hospital, Dhaka, Bangladesh;3Asia Pacific Burn Association, Bali, IndonesiaCorrespondence: Low Tzuemn LinBurns & Trauma 2019, 7(Suppl 1):S3

BackgroundBurn injuries are prevalent and devastating, be it for the patient, theirfamily, the community or the country. The effects are far-reaching.With proper measures, ranging from prevention to rehabilitation,burn outcomes can be dramatically improved. This study aims tolook at the effectiveness of burns management in Dhaka, a fast-developing capital.

Materials and MethodsInterviews were conducted one-to-one with a translator present at alltimes, specifically targeting nurses. Nurses were randomly selectedwhile they were working in the Burns Unit at Dhaka Medical CollegeHospital. Verbal consent was taken prior to the interview.Results30 Nurses participated in the survey. 20% were males while80% are females. 70% (21) of their language medium of choice wasEnglish. 10% (3) was other languages and 20% (6) was Bengali. Thetypes of burn injuries witnessed by this group of nurses include ther-mal (28), electrical (19), chemical (16), friction (15), radiation (2),lightning (2) and cold injury/frost bite (1). Thermal injuries were fre-quently caused by fire from cooking stove and open fires. The mostcommon cause was poor layout in terms of house kitchen as well ascity planning. Stoves were placed hazardously in households, oftenin make-shift kitchens and sometimes on the floor. It did not helpthat women wore sarees. There was the practice of burning rubbishin the open, at will, with no designated area, safety rules or regula-tions from the government. Also, women were known to practiseperineal warming after giving birth by sitting over or near fires. 2nurses attributed poor burn outcomes to religious practices, statingthat Muslim women had the tendency to present late for treatment.There was also inadequate understanding of first aid among thecommunity. Majority (23) thought that inadequate general publicawareness was the most important social cause for burns. The com-plication of burns which patients complained the most was infection.In order of importance, nurses were ranked the most important inspreading awareness, followed by patients, then doctors, thenteachers/instructors, state governors and lastly country politicians. 17(56.7%) thought that doctors, instead of nurses should lead burns re-suscitation whereas 29 (96.7%) thought that nurses should leadburns dressings.ConclusionsWithout a doubt, burns burden is high in Dhaka. Burns will not bemanaged effectively if one neglect the importance of primary pre-vention. Cultural practices need to be respected when formulatingsolutions. General public education can be reinforced, either by intro-ducing burn programs into the school curriculum or broadcastingawareness clips in the social media. Measures need to be taken to re-duce infection rates in burns.

Abstract Topic : Burns Education

S4Inhalational Injury – A Pictorial GradingDelong Zeng1, Suneel Ramesh Desai2, Chong Si Jack31Department of Plastic, Reconstructive and Aesthetics Surgery, SingaporeGeneral Hospital, Singapore; 2Department of Anesthesiology andSurgical Intensive Care, Singapore General Hospital, Singapore; 3AsiaPacific Burn Association, Bali, IndonesiaCorrespondence: Delong ZengBurns & Trauma 2019, 7(Suppl 1):S4

BackgroundInhalational injury as a cause of burns, or explosions can have seriousconsequences if not identified quickly and managed properly. Earlysurveillance of airway is essential in managing their complications.The Abbreviated Injury Score (AIS) for bronchoscopic evaluation isused for grading the severity of inhalational burns. This study aims toprovide a visual representation of the different AIS grades to aid inairway evaluation, as well as, propose a workflow for anyone thatcomes to the Accident and Emergency (A&E) department with pos-sible inhalational burns.Materials and MethodsPatients with varying degrees of inhalational injury were selected torepresent the AIS grading. No patient was identified as AIS 4, there-fore, a standard picture was used. These patients all underwent early


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evaluation of their airway with nasolaryngoscopy, followed by moredetailed assessment with bronchoscopy.ResultsA pathway is devised for the management of patients with varyingdegrees of inhalational burn. Pictures are incorporated into the work-flow to aid in visual guidance.ConclusionsClinical signs of airway injury can be non-specific, therefore, an upperairway nasolaryngoscopy is essential to evaluate the need for intub-ation. Lower airway bronchoscopy can be used to predict the likeli-hood of successful early extubation, or complications such as AcuteRespiratory Distress Syndrome or pneumonia. A pictorial grading ofinhalational injury, together with our management pathway, willgreatly help the speed and effectiveness of treating burn patientswhen they first arrive to the hospital.
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S5A 5-year retrospective study of liquefied petroleum gas-relatedburn patients in ChinaRonghua Jin, Jon Kee Ho, Chunmao HanDepartment of Burns & Wound Care Center, Second Affiliated Hospitalof Zhejiang University, College of Medicine, Hangzhou, ChinaCorrespondence: Chunmao HanBurns & Trauma 2019, 7(Suppl 1):S5

BackgroundLiquefied petroleum gas (LPG) is a widely used environment-friendlyfuel. According to the annual report of World Liquefied PetroleumGas Association in 2015, China has become the world’s second lar-gest LPG-consuming country. Previous studies have shown an in-creasing number of LPG-related burns [1]. Our study was designed toevaluate the epidemiologic pattern of these injuries and provide rec-ommendations for burn prevention.Materials and MethodsPatient data was collected from the clinical database of patients withLPG-related burns from burn units of eight different hospitals in Zhe-jiang Province from January 2011 to December 2015. Database vari-ables included patient demographics, accident characteristics andinjury characteristics.ResultsThis retrospective study included all patients with LPG-related burns ineight burn centers between 2011 and 2015. A total of 1898 patientswere included, 47.31% were male and 52.69% were female. The pre-dominant age group was 31~70 years (74.50%), majority were poorlyeducated and the incidence peaked from June to September. The mostcommon place of occurrence was home (74.08%) and gas leak was themost common cause. The four limbs (43.33%) were the most frequentlyaffected areas, the mean burn area was 25.19±20.97% of the total bodysurface area (TBSA) and most patients (46.89%) suffered from moderateburns. The mean length of hospital stay was 17.66±16.55 days and ma-jority of patients (89.36%) recovered with 0.84% mortality rate.ConclusionsOur findings reflected that the increase in incidence rate was alarm-ing. Therefore, this calls for simple but strict measures to preventthese burn injuries. Gas leak was the main cause of LPG-relatedburns, any part of LPG stove system that shows signs of weatheringshould be replaced regularly.

References[1] Jin Ronghua, Wu Pan, Ho Jon Kee, et al. Five-year epidemiology of lique-

fied petroleum gas related burns. Burns. 2018; 44:210-217.


S6Evaluation of a multidisciplinary burns training program inBangladeshAnna Tan, Florence ChiangOccupational Therapy Department, Singapore General Hospital,SingaporeCorrespondence: Anna TanBurns & Trauma 2019, 7(Suppl 1):S6

BackgroundBurns is one of the most common injury in Bangladesh. Thehuge number of patients coupled with limited number of desig-nated hospitals and skilled manpower resulted in death or severecomplication in burns survivors. As such, the government hadplanned for a new designated burns hospital to meet nationalneeds, and a multidisciplinary burns team in Singapore hasagreed to provide training to build the capacity of specialisedhealthcare workforce for this new hospital and beyond. Trainingconsists of a 5-day on-site teaching course that was planned torun 5 times over 3 years. It aims to train 310 nursing, doctor andrehabilitation specialists who in turn will train another 900 health-care workers. The 5-day on-site training consists of lectures; livesurgery demonstration; splinting workshop (hands-on); wounddressing workshop (hands-on); case scenario discussion andgroup presentations. A handbook was also published as trainingmaterial to aid the delivery of the information. Curriculum isplanned with inputs from both the Dhaka burns team andSingapore burns team. The aim of this paper is to evaluate theeffectiveness of the training course.Materials and MethodsThe course was evaluated based on the Kirkpatrick’s model of courseevaluation. Data was collected on the participants’ reactions to thetraining with a post training questionnaire. A pre and post-coursetest was also conducted to determine the participants’ extent ofknowledge gained.ResultsOne hundred and forty-six participants attended the course.Seventy-four participants completed the post training question-naire with 97 % of them rated the course as meeting or exceed-ing their expectation. Out of 79 participants who completed thepre and post-course test, 86% of them showed an improvementwith 29% of them achieving an improvement of 30% in their testscores.ConclusionsThe training has led to an improvement of knowledge amongparticipants.


S7Correlation Of Extended-Spectrum Beta-Lactamase Infection WithMortality In Burn Patients In Dr. Soetomo Hospital Burn CentreFrom 2015-2018Iswinarno Doso Saputro1, Lobredia Zarasade2, Caesarani Kristel31Senior Staff of Department of Plastic Reconstructive and AestheticSurgery, Airlangga University, Dr. Soetomo Hospital, Surabaya; 2SeniorStaff of Department of Plastic Reconstructive and Aesthetic Surgery,Airlangga University, Dr. Soetomo Hospital, Surabaya; 3Resident ofDepartment of Plastic Reconstructive and Aesthetic Surgery, AirlanggaUniversity, Dr. Soetomo HospitalCorrespondence: Iswinarno Doso SaputroBurns & Trauma 2019, 7(Suppl 1):S7


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BackgroundBurns results in suffering throughout the life of a person with high mor-tality and morbidity. Some studies suggest that infection of extended-spectrum beta-lactamase (ESBL) producing strains increase the mortalityrate in burn patients. Several studies have been carried out, but nocomplete data has been obtained at Dr. Soetomo Hospital. This studywas conducted to look at the correlation of ESBL infection with mortalityin burn patients in Dr. Soetomo Hospital, SurabayaMaterials and MethodsA cross sectional study of patients with burns admitted to the BurnCentre of Dr. Soetomo Hospital between January 2015 and December2018 were evaluated.Results313 subjects were involved in this study. 104 subjects are female (33,2%)209 subjects are male (66,8%). There were 76 subjects with 1-19 years ofage, 9 of them died. 29 subjects with extreme age (<1 year old or > 60years old), 13 of whom died. 62% of the burn injuries are caused by fire(195 subjects), 16% caused by electricity (50 subjects), 13% caused byscald (41 subjects). Inhalation injury was found in 118 subjects (37,7%)and 46 of them died, acute kidney injury in 37 subjects (11,8%) and 25 ofthem died, sepsis in 50 subjects (16%) and 23 of them died. Out of 313subjects, 75 subjects (24%) died, 62 subjects (82,7%) of it caused by fire,and 5 of them were infected with ESBL. Out of 5 subjects died with ESBLinfection, 2 of them with acute kidney injury, 4 of them with sepsis, and4 of them with inhalation trauma.ConclusionsIn 4 years period, 313 subjects were obtained, 19 subjects were in-fected with ESBL, 5 (26,3%) of them died. Mortality rates increases ifESBL infection is accompanied by other comorbidities such as acutekidney injury, sepsis, and inhalation trauma.

Abstract Topic: Critical Care/Resuscitation andPharmacology

S8Does Parkland Formula Remain As The Best Chosen Formula ForInitial Treatment In Patients With Burn Injury?: A SystematicReviewNadhira Anindita Ralena1, R. Aditya Wardhana21Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; 2Plasticand Reconstructive Surgery Department, Cipto Mangunkusumo Hospital,Jakarta, IndonesiaCorrespondence: Nadhira Anindita RalenaBurns & Trauma 2019, 7(Suppl 1):S8

BackgroundBurns can lead to abundant fatalities. It may cause temporary andpermanent disability. Initial fluid resuscitation is required to supportburn patients. It is significantly beneficial for the patients, especiallyon the first 24 hours. In majority of cases, Parkland Formula is used.However, fluid administration based only on Parkland Formula couldlead to less output of urine at certain conditions.Materials and MethodsA comprehensive literature searching was done by the authors start-ing from October 25th 2018 using electronic databases PubMed,Medline, Scopus, Embase, and Cochrane with key words includingadults, Parkland Formula and urine output. Authors finally gathered 8relevant articles. Cohort studies were critically appraised withNewcastle-Ottawa Quality Assessment and randomized controlled tri-als used PEDro Scale.ResultsLiteratures related to Parkland's Formula with its effects on urine out-put varying greatly. The types of studies consisted from cohort torandomized controlled trials. The subjects used also differ from hu-man to adult animals, with several comparison objects, such as ad-ministration of intravenous hypertonic fluid, rehydrated oral fluidsand bolus directly to the colon through the anus. Addition or reduc-tion in the speed of entering fluid was often done and adjusted for

the amount of urine output. There is no research that only relied tothe 2-4 ml*weight*TBSA% formula. Increasing the infusion rate afterthe first 8 hours of 24-hour fluid resuscitation could significantlymaintain the amount of urine output by 0.5–1.0 ml/kg/hour. Onestudy showed that hyperdynamic fluid resuscitation could signifi-cantly increase urine expenditure in the first 8 hours of subjects with60% TBSA burns. Another trial concluded that the provision of WHO-ORS with Sørensen formula was effective in patients with 15% TBSAburns and could produce urine output as targeted.ConclusionsFrom all the results shown, it can be directed that the Parkland For-mula alone cannot be used as a standard.


S9Role Of Acute Kidney Injury In Severely Burned PatientsZhiqiang Yuan, Bo You, Gaoxing Luo, Yizhi PengInstitute Of Burn Research, Southwest Hospital,Army Military MedicalUniversity,Chongqing,ChinaCorrespondence: Zhiqiang YuanBurns & Trauma 2019, 7(Suppl 1):S9

BackgroundThe aim of this study was to describe the epidemiological, clinicaland pathological characteristics of acute kidney injury (AKI) in severeburns, and identify the risk factors for early AKI and late AKI,respectively.Materials and MethodsA retrospective, descriptive study was performed to 637 adult pa-tients with total body surface area (TBSA) burns of more than 30%,They were admitted to the Institute of Burn Research, SouthwestHospital of Army Medical University of China during last six-yearperiod. The basic characteristics and prognosis were compared, therisk factors of AKI were filtered by multifactor logistic regressionanalysis.ResultsA total of 637 patients were included in analysis, 235 patients werediagnosed AKI, with an incidence of 36.89%,. The mortality of pa-tients with AKI was 34.23%. Multiple logistic regression analysis re-vealed that age, male sex, TBSA,full-thickness TBSA, pre-existinghypertension or/and diabetes, tracheotomy, hypovolemic shock ofearly burn were independently associated with both early and lateAKI, furthermore, sepsis was only with late AKI. Hypovolemic shockof early burn and sepsis increased the risks of late AKI 8.83 times,13.76 times, respectively.ConclusionsAKI remains prevalent and is associated with high mortality in severeburn patients. late AKI had a lower occurrence rate, but more severityand worse prognosis.

Abstract Topic: Nursing Care in Burn Centre

S10Progress in the diagnosis and treatment of ventilator-associatedlung injury after burn injuryGuanghua Guo, Jinxiu Zhou, Mingzhuo LiuDepartment of Burns, The first affiliated hospital of Nanchang University,Nanchang, Jiangxi, ChinaCorrespondence: Guanghua GuoBurns & Trauma 2019, 7(Suppl 1):S10

BackgroundAs one of the important means for severely burned patients, mech-anical ventilation could not only improve the function of importantorgans such as heart, lung, and kidney, but also stabilize the homeo-stasis of body, thus promoting the recovery of patients. Improper use


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of mechanical ventilation, however, could lead to many complica-tions, among which one of the most common and serious complica-tions is the ventilator-induced lung injury (VILI), accompanying with ahigh risk of mortality. The target of preventing VILI is to minimize therisk of lung injury caused by mechanical ventilation.Materials and MethodsIn this study, 29 articles on ventilator-related lung injury werescreened from the databases of CNKI, Pubmed, Wanfang data, andthe advanced viewpoints and experimental results were summarized.ResultsThis present article reviewed the pathogenesis, diagnosis, and earlyprevention of VILI in burned patients.ConclusionsThe formation of VILI is not caused by a single factor, but involvesmany factors such as physics, chemistry and biology. With the devel-opment of the current research on pathogenesis, some new treat-ment methods, such as biotherapy and gene therapy, have madeprogress in animal experiments. At present, the treatment and pre-vention of VILI need to be further studied. In our clinical diagnosisand treatment, it is necessary to monitor the changes of cardio-pulmonary function and condition of the patients at any time, evalu-ate the general conditions of the patients at any time, and adjust theparameters of mechanical ventilation to minimize the risk of VILI inpatients.


S11Increased phenotype of bone marrow dendritic cells and inhibitionof xenogenesis lymphocyte proliferation in mice with smokeinhalation injuryGuanghua Guo, Chunxia Gan, Mingzhuo Liu, Xincheng Liao1Department of Burn, The First Affiliated Hospital of NanchangUniversity, Nanchang, Jiangxi, ChinaCorrespondence: Guanghua GuoBurns & Trauma 2019, 7(Suppl 1):S11

BackgroundInhalation injury increases the mortality of burn patients. The maincause of death is the strong immune response in lung tissue aftersmoke inhalation. Dendritic cells are the strongest antigen presentingcells so far. There is no research between inhalation injury and den-dritic cells. From this point on, we will explore the changes of pheno-type and function of antigen presenting cells after inhalation injuryMaterials and MethodsMaterial:BALB/c mice, PrimeScript™ RT reagent Kit, TB Green™ PremixEx Taq™, GM-SCF, IL-4, flow cytometric antibody:CD4, CD8, MHC II, etc.Methods: 1, built the smoke inhalation injury model; 2, extracted lungtissues; 3, cultured the cell; 4, stain the flow cytometric antibodies; 5,analysis data.ResultsAfter injury, the alveolar wall became thicker, a large number of in-flammatory cells infiltrated (lymphocyte, macrophage), alveolar fu-sion and expansion occurred and fibrous tissue proliferationoccurred.The level of TNF-α , IFN-γ and IL-4 were increased. The ex-pression of FoxP3 was inhibited after injury. The costimulatory mol-ecule expression of CD80 and MHC-II on the DC is increased. Theability of stimulating allogeneic lymphocyte proliferation was signifi-cantly weakenedConclusionsBone marrow dendritic cells were increased and xenogenesislymphocyte proliferation were inhibited in mice after smoke inhal-ation injury


S12Early hemodynamic changes in extensive burn patients witheffective fluid resuscitationJian Liu1, Yiqing Liu1, Shengjun Liu2, Jiexin Zheng1, Yiwen Niu1, QinZhang11Burn & Plastic Surgery, Ruijin Hosptial, Shanghai Jiaotong University,School of Medicine, Shanghai, China; 2Clinical Medicine, ShanghaiJiaotong University, School of Medicine, Shanghai, ChinaCorrespondence: Jian LiuBurns & Trauma 2019, 7(Suppl 1):S12

BackgroundTo verify early hemodynamic changes following the effective fluid re-suscitation in extensive burn patientsMaterials and MethodsExtensive burn patients with more than 30%TBSA (Total Burn SurfaceArea), with no comorbities, in-hospitalized within 8 hours post-burnwere enrolled into the study. Fluid resuscitation were immediatelyadministered following the protocol of 1.5ml/kg.%TBSA and revisedby patients’ clinical manifestation with no prescription of sedativemedications and angio-active agents. Hemodynamic criteria, like cen-tral venous pressure (CVP), cardiac index(CI), general end diastolicvolume index (GEDI), left ventricular contract index(dPmax), systemicvascular resistance index(SVRI) and extravascular lung water index(-EVLWI) , were measured by PiCCO measurement in hypovolemicphase to evaluate patients’ hemodynamic changes and pulmonaryinterstitial edema.Results27 patients with a mean age of 46.43±10.85 years and a mean TBSAburn of 60.43±8.21%, were studied. Under the resuscitation protocol,it was successful to maintain urine output of 30-60ml/hr indicatingeffective fluid resuscitation. There was significant cardiac contractilityimpairment, indicated by left ventricular contract index(dPmax) atthe value of 980±234.9 , only 18.3% that of the normal value. And CIwere decreased to 2.07±0.28(L/min/m2), 68% of the normal value. Itpersisted until 48 hours postburn while EVLWI reached its peak at14.0±0.83 ml/kg. Furthermore, the extravascular lung water was im-pend to reach a high level of 6.0±0.42 ml/kg soon after the burneven before fluid therapy and it started to slope down after 72 hourspostburn spontaneously.ConclusionsThere existed the early myocardial contractility impairment soonafter the extensive burns with effective fluid resuscitation, whichcould be a clue for us to pursue preservation of myocardial contract-ility to restore pump function, minimize pulmonary edema so as topreserve effective tissue oxygenation.

Abstract Topic: Early Excision and SurgicalTechniques

S13The Effect of Tangential Excision and Split Thickness Skin Graft inReducing Length of Stay in Burns Patients in Jakarta IslamicHospital Cempaka Putih, IndonesiaGammaditya A Winarno1, Aditya Wardhana2, Sanjaya F Tanjunga1, AmaniS Augiani1, An’umillah A Zidna11Internship General Practitioner, Jakarta Islamic Hospital Cempaka Putih,Jakarta, Indonesia; 2Plastic Surgeon, Jakarta Islamic Hospital CempakaPutih, Jakarta, IndonesiaCorrespondence: Gammaditya A WinarnoBurns & Trauma 2019, 7(Suppl 1):S13


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BackgroundEarly tangential excision (TE) and split thickness skin graft (STSG)have increased outcome in burn patients treated at specialized burncenters. This study was conducted to compare the length of stay(LOS) in burn patients undergoing early TE & STSG and delayed TE &STSG.Materials and MethodsThis is a retrospective cross-sectional study including 42 patients withvaried burn degrees and TBSA admitted to Jakarta Islamic HospitalCempaka Putih (JIHCP) Burn Unit. They were assigned to two studygroups, the early TE & STSG group including 32 patients and the de-layed TE & STSG group including 10 patients. The data of all patientswere collected from medical records and compared between twostudy groups.ResultsMost of the samples were adult male, with average of 13.57±9.57%TBSA grade II burns, caused by flame. The mean of LOS in the groupwith early TE & STSG was shorter (9.81±6.41 days) than LOS in thedelayed TE & STSG group (15.80±5.67 days). The data of LOS be-tween these groups were compared using Independent T-test. TheLOS in the early TE & STSG group was significantly shorter than thedelayed TE & STSG group (p=0.012).ConclusionsIn patients with burn injuries, early TE & STSG is associated withshorter length of stay compared to the delayed TE & STSG. Our studyindicates that early excision within 5 days after burn injury is optimalto reduce length of stay in burn patients.

Abstract Topic: Tissue Engineering

S14Chronic wound animal modelTuan Ngoc Nguyen, Dzung Tien NguyenVietnam National Burns Hospital, Military Medical University, Hanoi,VietnamCorrespondence: Dzung Tien NguyenBurns & Trauma 2019, 7(Suppl 1):S14

BackgroundAn animal chronic wound is necessary for in vivo research. To today,most animal models of chronic wounds include ischemia, diabetes,pressure and reperfusion. In this study, we creased ischemia reperfu-sion wound (pressure ulcer) on rat and estimated histology charac-teristics of these wound.Materials and MethodsWe creased 30 ischemia reperfusion wounds on 30 rats. This studywas performed at Wound Healing Center, Vietnam Burns Hospitalfrom May to August, 2018. Animal wound model: Rats were anesthe-tized with Ketamine (80mg/kg IP). Surgical incision was conductedon dorsal skin. A steel plate (φ: 1.5cm) was inserted beneath the dor-sal skin through incision. A magnet (φ: 1.5cm) was put on skin andthe steel plate. We maintained this situation for 24h. Then we evalu-ated wound bed and biopsied damage skin for histology test.ResultsAverage wound size of 30 wounds was 1.766 ± 0.14 cm2. Theobteined wounds were grey skin necrosis. Their surfaces were moreconcave than normal skin. The wound histology had some featuredimages as the cutaneous injury expressed in various degrees. Thedermal connective tissue was injuried. In the subcutaneous, lookingat the inflammative, fibrosis or/and senescent tissues.ConclusionsThe obtained wounds by this model has manifestations of the ische-mia reperfusion wound (pressure ulcer). These wounds can apply forin vivo researchs.


S15Early excision and skin grafting of extensive deep burnsGuodong Song1, Donghui Bian21Department of Burns and Plastic Surgery, First Aid Center for Burns inJinan, Jinan Central Hospital Affiliated to Shandong University, Jinan,Shandong, PR China; 2Department of Burns and Plastic Surgery, The960th hospital of the PLA joint logistics support force, Jinan, Shandong,PR ChinaCorrespondence: Guodong SongBurns & Trauma 2019, 7(Suppl 1):S15

BackgroundEarly excision and skin grafting is a key technology of improving thesurvival and consequences of patients with extensive deep burns(EDB). However, the improvement of overall survival rate of EDB inthe world has been not remarkable over the past 20 years. This art-icle aims to discuss the several key issues in early excision and skingrafting of EDB.Materials and MethodsBased on the representative monograph at home and abroad,reviewing relevant literature and combining with our practices.ResultsThe accurate assessment about burn wound depth and the profoundunderstanding on wound development process are the pathophysio-logical basis of the wound management. The appropriate timing andarea of the wound excision should be chosen with the concept ofdamage control operation. Tangential excision is applicable to notonly deep dermal but also full-thickness burn wounds. The depth oftangential excision should effectively remove necrotic tissues andreach down to the level of the underlying viable dermis or subcuta-neous tissue. Tourniquet can be not used during limb tangential ex-cision surgery, instead, the wounded limb has been kept elevated asmuch as possible. If fresh wound after tangential excision is still obvi-ously dropsical, multipoint puncture reaching down to fascia shouldbe performed for drainage. The wound after tangential excisionwithin 14 days especially 7 days post burn should be grafted with vi-able alloskin or xenoskin for temporary coverage and later on auto-skin. Grafting of autologous microskin overlain with sheet alloskinshould be applied onto the wound after tangential excision, of whichthe blood supply tend to be improved after 7 days post burn. Peri-operative especially intraoperative management should bestrengthened.ConclusionsAlthough the treatment strategy on early excision and skin graftingof EDB has obtained the good curative effect, it needs still to be im-proved and verified.


S16Clinical evaluation and early management of hand deep burnsGuodong Song1, Donghui Bian21Department of Burns and Plastic Surgery, First Aid Center for Burns inJinan, Jinan Central Hospital Affiliated to Shandong University, Jinan,Shandong, PR China; 2Department of Burns and Plastic Surgery, The960th hospital of the PLA joint logistics support force, Jinan, Shandong,PR ChinaCorrespondence: Guodong SongBurns & Trauma 2019, 7(Suppl 1):S16


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BackgroundHand deep burns (HDB) is still one of the main reasons for resultingin physical disabilities of patients with burns, especially serious burns.Early accurate treatment of HDB is the foundation for the best recov-ery of hand function. This article aims to summarize experience ofclinical evaluation and early management of HDB.Materials and MethodsBased on evidence-based medicine principles, reviewing relevant lit-erature and combining with our practices.ResultsDorsal HDB is easy to damage deep tissue, especially central slip ofextensor expansion. Palmar hand burns is generally not too deep.And necrosis of finger ends is clinically common. In patients with typ-ical constrictive eschar on upper limb or signs of poor perfusion, anescharotomy should be performed as soon as possible. For patientswhose perfusion is not still restored, those with fourth-degree burns,or signs of osteofascial compartment syndrome, a fasciotomy shouldbe performed in time. For dosal hand deep dermal burns or full-thickness burns, tangential excision and medium thickness sheetauto-skin grafting should be performed as early as possible, whichshould focus on repair of opisthenar and dorsal finger and designreasonable surgical range. For palmar burns, it is necessary to wait2–3 weeks for healing. If not, full-thickness or thick sheet auto-skingrafting should be performed. Before and after surgery, HDB shouldbe treated by dressing change with local anti-infection, proper com-pression and elevation. And desiccation of finger ends should beavoided. During upper limb tangential excision surgery, tourniquetcannot be applied to limb. Hand joints should be kept in the positionof confrontation contracture. Once the wound is closed, systemic re-habilitation plan should be implemented.ConclusionsAccurate assessment of hand blood supply and timely decompres-sion treatment can effectively prevent secondary injury of HDB. Earlyexcision and skin (flap) grafting and systemic rehabilitation can max-imally restore hand function.


S17Development and clinical application of a new foam dressing fornegative pressure wound therapyJiake Chai, Huinan YinBurn Institute, Fourth Medical Center of PLA General Hospital, Beijing,ChinaCorrespondence: Jiake ChaiBurns & Trauma 2019, 7(Suppl 1):S17

BackgroundAt present, the widely use of negative pressure wound therapy(NPWT) has achieved remarkable therapeutic effects. However, somedefects were found during its clinical use. Because the foam dressingis in the form of a block and inflexible, when it is used for largewounds such as entire limbs or special parts of the body such ashands, it is time-consuming and laborious, et al which affects its useand treatment effects. In this study, a new foam dressing for entirelimbs and hands was introduced.Materials and MethodsThe new foam dressing with was thinner and much longer than theprevious foam dressing and had a bandage-like appearance. It canbe wrapped around the entire limbs and hands like a bandage. Thedrape for closing the limb wounds was much larger than the previ-ous one. One or two pieces can seal the entire limbs (usually onepiece for upper limb and two pieces for lower limb). A non-perforated drainage tube was used.ResultsWhen the new dressing was applied to the entire lower limbs, one staffcould complete the operation within 10 minutes, while the previousfoam dressing required 2-3 staffs to complete at least half an hour. Be-cause of the reduction of the number of drainage tubes and the

reduction of film splicing, the incidence of air leakage was reduced,and the wound sealing effect was better. The new dressing had lowerpressure on limb than the conventional dressing and would not causeischemia of the extremities. Clinical application showed that both thenew dressing and the previous foam dressing had good treatment ef-fects on the entire limb wounds and wounds of hands.ConclusionsThe new foam dressing for NPWT is safe, convenient to operate,time-saving, labor-saving, and has good sealing effect for entirelimbs and hands.


S18Use of Glycerol Preserved Allografts (GPA) in acute burnmanagementSunil KeswaniNational Burns Centre, Navi Mumbai, IndiaBurns & Trauma 2019, 7(Suppl 1):S18

BackgroundMajor burns which are deep second/third degree are not likely toheal spontaneously and invariably require resurfacing. If the woundsare not contaminated and patient has adequate donor area, auto-grafts are used. If the wounds are contaminated after excision, ini-tially allografts are applied which help prepare the wound fordefinitive resurfacing with autografts. If the patient does not haveadequate donor sites, then autografts are harvested from the limitedarea and meshed widely and then covered with allografts (meshed1:1 or 2:1), as a sandwich technique. The allografts help by providingtemporary cover facilitating autografts to take easily.Materials and MethodsPatients with deep burns were taken up for early excision and resur-faced with autografts alone or autografts (widely meshed) coveredby allografts (sparingly meshed). The results were analyzed in termsquality of healing and presence or absence of contractures. In theevent, the allografts were rejected, they were removed and fresh al-lografts were applied. In the wounds which were referred to the hos-pital in an infected condition excision was done and only allograftswere applied to be replaced by autografts once wound condition im-proved and the wound was ready for grafting.ResultsIt was observed that the use of GPA was associated with good healingof the wounds with lesser incidence of graft loss and better quality ofhealing, compared with patients where allografts had not been used.Conclusions Allografts have now come to stay and are a useful ad-junct in the burn surgeon’s armamentarium in the resurfacing ofmajor burn wounds.

Abstract Topic: Infection Control and Diseases

S19Are we doing enough for burns? Doctors in Dhaka have a sayLow Tzuemn Ling1, Tanveer Ahmed Himon2, Chong Xin Ying3, FoongShyn Yih Hayley3, Chong Si Jack31Ministry of Health Holdings, Singapore; 2Department of Plastic Surgeryand Burn Unit, Dhaka Medical College and Hospital, Dhaka, Bangladesh;3Asia Pacific Burn Association, Bali, IndonesiaCorrespondence: Low Tzuemn LingBurns & Trauma 2019, 7(Suppl 1):S19

BackgroundBurns are a global public health problem, accounting for an esti-mated 180 000 deaths every year, according to WHO. The vast major-ity occur in low and middle-income countries. Non-fatal burns oftenrequire lengthy and gruesome hospitalisations, where multiple treat-ments are administered, early rehabilitation and life-long follow up.The impact of burns on burns victims and the society can never beoverstated. Many factors, beginning from the cause of burns, affects


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the final burns outcome. This study aims to evaluate the epidemi-ology of burns in Dhaka.Materials and MethodsA survey form was employed to standardise the interview process.Survey form was prepared in English. Doctors were approached ran-domly at the local Burns unit at Dhaka, while they were at work. Allinterviews were conducted, one-to-one, with the assistance of atranslator and with the doctors’ verbal consent.Results15 doctors participated in the study. 60% of them were maleswhile the rest were females. 80% (12) chose English to be thelanguage medium of choice whereas 13.3% (2) was other lan-guages and 6.7% (1) was Bengali. The two most common burninjuries were thermal (15) and electrical burns (15). 100% agreedthat thermal burns were more prevalent than electrical burns.Other types of burns reported were chemical (9), friction (7), radi-ation (2), lightning (1) and abuse (1). 100% of them agreed thatthere were not enough safety precautions in place to preventelectrical burns. 80% of them thought that education was lackingin the community. Other popular causes reported were inad-equate general public awareness (73%, 11), overcrowding in poorhousing conditions (67%, 10), poor education levels (53%, 8) andpoor city/home layout/hazard placements (53%, 8). 11 (73.3%)thought that doctors, instead of nurses should lead Burns Resus-citation and 9 (60%) thought that doctors, instead of nursesshould lead Burns Dressings. According to this group of localdoctors, the complication of Burn Injuries which patients com-plain the most of was disfigurement.ConclusionsThe high prevalence of burns, undeniably is attributed to anthropo-genic reasons. Thus, burns are preventable, excluding that caused bynatural disasters for example in this study, lightning. The consensusamong these Dhaka doctors is that much effort is still needed tohelp the burns community. While the Dhaka authorities formulatetheir policies and plan their city, the authors recognise that a newtertiary level hospital is on the way in Dhaka.


S20Lytic Bacteriophage Screening Strategies against MultidrugResistant Bloodstream Infections from an Intensive Care Unit ofSouthwest China Burn Treatment CenterZichen Yang, Liuyang Deng, Supeng Yin, Bei Jiang, Yulong Zhang, BoYou, Cheng Zhang, Xiaoqiang Luo, Yizhi Peng, Yali GongState Key Laboratory of Trauma, Burns and Combined Injury, ChongqingKey Laboratory for Proteomics Disease, Institute of Burn Research,Southwest Hospital, the Third Military Medical University (Army MedicalUniversity), Chongqing 400038, ChinaCorrespondence: Yali GongBurns & Trauma 2019, 7(Suppl 1):S20

BackgroundBloodstream infection (BSI) is the dominant cause of death in se-verely burned patients. With increasing antibiotic resistance, more at-tentions should be paid. In this study, we collected and analyzed thepathogen distribution and drug resistance in 486 Burn Intensive CareUnit patients with bloodstream infections (BSI) that were admittedinto Burn Intensive Care Unit (BICU) of our hospital for seven years.Materials and MethodsThis retrospective observation study was conducted at the BICU ofSouthwest Hospital from January 2011 to December 2017. The studysubjects were all the severely burned patients diagnosed with BSI,whose blood samples was taken and cultured at least once. The anti-biotic susceptibility tests were performed.ResultsThe patients with extreme more severe burns had significantly morekinds of bloodstream infection. Gram-negative bacilli were the maincausative agents of BSI in severely burned patients (64.6%), followedby Gram-negative cocci (27.7%) and fungi (7.7%). Of all the patho-gens, the top three species in terms of the detection rate were A.

baumannii (26.0%), S. aureus (16.8%) and P. aeruginosa (14.2%) withmultidrug resistance (MDR) respectively.ConclusionsIn conclusion, we carried out an etiological characterization of the486 severely burned patients with bloodstream infections admittedinto BICU. Gram-negative (MDR) A. baumannii and P. aeruginosa andGram-positive drug-resistant S. aureus were the most importantagents of BSI in severely burned patients, when the infection anddrug resistance of K. pneumoniae and E. cloacae became newlyemerged threats. The etiologic agents of BSIs in our BICU differedfrom those previously reported studies suggesting a need in routinebacteria monitoring.


S21CRISPR-dCas9 mediated control of Pseudomonas aeruginosainfectionsGuangtao Huang, Zairong Wei, Dali WangDepartment of Burn and Plastic, Zunyi Medical University, Zunyi,Guizhou,ChinaCorrespondence: Guangtao HuangBurns & Trauma 2019, 7(Suppl 1):S21

BackgroundP. aeruginosa is a widely distributed non-fermentative Gram-negativebacteria. It is also an important leading opportunistic pathogen, caus-ing nosocomial infection. Gene interference is a necessary strategy toinvestigate the essential genes in P.aeruginosa.Materials and MethodsTo set up a gene interference platform in P. aeruginosa, CRISPR sys-tem was used with a deactive Cas9 protein. CRISPR-dCas9 systemwas cloned into an inducible shuttle vector pHERD20T.ResultsWhen an essential P. aeruginosa gene, prtR, was targeted by CRISPR-dCas9 system, a clear growth defect of the P. aeruginosa wasobserved.ConclusionsCRISPR-dCas9 based gene knockdown system has successfully beenbuilt in P. aeruginosa, which can be used as a powerful tool in the in-vestigation of essential or difficult-to-knockout genes of P.aeruginosa


S22Characteristics of fungal infections in severe burn patientsMinh Nguyen Thai Ngoc1, Lam Nguyen Nhu1, Anh Tran21Viet Nam National Burns Hospital, Military Medical University, Ha Noi,Viet Nam; 2Viet Nam Military Medical University, Ha Noi, Viet NamCorrespondence: Minh Nguyen Thai NgocBurns & Trauma 2019, 7(Suppl 1):S22

BackgroundInvasive fungal infection is a challenge, a burden for the health sec-tor due to high costs and high mortality rates. Severe burn patientstreated in ICU departments are in the group at high risk of invasivefungal infection.Materials and MethodsA prospective study was carried in Intensive care unit of Viet NamNational burns hospital from 1/2017 to 6/2108. Patients had at leastone blood culture test and / or biopsy tissue positive with fungal,which is the same type of fungal isolates in patient samples at othernon-sterile sites on the body. We diagnosed invasive fungal infec-tions in severe burn patients based on evidence of microorganismsand monitor assessments of clinical and subclinical symptoms ofpatients.Results30 patients with invasive fungal infection were recorded in our study.Total burn surface area was 52.8 ± 19.46%, deep burn was 33.4 ±16.17%. The Apache II score at admission was 14 ± 3.81 and the


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average time to diagnose invasive fungal infection was 21.6 ± 8.62days. In the study, we found 2 species of fungal pathogens: Candidaand Aspergillus. The proportion of Candida non-albicans species inthe study found 15 patients infected with Candida tropicalis (56%).ConclusionsSevere burn patients are at risk of invasive fungal infection from thesecond week after admission. Clinical symptoms are not specific butsuggestive of diagnosis and correspond to subclinical microbiologicalresults.


S23Identification of Candidate Biomarkers correlated with diabeticfoot ulcer with Bioinformatics analysisHongyan Zhang, Peng WangDepartment of burn ,The First Affiliated Hospital of Nanchang University,ChinaCorrespondence: Hongyan ZhangBurns & Trauma 2019, 7(Suppl 1):S23

BackgroundDiabetic foot ulcers (DFUs) are one of the major complications in dia-betes patients and can result in a high rate of amputation and mor-tality Its molecular pathology remains barely understood, impedingthe development of effective treatments.Materials and MethodsWe searched the Gene Expression Omnibus database (GEO, http://www.ncbi.nlm.nih.gov/geo/) for studies on DFUs, using the keywords“Diabetic foot ulcers.” microarray data was submitted to the Limmapackage of R software to the differential expression genes betweendiabetic foot ulcer and non-diabetic foot skin. Utilizing David Bio-informatics software, the selected differential genes were utilized toannotate the GO terms and pathways. Biological Chart visualizationtool Cytoscape software is utilized to construct the protein Inter-action Network (PPI), miRNA-DEGs, lnRNA-DEGs regulatory network.ResultsThree mRNA expression profiles (GSE80178, GSE84971, GSE68185)were issued by the GEO database. A total of 29 overlapped unregu-lated genes and 37 down regulated genes were identified. The ma-jority of the DEGs were focused on apoptosis and the process ofpositive regulation of apoptosis. In the course of biology, the highestenrichment is in the process of cell cycle change. The results of thecomprehensive PPI, miRNA-DEGs and lnRNA-DEGs control network,UBC, HSPA8 in the PPI network in the core node position, hsa-miR-185-5p, hsa-miR-4516s in an important position in the miRNA-DEGsregulatory Network diagram.NR-029894, NR-029410 are in the stra-tegic position of LnRNA-DEGs control Network diagram.ConclusionsThese data demonstrated UBC and HSPA8 are important markers ofthe evolution of DFUs. This can gain a better understanding of themolecular mechanisms and provide potentially valuable genes forprevention, diagnosis and treatment therapy.


S24A novel functionalized graphene nanocomposite with dual-targeting ability for chemo-photothermal ablation of multidrug-resistant Gram-negative bacterial infection of skin woundHe Wang, Wei Qian, Gaoxing LuoInstitute of Burn Research, Southwest Hospital, Army Medical University,Chongqing, ChinaCorrespondence: Wei QianBurns & Trauma 2019, 7(Suppl 1):S24

BackgroundMultidrug-resistant (MDR) Gram-negative bacterial infections of skinwounds have been a major challenge in the treatment of burns andtrauma. As one of the alternative strategies, PTT has recently becomea research hotspot. However, the greatest defect for PTT could bethe difficulty of targeting for the pathogenic bacteria to avoid theundesirable damage of ambient tissue. Furthermore, monotherapymay also be inefficient. To address these challenges, a novel gra-phene based nanocomposite with efficient dual-targeting ability forchemo-photothermal synergistic therapy was synthesized.Materials and MethodsAminobenzeneboronic acid (B) was grafted onto carboxyl gra-phene (CG) by the condensation reaction of amine groups on Band carboxyl groups on CG. The resultant B-CG composite wasthen quaternized to form B-CG-QAS nanocomposite. Thecharacterization of B-CG-QAS was performed by FTIR, TEM, AFM,etc. The in vitro and in vivo toxicity was evaluated on the 3T3fibroblast and mice, respectively. The MDR A. baumannii, K. pneu-moniae and P. aeruginosa were chosen as the testing bacteria.The targeting abilities for bacteria and biofilm were explored bythe methods of SEM observation, fluorescent staining and ther-mal imaging. The in vitro antibacterial and anti-biofilm efficiencieswere determined using the standard plate count method. Thein vivo antibacterial and anti-biofilm efficiencies were investigatedin the murine skin wound infection model and subcutaneous ab-scess model, respectively.ResultsDue to stable covalent bonding and electrostatic attraction betweenB-CG-QAS and bacterial cell or biofilm matrix, B-CG-QAS exhibits avery strong targeting ability for the bacteria and biofilms. In vitro,B-G-QAS mediated chemo-photothermal therapy can effectivelykill the MDR Gram-negative bacteria and biofilms; in vivo, it canalso ablate the bacterial and biofilm infection, significantly acceleratingwound healing. B-G-QAS shows excellent biocompatibility in vitro andin vivo.ConclusionsThe B-CG-QAS described here, provides a novel treatment strategy forMDR Gram-negative bacterial and biofilm infection of skin wound.


S25Clinical Effect of Hydrodynamic Debridement on Severe InfectiousWoundsZongyu Li, ZhuolyuDepartment of Burns, the Fifth Hospital of Harbin, Harbin, ChinaCorrespondence: Zongyu LiBurns & Trauma 2019, 7(Suppl 1):S25

BackgroundInvasive refractory infection is one of the common complications ofwounds by various pathogens. This kind wound easily inducessystemic infection, even sepsis. The most important treatment forthe invasive refractory infectious wound is to remove the local path-ogens effectively and immediately. It is difficult to delete the patho-gens and devitalized tissues precisely by the conventional methods.Hydrodynamic debridement was reported suitable to treat differentwounds for its accuracy and convenience. In this study we intend toobserve the clinical effects of hydrodynamic debridement on refrac-tory infectious wounds.Materials and MethodsFrom 2014 to 2018, there were 32 cases with refractory infectiouswounds involved in this study, in which 28 cases were induced byburn injury. All the wounds were treated with a hydrodynamic de-bridement system versajet-II. The clinical effects were observed andrecorded after the treatment.

http://dict.youdao.com/w/electrostatic%20attraction/#keyfrom=E2Ctranslation


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ResultsAfter the hydrodynamic debridement, 32 patients were immediatelyunderwent skin grafting or suture directly. More than 90% woundhealed well. Moreover, the induced systemic infections were effect-ively controlled. There was no patient died in this study.ConclusionsThe hydrodynamic debridement system is one of the effective clin-ical methods to treat refractory infectious wounds.





S26Effects of pulmonary protective ventilation strategy combinedwith lung recruitment on hemodynamics in patients with severeburn complicated with ARDS in different sedation modesTian Xinli,Geng Kang,Zhou Weiwei,Yan HongDepartment of Plastic and Burn surgery, the Affiliated Hospital ofSouthwest Medical University, Luzhou, Sichuan, 646000, P.R.ChinaCorrespondence: Tian XinliBurns & Trauma 2019, 7(Suppl 1):S26

BackgroundThe effect of pulmonary protective ventilation strategy combinedwith lung recruitment on hemodynamics in patients with severeburns complicated with ARDS with propofol, midazolam and dexme-detomidine sedation.Materials and MethodsThirty patients with severe burns complicated with ARDS were ran-domly divided into three groups. They were sedated with propofol,midazolam and dexmedetomidine. Mechanical ventilation was alsoperformed in the pulmonary protective ventilation strategy. The timetaken to reach the target sedation depth, dynamic monitoring ofhemodynamic parameters heart rate, mean arterial pressure (MAP),central venous pressure (CVP) and cardiac output (CO), extravascularlung water index (EVLWI) . The blood gas analyzer was used to deter-mine the blood gas analysis index PH value, PaO2, PaCO2, and theOI was calculated. The treatment status and results of the patientswere counted. Repeated measures analysis of variance and LSD testfor data row single dataResults(1) The MAP and HR variability of dexmedepine was lower than thatof propofol and midazolam. The difference was statistically significant(P<0.01). There was no significant change in heart rate, MAP, CVPand CO. (P>0.5). 2) Before the combination of lung recruitment, lungrecruitment and lung re-expansion, the changes of PaO2, EVLWI andOI in this group were significant (P<0.01), PH value and PaCO2, nosignificant change (P>0.05). (3) All patients were cured without othercomplicationsConclusions1) For patients with burn complicated with ARDS, sedative treatmentwith dexmedetomidine hydrochloride has less effect on hemodynamicsthan midazolam and propofol; 2) pulmonary protective ventilationstrategy combined with pulmonary complexion Zhang can significantlyimprove the oxygenation of patients with severe burns complicatedwith ARDS, and may improve the prognosis of patients


S27Treatment of carbapenem-resistant Klebsieila pneumoniaeinfection in burnsJingning HuanDepartment of Burn & Plastic Surgery, Ruijin Hospital, Shanghai JiaotongUniversity School of Medicine, Shanghai 20025,PR.ChinaBurns & Trauma 2019, 7(Suppl 1):S27

BackgroundThe emergence of carbapenem resistant Klebsieila pneumoniae(CRKP )is an important threat to burned patients.

Materials and MethodsThis retrospective study was conducted to collect information fromburned patients in Shanghai Ruijin Hospital between 2010 and 2017.ResultsA significant increase in number of CRKP isolated from burned pa-tients was observed between 2010 and 2017.CRKP were resistant toalmost all available antimicrobials and are susceptible only to poly-myxins, tigecycline. A minority of CRKP are also susceptible to thefew remaining aminoglycosides. Antibiotics which can been currentlyused to treat CRKP infections include polymyxins, tigecycline andsome type of aminoglycosides.ConclusionsThe efficacy of combination antibiotics therapy is better than single-agent therapy for the treatment of CRKP bloodstream infections. Inorder to control the spread of CRKP, strategy for preventing CRKPdissemination in hospitals were suggested.


S28Development of an isothermal recombinase polymeraseamplification assay for rapid and accurate detection ofAcinetobacter baumannii and carbapenem resistance geneShuang Liu1,Guangtao Huang2,Yali Gong2,Yudan Meng1,YizhiPeng2,Junning Zhao3,Li yang4,Xiaolu Li1,31The Affiliated Hospital of Southwest Medical University, the departmentof Plastic & Burns Surgery, Tai Ping Street, Luzhou 646000, People'sRepublic of China; 2Institute of Burn Research, Southwest Hospital, TheThird Military Medical University, Gao Tan Yan Zheng Street,Chongqing400038, People's Republic of China; 3Sichuan Academy ofChinese Medical Sciences, Sichuan Translational Medicine Center ofChinese Medicine, Ren Min Nan Lu Road, Chengdu 610041, People'sRepublic of China; 4State Key Laboratory of Biotherapy and CancerCenter, West China Hospital, Sichuan University and CollaborativeInnovation Center, Ren Min Nan Lu Road ,Chengdu 610041, People'sRepublic of China.Correspondence: Shuang Liu; Xiaolu LiBurns & Trauma 2019, 7(Suppl 1):S28

BackgroundAcinetobacter baumannii(A.baumannii) is a leading pathogen causinghospital-acquired infections, and the drug-resistance rate of A. bau-mannii has been increased continuously in recent years. In this study,we developed a new 15ul reaction system of recombinase polymer-ase amplification (RPA) for rapid detection of A. baumannii and car-bapenem resistance gene.Materials and MethodsWe collected 30 A. baumannii clinical isolates from Burn Institute ofArmy Medical University though 6 months and tested the antibioticsusceptibility by Kirby-Bauer method. A. baumannii was detected usingblaOXA-51 gene by PCR, qPCR and 15ul-RPA respectively. We evaluatedthe sensitivity, specificity and the detection rate of clinical isolates. Inaddition, we detected of blaOXA-23 resistance gene by 15ul-RPA.ResultsUp to 90% of these strains were resistant to meropenem and imipe-nem. The 15ul-RPA detected successfully A. baumannii within18min at42°C, the detection limit of blaOXA-51 gene was 2.86CFU/ml, which hadsame sensitivity as PCR, and qPCR. The specificity of two identificationgenes was also extremely high, no positive amplification signal in non-Acinetobacter was observed. The detection rate of A. baumannii clinicalisolates using blaOXA-51 gene was 100%. Furthermore, we tested theblaOXA-23 resistance gene of A. baumannii by 15ul-RPA, the resultshowed majority (90%) of clinical isolates examined carrying theblaOXA-23 gene. Compared with the results of the antibiotic susceptibil-ity test, we found that all carbapenem-resistant A.baumannii isolatescarrying the blaOXA-23 gene, while no the blaOXA-23 gene was detectedin carbapenem-sensitive A.baumannii.Conclusions15ul-RPA analysis for detection A. baumannii and blaOXA-23 gene wasfaster and simpler than qPCR, PCR, and cheaper than conventional


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a/article/7/Supplement_1/s41038-01

50ul-RPA. We consider that 15ul-RPA has potential as promising alter-native molecular diagnostic method to rapid and effective detectionof A. baumannii and drug resistance gene in the Point-of-CareTesting.


S29Quantitative analysis of bacterial load in burn patients treatedwith topical application of silver sulphadiazine cream andnanocrystalline silver hydrogelSanjeev Kumar Uppal1, Avinash Gupta1, Dipan Uppal2, Deepinder KaurChhina1, Rajinder K Mittal11Dayanand Medical College, Ludhiana , Punjab , India; 2Maulana AzadMedical College, Delhi , IndiaCorrespondence: Sanjeev Kumar UppalBurns & Trauma 2019, 7(Suppl 1):S29

BackgroundThe quantitative cultures are more valuable in prediction of meta-static invasion of organisms. It gives the critical bacterial load (10 5

CFU/gram of tissue) beyond which metastatic invasion is possible.The effect of conventional silver sulphadiazine dressing with colloidalnanosilver hydrogel dressing in burn wounds needs to be comparedbased on quatitative culturesMaterials and Methods60 patients of burns upto 60 % were included and divided into silversulphadiazine and nanosilver hydrogel groups. Wound cultures forqualitative and quantitative analyses were taken at the end of firstweek, second , third and fourth week.ResultsIn Nanocrystalline Silver group average bacterial load of Klebsiellaprogressively decreased Average bacterial load of E.coli also progres-sively decreased . There was progressive increase in average bacterialload of Pseudomonas during second and third weeks . The increasecontinued in the fourth weekConclusionsNanosilver hydrogel significantly reduces the bacterial load in burnwounds as compared to silver sulphadiazine. There is complete clear-ance of E coli in nanosilver hydrogel group during our study period.The effect of nano silver hydrogel was not significant inPseudomonas.

9-0164-1/5707515 by guest on 10 August 2022


S30Devastating Burns: Perspectives of Burns patients at DhakaMedical College HospitalLow Tzuemn Ling1, Tanveer Ahmed Himon2, Chong Si Jack3, Chong XinYing3, Foong Shyn Yih Hayley31Ministry of Health Holdings, Singapore; 2Department of Plastic Surgeryand Burn Unit, Dhaka Medical College and Hospital, Dhaka, Bangladesh;3Asia Pacific Burn Association, Bali SingaporeCorrespondence: Low Tzuemn LingBurns & Trauma 2019, 7(Suppl 1):S30

BackgroundWe acknowledge that it is impossible for anyone to understandthe pain of these burn victims, let alone begin to imagine howdevastating it must have been and still is for them. We endea-voured to explore the experiences of burn patients. In doing so,we hope to gain more insight, strive to alleviate their sufferingand provide comfort.Materials and MethodsInterviews were conducted in both male and female burns wards atDhaka Medical College Hospital. Verbal consent was taken with theassistance of a translator. Sleeping, paediatric and critical care pa-tients were excluded. Patients, who were unable to speak for variousreasons, were also excluded. This study was carried out with permis-sion from the Dhaka Medical College Hospital.

ResultsA total of 36 patients were interviewed. 20 (55.6%) were male and 16(44.4%) were female. All 16 females were housewives. Most of theirburn injuries were caused by poor city layout, home layout and haz-ardous placements (17, 47.2%) and lack of safety installations in theform of wire insulations, faulty electrical circuits (15, 41.7%). 3 (8.3%)of the patients thought that the community was too overcrowded.63.9% were thermal injuries, 33.3% were electrical injuries and theremaining were chemical injuries (2.8%). All of them spoke Bengali,only 1 was able to speak both Bengali and English. He used to workin Singapore as a construction worker. 6 (16.7%) of them were un-educated. Majority of them 19 (52.8%) were of primary schoolqualifications.ConclusionsAccording to WHO, the vast majority of burns worldwide occur inlow- and middle-income countries. Within all countries, burn risk cor-relates with socioeconomic status. Nearly 173000 Bangladeshi chil-dren are moderately or severely burnt every year. The effects ofburns are far-reaching and reasonably more damaging for childrenthan adults. However, this study is limited to adults and future studycan be considered to include children for a more wholesome picture.


S31The Experience of Compassion Fatigue after Caring of MajorBurned Patient among Nurses in the Burn CenterFeng-Mei Tseng1, Ching-Huey Chen21Burn center, National Cheng Kung University Hospital, Tainan City,Taiwan; 2PhD, RN, Professor, Department of Nursing, Chang JungChristian University, Tainan City, TaiwanCorrespondence: Feng-Mei TsengBurns & Trauma 2019, 7(Suppl 1):S31

BackgroundThe purpose of this study was to understand the experience of com-passion fatigue after caring of major burned patient among nurses inthe burn center.Materials and MethodsUsing qualitative research, nine burn center nurses were selected ata medical center in southern Taiwan to collect data with interviews,observations, and reflective records.ResultsThe period of research is from January 1, 2018 to June 30, 2018. Thefindings are as follows: (1) " Empathy" is a key element in the con-tinuation of nursing and a factor that causes compassion fatigue. (2)Symptoms of compassion fatigues (such as physical and mental fa-tigue, anxiety, etc.) will affect the nurses, showing a lack of sense ofaccomplishment, want to escape and other characteristics; if notproperly resolved, will lead to personal trapped in negative emo-tions.(3) The caregiver is afraid of family concerns and is solely re-sponsible for the fatigue that is not seen. (4) The mutual support ofthe burn team members has become a major factor in reducingcompassion fatigues.ConclusionsUnder the pressure of high compassion fatigues, it will affect the motiv-ation of continuous service in the burn center. Therefore, the supervisorshould pay attention to and care for the nurses, continue to providepsychological support, and infuse positive energy. The nurses also needto identify themselves. Support each other then will coexist.


S32Project to Improving the Nurses Working Overtime——A MedicalCenter Burn ICU in TaiwanChen-Chun Chen, Meng-Jung Chuang, Ling-Yin Chiu, Feng-Mei TsengNursing Department, National Cheng Kung University Hospital , Tainan,TaiwanCorrespondence: Chen-Chun ChenBurns & Trauma 2019, 7(Suppl 1):S32


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BackgroundThis is a burn intensive care unit, which mainly cares for severelyburn patients and the other critical patients. When the registeredprofessional nurses seriously work overtime, they will directly affecttheir physical and mental health, which will lower the care qualityand influence the safety of the patients. This project is investigatingovertime to offer improve strategies to reduce working overtime.Materials and MethodsThis project is from November, 2017 to April, 2018, through Platoand fishbone diagram analysis mainly reason of work overtime andget on countermeasures, including: (a) revising the content of theshift specification (b) adding the auxiliary shift card (c) adding theauxiliary shift card holders(d) using the electronic shift system tostreamline the shifts(e) adjusting the medical supplies count to sim-plify the procedure(f) rearranging the auxiliary responsibilities ofmanpower and work content.ResultsThe average working hour overtime was reduced from75 to 46.25points, to reach the project's goals.ConclusionsWe hope the project's results can be to promote mental and physicalbalance, enhance patient safety and quality of care.


S33Exploring the Therapeutic Intervention Scoring System-28 (TISS-28)Established by Clinical Information System- A Medical Center BurnICU in TaiwanLing-Yin Chiu, Meng-Jung Chuang, Li-Chuan HungNursing Department, National Cheng Kung University Hospital, Tainan,TaiwanCorrespondence: Ling-Yin ChiuBurns & Trauma 2019, 7(Suppl 1):S33

BackgroundThere are daily frequent nursing activities and huge physiological sig-nals in the burn intensive care unit. If these signals could be con-verted into useful information, it will be helpful for clinical care.Therefore, the patient severity classification (such as TISS-28, APACHEII) is expected by automatically collecting data, and the error ofmanually collecting data is reduced, that more accurate data as a ref-erence for assessing of nursing manpower.Materials and MethodsThis Study was from June, 2015 to May, 2016, planning the TISS-28based form established by clinical information system, through link-ing existing medical information system in the first phase. After con-firming the correctness of the data, the relevant reports were createdin the second phase, and the data was analyzed with SPSS 17.0, toexplore the correlation between TISS-28 score and nursing workload.ResultsThe results showed that the TISS-28 based form of automatic captureand calculation was established. The TISS-28 score was positive cor-relation with nursing workload.ConclusionsThe TISS-28 established by clinical information system provides theinformation of nursing workload, as evidence-based resources formanpower policy.


S34Nurse-controlled analgesia with fentanyl for burn dressingchangesThach Ngoc Nguyen1, Quynh Van Nguyen1, Thang Quoc Tran21Department of Anesthesia, Vietnam National Burns Hospital, MilitaryMedical University, Hanoi, Vietnam; 2Intensive Care Unit, Hospital 354,Hanoi, VietnamCorrespondence: Thach Ngoc NguyenBurns & Trauma 2019, 7(Suppl 1):S34

BackgroundAnalgesia during burn dressing change is indispensable. Fentanyl hasgreat analgesic potency and short onset of action. Fentanyl has beencommonly used for analgesia during burn dressing changes in theUnited States. Today, the most common analgesic method is patient-controlled analgesia, however, nurse-controlled analgesia method is alsoused and differences between the two methods in their analgesic effi-cacy and side effects were statistically insignificant. Up to now, however,in Viet Nam, there hasn’t been any report of nurse-controlled analgesiawith fentanyl for burn dressing changes. Therefore, we conducted thisstudy with the aim of evaluating the effectiveness and safety of nurse-controlled analgesia with fentanyl for burn dressing changes.Materials and MethodsThirty two adult burn cases were given nurse-controlled analgesiawith the initial intravenous injection dose of fentanyl 1mcg/kg andthe additional intravenous injection doses of fentanyl 30mcg/timewhenever their Wong-Baker pain score was ≥ 3 during dressingchanges at Intensive Care Unit, National Institute of Burns in Vietnamfrom July 2017 to February 2018.ResultsThe number of additional fentanyl intravenous injection times was2.1 ± 1.16 and the total amount of fentanyl used for analgesia duringburn dressing changes was 124.7 ± 34.92mcg. The smallest and thebiggest of Wong-Baker average pain scores after fentanyl intravenousinjection were 0.3 ± 0.46 and 2.9 ± 0.35, respectively. Satisfied nurserate was 96.875%. The rate of dizziness, nausea and vomiting, prur-itus, sedation with OAA/S4 was 9.3%, 3.1%, 3.1%, 3.1%, respectively.ConclusionsNurse-controlled analgesia with fentanyl was effective and safe forburn dressing changes


S35Efficacy of ultrasound-guided implantation of PICC on childrenwith severe burnsYan Ma, Nan zhang, Duo Cai, Weiwei WuBruns Department, the First Hospital of Jilin University, XiminZhu StreetNo 1409, Changchun, ChinaCorrespondence: Weiwei WuBurns & Trauma 2019, 7(Suppl 1):S35

BackgroundTo investigate the clinical efficacy of ultrasound-guided implantationof PICC in children with severe burns.Materials and Methods24 children with burned area more than 16%TBSA or deep dermalburned area greater than 10%TBSA, age ranging from 2 to 10 yearsold were included with randomly grouping according to single ordouble numbers. PICC catheter was implanted under non-anestheticultrasound guidance in the control group, while under ultrasoundguidance with general anesthesia for control group. Success rate ofthe first implantation, implantation time and the incidence of sub-cutaneous hemorrhage were calculated.ResultsThe success rate of the first implantation in the observation group washigher than the control group (x2 = 14.4, P = 0.00015 < 0.05); implant-ation time in the observation group was significantly shorter than thecontrol group (t = 5.665, P < 0.05); the incidence of subcutaneoushemorrhage in the observation group was lower than the controlgroup (x2 = 9.882, P = 0.00167 < 0.05).ConclusionsPICC provides an ideal venous access for children with severe burnsand solves difficulties on peripheral venous catheterization in chil-dren. However, the poor coordination in children reduces the successrate of catheter implantation, and increases the incidence of mech-anical phlebitis and venous thrombosis after catheterization. Theultrasound-guided implantation of PICC is a safe and practical cathe-terized method, which ensures the treatment of children with a in-creasing success rate. The upper elbow catheter implantation can


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avoid the traction and friction of the catheter effectively when chil-dren moving, reduce the occurrence of complications aftercatheterization, and open up a new intravenous way for the treat-ment of children with severe burns.


S36The Effectiveness of Supervised Exercise Training for Venous LegUlcer: A Quasi-Experimental StudyShu-Fen, KaoHead Nurse, Burn Center, Department of Nursing, Taipei VeteransGeneral Hospital ,TaiwanBurns & Trauma 2019, 7(Suppl 1):S36

BackgroundVenous leg ulcers were important medical problem. Standardevidence-based care includes exercise training, which have beenshown to accelerate healing, improve quality of life, and likely reducecost.Materials and MethodsThis study was quasi-experimental research design. The purpose ofthe study was to develop and evaluate the effect of a exercise train-ing programs (aerobic exercise with resistance training) in venous legulcer patients. Then to compare the effectiveness about lower ex-tremity muscle strength, wound healing、medical cost.ResultsAfter paired samples t test found that aerobic exercise and resistancecombined aerobic exercise in the two groups after the implementa-tion of four weeks before the implementation of significant differ-ences (P <.05), four groups after the implementation of the fourweeks before the implementation of significant Differences (P <.05).ConclusionsExercise training for lower extremity venous ulcer patients with lowerlimb muscle strength has significant progress in the effectiveness ofexercise training on the peripheral circulation benefits, some studieshave shown that after exercise therapy ankle - arm arterial bloodpressure index was significantly improved.


S37Safety of placing peripherally inserted central catheter via femoralversus non-femoral vein in burn children: a retrospective analysisYanxu Lu1, Rongchan Wu2, Ying Wu2, Xiaoyuan Huang2, Li Xiao2, Li Xie21Changsha Medical University, Changsha 410219, Hunan, China;2Department of Burns and Plastic Surgery, Xiangya Hospital, CentralSouth University, Changsha, Hunan, 410008, P. R. China.Correspondence: Ying WuBurns & Trauma 2019, 7(Suppl 1):S37

BackgroundPlacing peripherally inserted central catheter (PICC) is currently popu-lar among burn patients. However, most subjects of previous studieshave been adults and insertion sites are predominantly non-femoralveins. Such an approach is quite limited for PICC studies of burnchildren.Materials and MethodsFrom February 2014 to August 2018, retrospective analysis was per-formed for 76 burn children with implanted PICC at our department.The relevant data included general demographics, catheter charac-teristics and complications.ResultsThe age range was 3 to 120 months. A total of 79 single-lumen 3/4Fcatheters were implanted. The insertion sites were non-femoral vein(25 catheters, n=22) and femoral vein (54 catheters, n=54). The meanindwelling duration of non-femoral and femoral veins was 27.28(9-47)and 22.33(2-130) days respectively. Inter-group statistical differencesexisted in insertion mode and insertion length (P<0.05). In non-femoralvenous catheterization group, insertion was blind (n=14, 56.0%) andultrasound-guided (n=11, 44.0%); in femoral venous catheterization

group, placement was blind (n=54, 100%). There were statistically sig-nificant inter-group differences in puncturing mode and indwelling dur-ation (P<0.05). The overall incidence of PICC complication was 17.7%.Neither group had any occurrence of catheter-related infections. Basedupon generalized linear model, no inter-group statistical differencesexisted in adjusted age, burn area, hospitalization length, number ofoperation, puncturing mode or complication (P=0.498>0.05). All chil-dren were cured and discharged.ConclusionsFor burn children, placing PICC via femoral and non-femoral veinsare both safe and effective. For those with difficult accessing at othersites, PICC via femoral vein is also a safe option.


S38Construction of Standardized Nursing System for Patients withSevere Burn Treated with Citrate as An in vitro Anticoagulant forBlood Purification TherapyLiNing, ChenHualingThe First Affiliated Hospital of Army Medical University, Chongqing,ChinaCorrespondence: LiNingBurns & Trauma 2019, 7(Suppl 1):S38

BackgroundThe purpose of this study is to construct a scientific, systematic andapplicable standardized nursing system for patients with severe burntreated with citrate as an in vitro anticoagulant for blood purificationtherapy, in order to provide the basis for standardized nursing forblood purification therapy with citrate as an in vitro anticoagulant.Materials and MethodsA multidisciplinary team was built. Relevant domestic and foreigndocuments were referred to and 26 experts were consulted for tworounds by Delphi method and a preliminary standardized nursingsystem for patients with severe burn treated with citrate as anin vitro anticoagulant for blood purification therapy was constructed.ResultsThe response rate of two rounds of expert consultation was 91.10%and 100.00%, respectively; the authority coefficient (Cr) was 0.943.The expert coordination coefficient was 0.501 and 0.713, respectively.Hence, the expert coordination was high (P < 0.05). Four first-gradeindexes, including evaluation system, standard operation system,early warning and nursing system for complications and quality con-trol system, and 19 second-grade indexes and 43 third-grade indexeswere established.ConclusionsThe standardized nursing system for patients with severe burntreated with citrate as an in vitro anticoagulant for blood purificationtherapy can help improve continuity of care, reduce unplanned extu-bation rate and operation opportunity disruption rate, lower rate ofcomplications and shorten average stay in ICU and cut expenses andalso improve quality of care.


S39Application of standardized communication (SBAR) modelhandover sheet in transfer and handover of emergency patientswith extensive burnsLiNing, LiuTingminThe First Affiliated Hospital of Army Medical University, Chongqing,ChinaCorrespondence: LiNingBurns & Trauma 2019, 7(Suppl 1):S39

BackgroundThe purpose of this study is to discuss the effect of application of stan-dardized communication (SBAR) model in the handover of emergencypatients with extensive burns for the large amounts of information andspecialized contents.


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Materials and MethodsProspective comparison study was conducted. From January to December2017, 45 emergency patients with extensive burns in our hospital formeda control group and were transferred and handed over by conventionalmodel. From January to December 2018, 54 emergency patients with ex-tensive burns in our hospital formed an experimental group. On the basisof conventional handover model, the emergency patient handover sheetof the experimental group was prepared by following the SBAR standards,covering the patient name, diagnosis and other basic information; briefmedical history, current drug and oxygen treatment, activity and skin;state of consciousness, vital signs and life-threatening factors; therapeuticmeasures adopted and cautions. A statistical analysis was conducted onthe two groups’ observation indicators such as adverse event rate, hand-over duration and satisfaction of medical staff.ResultsThe adverse event rate of the observation group was reduced by8.1%, average handover duration was 13±4.5 minutes shorter, thedoctors’ satisfaction with nurses’ handover was increased by 3.8%and the nurses’ satisfaction with handover process was increased by5.6% (P<0.05).ConclusionsThe SBAR standardized communicate model is a safe, effective, evidence-based and result-oriented communication model, which can improve thecritical thinking ability of nurses, improve satisfaction of medical staff andpatients, reduce communicate-related adverse event rate and shortenthe handover duration to better guarantee the handover safety of emer-gency burn patients.


S40Pathogen Characteristics of CVC-related Bloodstream Infection inExtensively Burned Patients and Analysis on Effects of Bundles ofCareLiNing, GongYaliThe First Affiliated Hospital of Army Medical University, Chongqing,ChinaCorrespondence: LiNing1

Burns & Trauma 2019, 7(Suppl 1):S40

BackgroundThe purpose of this study is to investigate the pathogen characteris-tics of CVC-related bloodstream infection in extensively burned pa-tients, drug tolerance and effects of bundles of care.Materials and MethodsConvenience sampling was used to select 224 cases of extensiveburn occurred from January 2013 to December 2015 as the controlgroup from the ICU of Department of Burns of a 3A hospital inChongqing, and 234 cases of extensive burn occurred from January2016 to December 2018 as the experiment group. And the pathogencharacteristics and drug sensitivity of CVC-related bloodstream infec-tion of the two groups were taken as observational indexes for statis-tical analysis.ResultsThere was a significant difference between the control group and theexperimental group in the detection of G+, G-and fungi. Acinetobacterbaumannii, Pseudomonas aeruginosa G+ Staphylococcus aureus andfungi in the control group were significantly lower than those in thecontrol group. The G-Klebsiella pneumoniae in the experimental groupwas significantly higher than that in the control group (P < 0.05). In thecontrol group, the detection rate of multi-drug-resistant bacteria in-creased during 2013 to 2015 and then decreased year by year afterreaching the peak in 2015 (P < 0.05).Most of the gram-negative bac-teria were only susceptible to β-lactam,carbapenems and aminoglyco-sides with relatively low resistance rates, But the resistance ratesshowed an increasing trend (P < 0 05).Especially, the drug resistance ofKlebsiella pneumoniae was serious (P < 0.05).ConclusionsThe detection rate of pathogen causing burn unit-acquired infectionwas high and most of the pathogens were highly drug-fast. The appli-cation of bundles of care to strengthen infection control management

in hospital wards and reasonable use of antibacterial agents have goodeffects on reducing drug-fast bacteria, improving anti-infectious treat-ment and controlling nosocomial infection rate.


S41Airway management experience in batched burn patientscombined with inhalation injuryLiping Zhang1, Huaqing Chen1, Haiping Hua1, Xingang Wang1, Hao Xu1,Jiyong Jing1, Junfeng Xu1, Xiong Zhao2, Xiaojie Yue2, Chunmao Han11Department of burn, second Affiliated Hospital of Zhejiang University,College of Medicine, Hangzhou, China; 2Department of Burn and PlasticSurgery, Children's Hospital of Zhejiang University, College of Medicine,Hangzhou, ChinaCorrespondence: Haiping HuaBurns & Trauma 2019, 7(Suppl 1):S41

BackgroundOn July 5, 2014, a total of 32 passengers were hospitalized for burnsin Hangzhou bus fires. 32 patients had different degrees of inhalationinjury. The medical team involved in the treatment has taken theprinciple of “optimized treatment and refined care” and activelytreated respiratory tract burns with multi-disciplinary technical ad-vantages, and achieved good results.Materials and MethodsA multidisciplinary and specialized airway management team wasestablished to implement airway management strategies in a compre-hensive, whole-process and refined manner. Team members including:respiratory therapist, nursing management specialist, responsiblenurses, pediatrician, burn doctors, nutrition therapist, ENT doctors, ICUdoctors, psychiatrist, hospital-acquired infection control department.This study with a focus on emergency respiratory assessment and treat-ment, airway management, anti-shock and drug used, psychologicalintervention and environment management, etcResultsThere were 32 burn patients with different degrees of inhalation in-jury in this bus fire accident. By taking active airway managementmeasures, 7 of 10 ventilator-assisted patients were successfullyweaned on day 7 after injury by taking effective airway managementmeasures. 14 days after injury, except for one severely ill patient, allother patients spontaneously breathed without serious pulmonary in-fection. The fiber bronchoscope revealed that the airway mucosahealed significantly without complications such as airway stenosis.Compared with previous patients with burns and respiratory tract in-juries, we found that managing airways through multidisciplinarytreatment can shorten ventilator offline time, reduce the incidence oflung infection. However, the healing time of the respiratory tract andthe narrowing of the airway cannot be compared.ConclusionsThe multidisciplinary joint strategy fully highlights the professional-ism of the various disciplines involved in treatment and play an im-portant role in improving the efficiency and refinement of airwaymanagement in batched burn patients. The relevant experience isworth promoting

Abstract TopicL: Nursing Care in Burn Centre

S42A Systematic Review: Topical Sucralfate for Burn WoundLoelita M Lumintang, Made S Adnyana, Nyoman P RiasaDivision of Plastic Reconstructive and Aesthetic, Surgery Department,Faculty of Medicine Udayana University/Sanglah General Hospital,Denpasar, Bali, IndonesiaCorrespondence: Loelita M LumintangBurns & Trauma 2019, 7(Suppl 1):S42

BackgroundTopical Sucralfate has been used for burn and non-burn skin and muco-sal lesion with remarkable results. The healing rate of mucosa is faster


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than skin lesion. This systematic review was conducted to determine thebenefits of topical sucralfate for burn wound, to show on which degreeof burn wound it works, how it works and the outcomes compared toSSD as a gold standard of burn wound therapyMaterials and MethodsDatabases were searched for relevant studies: google scholar, PUBMED,and ProQuest. Data sources were searched using MeSH terms: ‘topicalsucralfate’ and ‘burn wound’ for all publications up to December 2018.All English papers were included. Both in vivo and in vitro comparativestudies, performed in humans or animals, were included. A total of2437 publications were found, of which 4 studies met the inclusion cri-teria and were relevant to be used in this systematic review. The pri-mary outcome was burn wound healing.Data from retrieved studies were reviewed and tabulated accordingto year of publication, study design, human or animal studies, char-acteristics of the population, and outcomes.ResultsA total of 2 randomized controlled trials, 1 case control trial and 1observational comparative study were found. All trials are on seconddegree burn wound patients. Jadad score was used to assess themethodological quality of the article. Three publications demon-strated favorable outcomes with the use of topical sucralfate andone publication with no significant differences.ConclusionsThis systematic review shows a noticeably beneficial effect of topicalsucralfate for burn wound. It is better than SSD in wound healingrate, decreased infection rate and enhancement of epithelializationwith no local or systemic adverse reactions. However, multicenterRCT with larger sample size are needed to make recommendationfor burn wound treatment.


S43The effects of humidity combined with oxygen therapy on facewith superficial partial-thickness burnWeiwei WuThe first hospital of Jilin university, Changchun, Jilin, ChinaBurns & Trauma 2019, 7(Suppl 1):S43

BackgroundTo access the healing time on face with superficial partial-thicknessburn when treated humidity combined with oxygen therapy.Materials and MethodsThis clinical trial was conducted with 68 hospitalized patients withsuperficial partial-thickness burn on face from October 2016 to Febru-ary 2018 .They were randomly divided into two groups. In the controlgroup,35 patients were treated with recombinant human granulocytemacrophage stimulating factor gel 3 times once a day and treated withexposure therapy. In the intervention group (33 patients), in addition tothe control group’s treatment, active humidification combined oxygentherapy device to humidify the wound, which was performed 3 times aday,40 min once time. The humidification temperature was 37.0°C, thehumidification humidity was 60°C,and the oxygen concentration is50%.Compared the average healing time and comfort score about thewound between groups.ResultsThe average of the healing time was (9.3 ± 1.5) days in the intervi-tion group compared with( 11.7 ± 1.2 )days in the control group.There was significant difference between the two groups ( P < 0.05 ).What’s more,The comfort degree of the wound was (95±8.2) pointsin the intervention group and (88±9.7) points in the control group .Astatistically significant reduction was reported for the interventiongroup compared with the control group(P<0.05).ConclusionsHumidity combined with oxygen therapy not only shorten thewound healing time but also improve wound comfort.

Abstract Topic: Others

S44A systematic review and meta-analysis of enteral glutaminesupplementation in critically burned patientGuanghua Guo, Lian Zhang, Mingzhuo Liu, Xincheng LiaoDepartment of Burn, The First Affiliated Hospital of Nanchang University,Nanchang, Jiangxi, ChinaCorrespondence: Guanghua GuoBurns & Trauma 2019, 7(Suppl 1):S44

BackgroundAfter severe burns, the body is continuously in a state of high metab-olism and decomposition. Severe burns after many amino acids in astate of output, such as skeletal muscle and organ of glutamine, ala-nine, arginine, they transport it, at the same time provide energy forliver function, and the satisfaction of energy on the formation of anew skin plays a very important role, including glutamine also has tomaintain the intestinal immune function. The purpose of this meta-analysis is to collect, summarize and analyze the existing clinical trialdata to determine whether intestinal glutamine supplementation canpositively affect cicadas in critically burned patientsMaterials and MethodsThe following databases were searched by computer: PubMed, baiduScholar, Cochrane clinical trial.The retrieval time is from the databasebuilding to February 2019.A randomized controlled trial of enteralGLN supplementation in critically burned patients was included.Thequality of the included literature was evaluated using the cochranemanual, the data were combined, and statistical analysis was per-formed using the RevMan5.3 softwareResultsA total of 13 articles, a total of 490 cases (control group, 242 cases ofvs group, 248 cases), the evaluation standards of hospitalization days(the control group, 210 cases of vs the experimental group, 219cases), wound healing rate of 118 cases (control group vs the experi-mental group 122 cases), infection rate of 134 cases (control groupvs the experimental group 133 cases), 11, 6, 7) research and analysis,respectivelyConclusionsEnteric glutamine supplementation can reduce the incidence of infec-tion in burn patients, promote wound healing, and reduce the numberof days in hospital. This is the analysis result of a small trial, and a largerandomized double-blind controlled trial is still in progress

Abstract Topic: Nutrition and Metabolism

S45Propranolol use in adult burn patients and dosing practices atSingapore General Hospital Burns Centre: Implication for safetyHong Ngee Chan1, Jasmine CL Ong1, Jie Lin Soong1, Shin Yi Ng2, YeeSiang Ong31Department of Pharmacy, Singapore General Hospital, Singapore;2Department of Surgical Intensive Care, Singapore General Hospital,Singapore; 3Department of Plastic, Reconstructive & Aesthetic Surgery,Singapore General Hospital, SingaporeCorrespondence: Hong Ngee ChanBurns & Trauma 2019, 7(Suppl 1):S45

BackgroundPropranolol has been shown to be efficacious modulator of postburn cardiac response and increase muscle protein synthesis in se-verely burned children. However, safety, efficacy and optimum dosein adults are less well established. The primary objective of our studyis to investigate the safety of propranolol in adults with ≥20% TBSAburns. The secondary objective is to determine the propranolol doselevels that are tolerated by our local population.


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Materials and MethodsWe retrospectively reviewed medical records of burn patients be-tween 21 - 65 years old with ≥ 20% TBSA burns that were on pro-pranolol from January 2010 to October 2017. Propranolol dose andpatient clinical data were obtained from hospital electronic medicalrecords. Hypotension is defined as SBP < 100 or MAP < 60 mm Hg,and bradycardia as HR < 60 bpm. Descriptive statistics were used toreport results.ResultsForty-one patients met the inclusion criteria with median age of 31years, median burn size of 50% TBSA and 39% had inhalational in-jury. Mortality was 19.5%. Median time to propranolol initiation was3 days from hospital admission, Median episode of dose held was 4per treatment course. Low blood pressure accounted for 39.8% pro-pranolol dose withheld. Less than 5% dose withheld was associatedwith bradycardia, 25.9% due to nil by mouth or in operation, 28.9%with no reason stated. Some 43.9% of patient required vasopressorat some point. The median dose administered during hospital staywas 0.3 mg/kg/day (IQR 0.2 to 0.5 mg/kg/day).ConclusionsThis study indicates that our patients did not tolerate similar pro-pranolol dose reported in other adult studies. Vasopressor use sug-gests presence of shock which may explain lower propranolol dosesused and lower threshold to withhold doses. Future prospective,dose finding studies are needed to determine the optimum dose ofpropranolol in adult burns patients.

Abstract Topic: Paediatrics Wound Management

S46Application of music video finger function rehabilitation exercisein continuous nursing care of burned childrenWu Weiwei, Cai Duo, Xu Xiaochuan, Cheng Dan, He Tingting, Zhou YanDepartment Of Burn Surgery, The First Hospital of Jilin University,Changchun city, Jilin, ChinaCorrespondence: Wu WeiweiBurns & Trauma 2019, 7(Suppl 1):S46

BackgroundTo observe the application effect of music video finger function re-habilitation exercise in continuous nursing care of burned children.Materials and MethodsFrom January 2017 to January 2018, 69 children were divided intocontrol group and experimental group according to random numbertable, 34 cases in control group and 35 cases in experimental group.After discharged from hospital, the experimental group adopted themusic video finger function rehabilitation exercises in the guidancemethod, guiding the children to do finger function exercises for 40minutes once a day ;the control group was according to the routineguidance method after discharged, it is by using the words and pic-tures to guide the children and their families to do hand function ex-ercises, by observing the total activity range (TAM) of the two groups3 months after discharge to assess the joint range of motion andcompare the satisfaction scores of family members of the two groupsto perform the T test and χ2 test of the data.ResultsThe TAM assessed good ratio in the experimental group was 82.85%(29/35),and the control group was 58.82% (20/34),which has statis-tical significant of the difference between the two groups(χ2=4.839,P=0.038); the family satisfaction score of the experimental group was(9.5 + 2.8) and the other was (8.2 + 2.1), which has statistical signifi-cant of the difference between the two groups(t=18.105, P=0.000)ConclusionsMusic video finger function rehabilitation exercise is conducive tothe recovery of hand function of burned children, and the improve-ment of the satisfaction of continuous nursing care.


S47Sollerman Test: A simple, effective & reproducible test forfunctional evaluation in reconstructed post burn hand deformitySeema Rekha Devi, Paresh Baruah,Vaibhav Bhisikar, Sonali Uchil, BirajSaikiaPlastic surgery Department, Gauhati Medical College & Hospital,Guwahati, Assam, IndiaCorrespondence: Seema Rekha DeviBurns & Trauma 2019, 7(Suppl 1):S47

BackgroundPost Burn hand deformity is a common occurrence despite increas-ing sophistication of management of acute thermal injuries. Qualityof life of burn survivors depend upon the functionality of the hand.:Functional outcome of post burn hand deformity is still vague andcontroversial. Main principle in severe hand burn deformity is restor-ing function rather than individual movement of all joints.Materials and MethodsThis is a three year study carried out at the Dept. of Plastic Surgeryat GMCH, in 65 patients in 75 hands with unilateral and bilateral in-volvement with varying severity from January 2015 to March 2018,which includes patients with post burn hand deformity. Age groupvaried from 2 years to 45 years, mean age is 18.5 years. ‘SollermanHand Function Test is used (pre and post-surgery) which is a stan-dardized method based on eight most common hand grips and 20subtests of activities of daily living. For Final evaluation of the validityand reliability of the tests, scoring as described has been used.ResultsThe results in the studied population showed reliability of the pre-operative prognostic analysis with the subjective estimation of handfunction which was assessed with post-operative scoring of handfunction.ConclusionsThe test is simple and reliable & gives a true picture of Grip Functionin activities of daily living besides giving a moral boost to the patientin continuing the physical therapy for continued improvement


S48Post Burn Breast Reconstruction, a challenge in plastic surgerySeema Rekha Devi, Jyotirmay BaishyaPlastic surgery Department, Gauhati Medical College & Hospital,Guwahati, Assam, IndiaCorrespondence: Seema Rekha DeviBurns & Trauma 2019, 7(Suppl 1):S48

BackgroundBurn injury to the anterior wall of the female breast can result invarious deformities due to extensive scar contractures. The de-formities may vary according to the age, type and nature, thedepth and extent of injury. The deformities in pre pubertal breastcan result in hidden breast or under developed breast, and/ordestruction of NAC, whereas in a post pubertal breast, it may re-sult in distortion of contour, with displacement, difficulty in lacta-tion (NAC disfigured or destroyed). There is usually absence ofthe infra mammary fold, inadequate breast proportion, underdevelopment of breast and alteration of the nipple areola com-plex position.Materials and MethodsIn post burn breast reconstruction both functional and cosmetic as-pects are taken into account including breast feeding and nipplesensation. Although some nipple sensation recovers, breast feedingcannot be achieved always when there is destruction of nipple


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areolar complex .Total 50 numbers of cases of post burn breast re-constructions done in last 10 years will be presented. Cases wereclassified according to severity into Type 1, Type 2, Type 3. Out of 50cases Type I are 12 Type II 30 & Type III 8 cases & 17 cases pre puber-tal and 33 post pubertal. All cases were managed with surgeryfollowed by post-operative care including pressure garments, splints,massage and exercise.ResultsThe patients were assessed on the basis of patient satisfaction, size andshape of the axilla and contour of the breast and position of the NACfrom defined landmarks & complications if any. It was found to be aes-thetically fair in 25, good in 19, and excellent in 6 cases. Complications in-cluded small graft loss (6), scar hypertrophy 8, re-contracture 4.ConclusionsKnowledge of anatomy & good pre-operative planning and post-operative care gives good long term results. He video on a post burnBreast reconstruction shows steps of breast reconstruction and post-operative result.


S49Difference in TBSA Estimation Between Emergency Room and BurnUnit in Second Tier Hospital in Central JakartaSanjaya F Tanjunga1, Aditya Wardhana2, Gammaditya A Winarno1, AmaniS Augiani1, An’umillah A Zidna11Internship General Practitioner, Jakarta Islamic Hospital Cempaka Putih,Jakarta, Indonesia; 2Plastic Surgeon, Jakarta Islamic Hospital CempakaPutih, Jakarta, IndonesiaCorrespondence: Sanjaya F TanjungaBurns & Trauma 2019, 7(Suppl 1):S49

BackgroundBurn TBSA estimation is essential to administer fluid resuscitation.There are some well-known methods including Rule of 9 and Lund-Browder Chart. This study aims to identify the difference in TBSA esti-mation in Emergency Room & Burn Unit.Materials and MethodsThis is a retrospective cross-sectional study. Samples are patients admit-ted to Jakarta Islamic Hospital Cempaka Putih (JIHCP) Burn Unit be-tween April 2015-September 2018. Inclusion criteria are patientsadmitted to JIHCP burn unit with complete TBSA estimation betweenthe emergency room and burn unit. Exclusion criteria are missing vari-ables in records. The estimation of TBSA in emergency room is done byGeneral Practitioner, while in burn unit is done by Plastic Surgeon.ResultsAdmission of patients reached 160, and 142 patients were eligible inthe inclusion criteria, most of it were adult male with average of 28.3years old, suffering a grade II burn injury, caused by scald. There is ahigher mean of TBSA estimation in the Emergency room with 15.83(SD 12.21) compared to Burn Unit with 12.92 (SD 12.00). The max-imum TBSA overestimation in ER reached 24% TBSA compared toBU, while the minimum being 0.5%. Maximum TBSA underestimationreached 20%, and minimum underestimation was also 0.5%. In aver-age, ER overestimated about 6.7% TBSA, and underestimated about2.8% TBSA compared to BU.ConclusionsThe emergency Room has the tendency of overestimating the TBSA,with almost 3% difference in mean (p<0.05). Further investigation isneeded to analyze which TBSA estimation method is used in eachroom.


S50Nanotechnology for burns: Epicite hydro

Joel Casas-Beltran, Pablo Rodriguez-FerreyraBurn Unit, Mexican Institute of Social Security, Hermosillo, Sonora,MéxicoCorrespondence: Joel Casas-BeltranBurns & Trauma 2019, 7(Suppl 1):S50

BackgroundBiotechnology provides access to modern new natural materials formedicine. Epicite hydro is an innovative material made of biotechnologi-cally generated pure cellulose and water. Due to its highly structuredthree dimensional fiber network and water content of at least 95%, it pro-vides skin with water and supports it in the process of woundregeneration.Objectives: To demonstrate the safety and clinical outcomes of usingepicite hydro in burns, as an alloplastic temporal skin substitute forthe treatment of burnsMaterials and MethodsRecords of all patients attended for burns treated with epicite hydro,at least 6 months prior to the present study, analyzing sex, cause,depth, and percentage affected, as well as pain scale, time of healingprocess and complications. Vancouver scar scale recording data at 6months, after treatmentResultsFrom October 2017 to March 2018, 37 files of patients with burnstreated with epicite hydro were collected. Patient demographics was63% male (23), 37%,female (13), mean age 36 years (range 2 to 58years), mean percentage 15% (range 1% to 25%), 73% 2nd degree burn(27 cases), 27% for 3rd degree burn (10 cases). Cause of burns 44% fire,40% scald, 5% contact whit hot material and 1% chemical. The meanpain scale 2 (range 1-4), mean epithelization 7 days (range 5-14 days),3rd degree burns generated granulation tissue (mean day 17). No com-plications, infections or allergic reactions. Vancouver scale at 6 monthsaveraging 2.9 (2nd degree)ConclusionsEpicite hydro can be safety used on burned skin surfaces where theepithelium is missing. The structured fiber network as a cell free, allo-plastic temporal skin substitute reduce pain and prevent infections.The biomaterial allows an optimized fluid homeostasis, creating anenvironment that stimulates the wound healing process, helps redu-cing time of reepithelization and with low scaring, making a promis-ing novel treatment for burns


S51Epidemiology of burns patients presenting to emergencydepartment in a secondary care hospital in East Nusa Tenggara,Indonesia from 2016 to 2018Agustini SongEmergency Department, S.K. Lerik Regional Public Hospital, Kupang City,East Nusa Tenggara, IndonesiaBurns & Trauma 2019, 7(Suppl 1):S51

BackgroundAlthough burn remains as a significant, preventable cause of morbidityand mortality in Indonesia, there is still no national guideline of burn inthis country. Despite some extensive studies about the epidemiologyof admitted burn patients in some burn centers in Indonesia, the studyinvolving the whole population, including the minor burn outpatientadmitted in emergency department (ED), is still scant. The objective ofthis study is to provide the characteristic of all burn patient as a guide-line for burn prevention planning program in Indonesia.Materials and MethodsThe medical records of patients with burns admitted to the ED of S.K. Lerik Regional Public Hospital between January 2016 and Decem-ber 2018 were evaluated retrospectively and analyzed.ResultsFrom 2016 to 2018, the average number of admission was 4.3 ± 2.26patients per month and 52 patients per year. Of the 155 includedburn patients, 60.7% were male and 56.8% of all patients were in theworking age group (15-64 years old). The majority of patient (31.6%)suffered from second degree (superficial partial-thickness) burn.There were 45.2% patients with no health insurance, accounted forthe majority of the subjects. A total of 102 patient (65.8%) weretreated as outpatient, with 12 patients (7.7%) discharged againstmedical advice due to cost issue.


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ConclusionsWorking age group, which is 15-64 years old, with male predomin-ance is at the highest risk of suffering burn injury. Most burn patientsin this study still had no health insurance, therefore contributed tothe high number of discharge against medical advice which hinderedthem from getting the best possible treatment, hence the increasingmorbidity and mortality. Occupational burn prevention and thesocialization of public health insurance should be the priorities inplanning the program for burn prevention in this country.


S52The importance of absolute rest in the management of lower legburnsYosuke Ojima, Munenori Sato, Hajime MatsumuraDepartment of Plastic and Reconstructive Surgery, Tokyo MedicalUniversity, Shinjuku, Tokyo, JapanCorrespondence: Yosuke OjimaBurns & Trauma 2019, 7(Suppl 1):S52

BackgroundIn the management of lower leg burns, absolute rest of affected limbs isquite important for the success of treatment. Sometimes, we experiencethe cases that the patients get better soon after they admitted to thehospital and just rested their affected limbs on the bed, while they havehad refractory wounds in the outpatient clinic. The purpose of this studywas to evaluate the importance of absolute rest in the lower leg burns.Materials and MethodsWe retrospectively studied 125 lower legs of 108 patients who came toour hospital with Second-degree or Third‐degree lower leg burns be-tween October 2014 and April 2018. Age, sex, mechanism of injury, per-centage of the total body surface area (%TBSA), the treatment situation(admission or outpatient clinic treatment), the method of treatment(conservative or surgical treatment), wound healing period and compli-cations were investigated.ResultsWe included 57 male lower extremities and 68 female lower extrem-ities. Mean age was 41 years old, and the most frequent mechanism ofinjury was scald burn. 90 lower extremities were treated in the out-patient clinic, and 35 lower extremities were treated in hospital. Mean%TBSA were 0.85% and 1.51%, respectively. 13 cases were convertedfrom outpatient clinic to admission treatment because of refractoryburn wounds. Mean %TBSA of them was larger than that of the casestreated in the outpatient clinic to the end (1.45% vs 0.75%; p<0.05).ConclusionsUnder the outpatient treatment, the patients cannot have absoluterest because of their daily lives, and sometimes it lead to a worsen-ing of their burn wounds. Considering from our study, the lower legsburns more than 1.5% TBSA should be hospitalized unless keepingbed rest or leg elevation.


S53An Retrospective analysis on Marjolijn’s UlcerHuibin Li1, Xing Yang1,2, Chenghao Hu1,2, Dongyu Li3, Feng Zhao1, YuhuiDongye1,21Department of Burns and Plastic Surgery, People's Hospital of Linyi,Linyi, Shandong 276000, China; 2School of Clinical Medicine, WeifangMedical University, Weifang, Shandong 261000, China; 3College ofAgricultural and Life Science, University of Wisconsin-Madison, Madison,WI, 53706, USACorrespondence: Huibin LiBurns & Trauma 2019, 7(Suppl 1):S53

BackgroundTo investigate the clinical feature, diagnosis, and treatment for Marjolijn’sUlcer.

Materials and MethodsAnalyze the Clinical resource of 32 cases of patients who was diag-nosed with Marjolijn’s ulcer pathologically since 2005-2018 in LinyiPeople’s Hospital.ResultsAll 32 cases are chronic. 29 cases (90.62%) are ulcerous and 3 cases(9.37%) are hyperplastic. In addition, 22 patients (68.75%) in thisstudy are above 50’s. The primary injury of all cases is due to flameor thermal liquid. Sorted by anatomical locations, 23 cases (71.87%)originated in joint, followed by 6 cases (18.57) in torso. Only 3 casesof Marjolijn’s ulcer stems from head, accounting for 9.37%. The latentperiod ranges from 2-25 years, 8.43 in average. Further analysisproved no relationship between the age and latent period. Accordingto Immunohistochemistry(IHC) staining, 27 cases (84.37%) are squa-mous carcinoma. Among these cases, 26 cases are well-differentiatedwhereas only one case is moderate-differentiated. After surgical exci-sion, reoccurrence is observed only in moderate-differentiated case.ConclusionsMarjolijn’s ulcer is more frequently observed among patients above50s. IHC is the golden rules for diagnosis. Early intervention such as sur-gery will yield good prognosis for well-differentiated squamous cancer(SC) whereas prognosis for moderate SC is not optimal. Therefore, earlydiagnosis, intervention, and management remains an important factorfor preventing or treating Marjolijn’s ulcer.


S54Sera from Diabetic ulcer patients induced inflammatory andsenescence of vascular endothelial via activating JMJD3Lian Wang1,2, Juanjuan Xing1, Jinhua Luo1, Xincheng Liao1, YoulaiZhang1, Tianning Wu3, Fei Guo1, Guanghua Guo11Burn center of the First Affiliated Hospital of Nanchang University,Nanchang, Jiangxi, China; 2Graduate school of Nanchang University,Nanchang, Jiangxi, China; 3Affiliated High School of NanchangUniversity, Nanchang, Jiangxi, ChinaCorrespondence: Fei GuoBurns & Trauma 2019, 7(Suppl 1):S54

BackgroundTo analyze the effect of sera from diabetic ulcer patients on the pro-liferation, migration, senescence, activation, and injury of vascularendothelial cells, and the underlying epigenetic mechanisms.Materials and MethodsThe serum pools of diabetic ulcer group and healthy control groupwas established accordingly. Human umbilical vein endothelial cell(HUVECs) were cultured with the conditioned medium containing 5%human serum, with or without the histone H3K27me3/2 demethylasespecific inhibitor, GSK-J4. Cell viability detected by CCK-8; Cell senes-cence measured by β-galactosidase in situ staining assay; Cell cycleanalysis with flow cytometry; Cell migration and repairing abilityscratch test; The expression of JMJD3 and methylation status of his-tone H3K27 in HUVECs monitored by laser scanning confocal micros-copy; Gene expression of related factors determined by RT-PCR.ResultsThe human diabetic ulcer sera promote HUVECs cell senescence and in-duce the G2-M phase arrest within 48h-incubation. We found that withinthe scratch repairing area, the cell density of the diabetic ulcer group de-creased significantly comparing with control group. Meanwhile, The hu-man diabetic ulcer sera induced up-regulation of JMJD3, a histonedemethylase, which down-regulated H3K27me3/2 levels in the nuclei ofHUVECs. Importantly, treatment with GSK-J4, can reverse the diabeticulcer sera- induced senescence and G2-M phase arrest via restoring theH3K27me2/3 levels. We measured the expression of factors related tosenescence, cell cycle arrest and cell migration. We found that eNOS,RAGE122, IL-1β, IL-6, IL-12 and TNF-α gene expressions were significantlyup-regulated by diabetic sera and GSK-J4 treatment reversed effects.Interestingly, while the diabetic sera treatment down-regulated the ex-pressions of ICAM-1, VEGF192 and TGF-β, GSK-J4 treatment rescued theaforementioned genes expression.


ConclusionsOur findings indicate that the human diabetic ulcer sera induce humanendothelium senescence, cell cycle and functional disorder by activatingJMJD3 signaling which down-regulating the global methylation level ofH3K27 and promoting the expressions of pro-inflammatory and RAGEgenes.

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S55In-vitro Influence of IL-10 modified hAMSCs on fibroblast andmacrophage phenotypic transformationGuangtao Huang, Zairong Wei, Dali WangDepartment of Burn and Plastic, Zunyi Medical University, Zunyi,Guizhou,ChinaCorrespondence: Guangtao HuangBurns & Trauma 2019, 7(Suppl 1):S55

BackgroundIn chronic wounds, the wound remains in the inflammatory phase, theproliferative and remodeling stages do not readily occur. There is aneed to find better strategies to promote chronic wound healing, espe-cially of more effective regulation inflammation and promote cell prolif-eration in chronic wounds remain a challenge. Both macrophages andfibroblasts play key roles in inflammation regulation and tissue repair ofwound healing. Mesenchymal stem cells (MSCs) and IL-10 have beenshown to accelerate open wound healing by regulating the inflamma-tory response and promoting fibroblasts proliferation.Materials and MethodsThe study explore the influence of IL-10 modified hAMSCs on macro-phage phenotypic transformation and fibroblast in vitro, in order toimprove MSCs biological effects of promote chronic wounds healingResultsOur results showed IL-10 modified hAMSCs promoted the transform-ation of inflammatory M1 macrophages to tissue-repaired M2 macro-phages,and showed the better capability of promoting fibroblastproliferation and repair gene expression than hAMSCs alone.ConclusionsIt may have great potential in promoting the chronic woundshealing.

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S56The epidemiology and clinical characteristics of epilepsy burnpatients in the southwest of ChinaSong Wang, Xiaorong Zhang, Gaoxing LuoInstitute of Burn Research, Southwest Hospital, ThirdMilitary(Army)Medical University, Chongqing, ChinaCorrespondence: Gaoxing LuoBurns & Trauma 2019, 7(Suppl 1):S56

BackgroundThe epidemiology of epilepsy burn patients has been reported inseveral countries and areas. However, no such study has been con-ducted in China. The aim of the study is to investigate the epidemi-ology of the epilepsy burn patients and the effect of an epilepticseizure on the clinical characteristics of burn patients.Materials and MethodsThe collected burn registry data from patients admitted to the South-west Hospital burn centre from January 2011 to December 2017 wasused to do a retrospective cohort study. A propensity score methodwas applied to reconstruct a 1:1 matched-pair cohort between burnpatients secondary to an epileptic seizure to those not.

ResultsOf the 7,683 patients, 66 (0.86%) burn patients were secondary to anepileptic seizure. Among 66 epilepsy burn patients, 48.3% were fe-male, the median age was 28.5 years(IQR:20.8-45.2), a flame injurywas the most common etiology, the incidence of burns peaked onJanuary, and the incidence was highest in upper limbs and lowest inthe perineum. Compared to the non-epilepsy group patients, the epi-leptic seizure resulted in the 3rd-degreee TBSA, cost, LOS, cost/TBSAand LOS/TBSA significantly increased. However, a significant decreasewas found in the superficial 2nd-degree TBSA and no difference wasshown in deep 2nd-degreee TBSA and TBSA. The epileptic seizureshowed a strong association with full-thickness burns (OR 8.52, 95%CI 4.21–17.23).ConclusionsOur results suggested that an epileptic seizure may have a significanteffect on the epidemiology and clinical characteristics of burn patients.


S57A Prospective Comparative Study on the Effectiveness of TwoDifferent Non-Adherent Polyurethane Dressings on Split-ThicknessSkin Graft Donor SitesDarshini Devi Rajasegeran1, Fazila Binte Abu Bakar Aloweni1, Chong SiJack2, Lim Xinyi1, Saranya Chandra Sekaran1, Zhang Lei1, Lim Li PinBrenda1, Kok Yee Onn11Singapore General Hospital, Singapore; 2Association of Burn Injuries,SingaporeCorrespondence: Darshini Devi RajasegeranBurns & Trauma 2019, 7(Suppl 1):S57

BackgroundThe current wound management SSG donor site in SGH Burns Unit isto apply ALLEVYN Non Adhesive. Numerous new polyurethane dress-ings with enhanced properties, such as BETAplast™N, are now avail-able. However, there is limited research regarding their efficacy.This is a prospective comparative clinical study analyzing differencesin exudate absorbency, ease and pain on dressing removal and epi-thelization between Allevyn and Betaplast.Materials and MethodsPatients in the general ward undergoing SSG were recruited. Allevynand Betaplast were applied on the same donor site after SSG harvest-ing. Dressings were secured using OPSITE film and bandage. Absorp-tive capacity was assessed daily using an absorbency grading chart.Dressing change was done on POD 5. Ease of dressing removal wasassessed with a visual chart, and pain score using the Wong-BakerPain Scale. The percentage of full re-epithelization in terms of surfacearea for each dressing was assessed.ResultsThe exudate absorption of Allevyn and Betaplast comparing betweenPOD 1 and POD 5 was significant (P<0.05), indicating that both dressingscontinued to absorb exudate from POD 1 to POD 5. When comparing ab-sorption from one POD to the subsequent POD, absorption for Allevynwas significant (P<0.05) only from POD 1 till POD 4, while absorption forBetaplast remained significant (P<0.05) from POD 1 until POD 5. Therewas no significant difference (p=0.05) between Betaplast and Allevyn forthe percentage of re-epithelization. Descriptive statistics indicated highermean percentage for Betaplast (mean= 62.73%) compared to Allevyn(mean= 49.09%), with 7 out of the 11 patients having better re-epithelization with Betaplast. No differences in ease of removal and painscore were found.ConclusionsCompared to Allevyn, Betaplast has better capacity and is more effect-ive in exudate absorption. Betaplast may have a faster rate of re-epithelisation compared to Allevyn, allowing faster donor wound heal-ing and improving overall patient recovery.


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S58A Clinical Study on Keloid Formation After HypertrophicSyndactyly ReleaseZhu Wei1, Tian Xiaofei21Institute of Burn Research, Southwest Hospital, State Key Laboratory ofTrauma, Burns and Combined Injury, the Army Medical University,Chongqing 400038,China; 2Department of Burns and Plastic Surgery,Children’s Hospital of Chongqing Medical University, Ministry ofEducation Key Laboratory of Child Development and Disorders, ChinaInternational Science and Technology Cooperation base Childdevelopment and Critical Disorders, Chongqing Key Laboratory ofPediatrics, Chongqing 400014,ChinaCorrespondence: Tian XiaofeiBurns & Trauma 2019, 7(Suppl 1):S58

BackgroundWe have shown that keloid formation after syndactyly release is associatedwith pachydactyly and skin-grafting in the previous retrospective study, Tofurther explore the clinic cause of keloid formation after syndactyly releaseMaterials and MethodsThe syndactyly appearance was preoperative evaluated for all patientsfrom January 2015 to January 2017. Child with pachydactyly, carriedout needle-scar response experiment firstly, according to the prelimin-ary experimental results and the patients’ opinions decide whether per-form syndactyly release furtherly. Postoperative skin grafting and scarhyperplasia were followed upResultsThere are 10 cases with the preoperative pachydactyly in two years.Among them, needle-scar response prediction experiments were carriedin 5 cases,9 toes with pachydactyly occurred keloid, the other normal toedid not develop keloids after surgery; There were 6 cases performed syn-dactyly reconstruction, 9 toes with pachydactyly occurred keloid, 4 nor-mal toes did not. 6 toes skingrafting and 7 toes noConclusionsKeloid formation after syndactyly release is related to the local damageof the toe with pachydactyly, but not significantly correlated with theskin-grafting


S59Selective mitophagy protects against early burn-woundprogression via eliminating effects of damaged mitochondriaSongxue Guo1, Chunmao Han2, Quan Fang1, Liping Zhang21Department of Plastic Surgery, the Second Affiliated Hospital ZhejiangUniversity School of Medicine, Hangzhou, China; 2Department of Burns,the Second Affiliated Hospital Zhejiang University School of Medicine,Hangzhou, ChinaCorrespondence: Songxue GuoBurns & Trauma 2019, 7(Suppl 1):S59

BackgroundDeep burn-wound undergoes a dynamic progression in the initial orperi-burn area after insults. The stasis zone has a higher risk of deteri-oration and is considered as a salvageable target for burn-woundprogression. Although multiple efforts have been made to under-stand mechanism and treatment, few work explores the role of mito-chondrial damage in this process and potential self-protection withinhuman body.Materials and MethodsA classic“comb”burn rat model was established in this study for fur-ther assessments. Hemodynamic and pathological evaluations wereperformed with helps of Laser speckle imaging and Hematoxylin andeosin staining. The changes of oxidative stress and apoptosis in thezone of stasis were detected by commercial kits. Mitochondrial dam-age and mitophagy were studied based on the results of

transmission electron microscope and western blots. Fluorescence-labelled adenovirus for HIF-1α silence was applied to clarify the roleof HIF-1α on regulating mitophagy in the zone of stasis.ResultsWe found burn insults bring about typical ischemia and histological deteri-oration in the zone of stasis, in parallel with increases of oxidative stressand apoptosis. It was also found some clues about the involvement ofmitochondrial damage in aforementioned changes. Furthermore, we de-tected typical mitophagy in burn-wound in the early stage after injury, pre-senting an opposite fluctuation to the conversion of burn-wound. Finally,we suggested HIF-1α is a key regulator on mitophagy in the zone of stasiswith downstream involvement of BNIP3 and PARKIN.ConclusionsHence, we demonstrate burn-induced mitochondrial impairmentcontributes to the mobilization of injurious mechanism in the zoneof stasis and mitophagy provides a way to protect against burn-wound progression via eliminating damaged mitochondria. Further-more, our findings offer insights in mitochondrial quality control inburn-wound progression and suggest a novel concept that HIF-1αcould be a potential therapeutic target in view of its regulation onBNIP3 or PARKIN-mediated mitophagy upstream.


S60Severe burn injury alters intestinal microbiota composition andimpairs intestinal barrier in miceYanhai Feng1, Yalan Huang2, Yu Wang3, Pei Wang1, Fengjun Wang11State Key Laboratory of Trauma, Burns, and Combined Injury, Instituteof Burn Research, Southwest Hospital, Third Military Medical University(Army Medical University) , Chongqing, China; 2Department of MilitaryNursing, School of Nursing, Third Military Medical University (ArmyMedical University), Chongqing, China; 3Department ofGastroenterology, Southwest Hospital, Third Military Medical University(Army Medical University), Chongqing, ChinaCorrespondence: Yanhai FengBurns & Trauma 2019, 7(Suppl 1):S60

BackgroundThis study was aimed to investigate the changes of intestinal micro-biota and barrier function in burned mice to further comprehend themechanisms of burn-induced intestinal barrier dysfunction.Materials and MethodsSamples were from mice inflicted with 30% TBSA full-thickness burns. Theintestinal permeability, tight junction proteins’ expressions, ZO-1localization, inflammatory cytokines’ expressions, and short-chain fattyacids (SCFAs)’ contents were determined. The microbial community wasassessed via 16S rDNA Illumina sequencing.ResultsThe intestinal permeability was increased after severe burn injury,peaking at 6 hour post-burn, with approximately 20 folds of thecontrol (p<0.001). The expression of tight junction proteins (ZO-1,occludin, claudin-1 and claudin-2) was significantly altered (p<0.05). The ZO-1 morphology was dramatically changed followingburn injury. The fecal SCFAs’ (acetate, propionate, butyrate, isobu-tyrate and isovalerate) contents were noticeably declined afterburn injury (p<0.05). The expressions of pro-inflammatory cyto-kines (IL-1β and IL-6) in ileal mucosa were increased, whereas theexpressions of anti-inflammatory cytokines (IL-4 and IL-13) weredecreased following burn injury (p<0.05). In addition, burnedmice showed an alteration of intestinal microbial community,such as decreased diversity, reduced Bacteroidetes abundance andincreased Firmicutes abundance.ConclusionsThe severe burn-induced intestinal barrier dysfunction is along withthe alterations of microbial community. Certain bacteria such asRuminococcaceae may contribute to maintain intestinal homeostasisafter severe burn injury.


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S61Burn Injuries Management in a Recently Established Burn Unit: 1Year Experience and Outcome. Is conventional method stillacceptable?Chairani Fitri SaphiraDepartment of Neurosurgery, Plastic Surgery, Cardiothoracic Surgery andUrology, Dr. Mohamad Soewandhie General Hospital, Surabaya,IndonesiaBurns & Trauma 2019, 7(Suppl 1):S61

BackgroundWhile the overall number of hospital visits due to burn injuries is note-worthy in Indonesia, resources for managing these patients are stillrelatively limited. This article will describe our experience and outcomein managing patients with burn injuries in a recently established burnunit of a primary referral hospital in a developing country. It willemphasize on the optimization of the limited available resources in themanagement process.Materials and MethodsDuring 2018, all new of patients with burn injuries in Dr. Mohamad Soe-wandhie were recorded. The patients were categorized and analyzedwith consideration of their management and outcome. All acute burnspatients were resuscitated using modified Parkland formula as indi-cated. Burns wounds were debrided and dressed using paraffin gauzeand silver sulfadiazine cream. No early excision performed. Patientswith wounds that failed to heal secondarily in the expected periodunderwent definitive surgical wound coverage of skin grafts or flaps.ResultsA total of 104 new burn patients were recorded, with 39 of them withmajor burn injuries. Of the patients TBSA of burn, 67 had <10%, 20 had10-20%, and 17 had >20%. Rate of surgery among patients who under-went surgery was 1.6 per patients. One patient with inhalational traumaand 1 pediatric patient died during hospitalization. Burn scar was themost reported complication during the follow up period.ConclusionsThis manuscript proves that burns management using conventionalmethod and dressing is still applicable where resources are limited. Themortality rate is comparable to those of other developing countries anddeveloped countries. But in terms of length of hospitalization and numberof surgeries underwent, conventional method is inferior compared tocurrent recommendation of practice guidelines for burn care. Conventionalmethod should be slowly replaced with a more modern and up to datemethod along with the development of accessible resources.


S62Investigation and analysis of burn pain of inpatients in southwestChinaHuang Min, Yan HongDepartment of Plastic and Burn Surgery, the Affiliated Hospital ofSouthwest Medical University, Luzhou, Sichuan, 646000, P.R.ChinaCorrespondence: Huang MinBurns & Trauma 2019, 7(Suppl 1):S62

BackgroundTo understand the status of burn patients' perception and attitudetowards burn pain in southwestern China, and to provide referencefor improving the pain management level of medical staff in burndepartmentMaterials and MethodsQuestionnaire survey of 219 burned hospitalized adult patients in 8tertiary hospitals with independent burn specialists in SouthwestChinaResults95.83% of the patients thought that the pain response after burnwas normal and should be tolerated as much as possible; 66.67%of patients were worried about side effects of painkillers; 35.33%patients did not receive any analgesia during hospitalization;

Preoperative analgesics were used in 33.33% of patients beforedressing change; When the patients reported to the medical staffthat the pain was unbearable, the rate of receiving analgesictreatment within 10min was 73.52%; 46.58% of patients thinkthat medical staff are concerned about their painConclusionsInpatients with burns in southwest China are lack of knowledge ofpain, so pain knowledge education should be strengthened.At thesame time, the pain management during hospitalization is not stan-dardized, and individual differences are large. Therefore, the painmanagement of burn patients should be strengthened, so as to im-prove the quality of pain management of burn patients and alleviatetheir pain


S63Characteristic of blast injury patients from Idi Rayeuk illegal oilmining explosion in East Aceh, IndonesiaSyamsul Rizal1, Muhammad Jailani1, Mirnasari Amirsyah1, Anastasia DessyHarsono2, Meilya Silvalila3, Emil Muzammil41Plastic, Reconstruction, and Aesthetic Surgery Department, MedicalFaculty Syiah Kuala University/ Zainoel Abidin General Hospital, Aceh,Indonesia; 2Plastic, Reconstruction, and Aesthetic Surgery Department,Medical Faculty Syiah Kuala University/Gatot Soebroto Army Hospital,Jakarta, Indonesia; 3Emergency Medicine Department, Medical FacultySyiah Kuala University/ Zainoel Abidin General Hospital, Aceh, Indonesia;4Medical Research Unit, Medical Faculty Syiah Kuala University, Aceh,IndonesiaCorrespondence: Emil MuzammilBurns & Trauma 2019, 7(Suppl 1):S63

BackgroundBlast injury is a complex and challenging burn case because couldaffect many person in one incident. The aim of this study was toanalyze the characteristic of all hospitalized patients from a gas ex-plosion incident occurred in April 25th 2018.Materials and MethodsThis is a retrospective descriptive study. All data was collected frommedical record in Zainoel Abidin General Hospital, data that wastaken including gender, total body surface area (TBSA), severity ofburn, laboratory examination, and cause of death.ResultsFrom total 39 burn injury patients from the incident, 9 patients were re-ferred to Zainoel Abidin General Hospital, but one patient died in trans-fer process. There were 7 male patients and 2 female patients. From allpatients, 7 patients have TBSA >50%. All patients were afflicted withsecond degree burn injury. Mortality rate was 77.77%, death mostlycaused by severe infection.ConclusionsGood triage, early adequate resuscitation, and primary emergencycare before patient transfer have important role to achieve optimalof therapy for burn injury cases from explosion incident that affectmany person at once.


S64Age and gender difference on the epidemiology and outcomes ofburn patients in southwest of China: a 15-year retrospective studyLiNing1, WangZhonghua21The First Affiliated Hospital of Army Medical University, Chongqing,China; 2School of Nursing, Army Medical University, Chongqing, ChinaCorrespondence: LiNingBurns & Trauma 2019, 7(Suppl 1):S64

BackgroundThe purpose of this study was to investigate the epidemiology, out-come, cost and risk factors among burn patients in one of the Chin-ese earliest specialized burn centers in the southwest China.


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Materials and MethodsThis 15-year retrospective study was performed at the Institute ofBurn Research of the. Information regarding demographic, burn char-acteristics, the burn severity of ABSI and were collected, calculatedand compared. Descriptive statistics, t-test,and x2 test were con-ducted according to the data types.ResultsA total of 16,614 burn patients were included. The mean age was26.18±21.74 years old, ranging from 257 days to 95 years old. Thepediatric patients under the age of 18 years old accounted for 40.3%,while the adult patients under the age of 60 years old accounted for53.9%. Scalding and flame were the two most common cause toburn injuries, comprising of 90.96% in total. head/face/neck, limbsand trunk were the most frequently occurred burn sites, with thenumber and the percent of 6972 (41.96%), 6105 (36.75%), and 6031(36.30%), respectively. The average total body surface area (TBSA)was 13.58±16.81% (median 8%) with a range of 0.1~100%. A total of802 (4.8%) patients had TBSA >50%. The presence of a burn with aninhalation injury was confirmed in 502 patients (3.02%). The averageLOS was 32.53±68.11 days (median: 17days).ConclusionsThis 15-year retrospective study examined the epidemiology andoutcomes of burn patients in southwest of China. The annual num-ber of burn injuries has kept decreasing, which was partially attrib-uted to the increased awareness and education of burn preventionand the improved burn-preventative circumstances. However, theburn severity and the economic burden were still in a high level.And the gender difference and age difference should be consideredwhen making individualized interventions and rehabilitativetreatments.


S65The epidemiology of burns in Japan: A national burn registry-based studyJunichi Sasaki1,2, Hiroto Ikeda1,3, Yoshiaki Inoue1,4, Jiro Katahira1,5, MiyukiKishibe1,6, Chu Kimura1,7, Yukio Sato1,2, Kiyotsugu Takuma1,8, KatsumiTanaka1,9, Minoru Hayashi1,10, Asako Matsushima1,11, HajimeMatsumura1,12, Hiroshi Yasuda1,13, Yuya Yoshimura1,14, Daizoh Saitoh1,141Academic Committee of the Japanese Society for Burn Injuries, Tokyo,Japan; 2Keio University Hospital, Tokyo, Japan; 3Teikyo UniversityHospital, Tokyo, Japan; 4University of Tsukuba Hospital, Ibaraki, Japan;5Tokyo Women's Medical University Hospital, Tokyo, Japan; 6KanazawaMedical University Hospital, Kanazawa, Japan; 7Hakodate Central GeneralHospital, Hokkaido, Japan; 8Kawasaki Municipal Hospital, Kanagawa,Japan; 9Nagasaki University Hospital, Nagasaki, Japan; 10Maebashi RedCross Hospital, Gunma, Japan; 11Nagoya City University Hospital, Aichi,Japan; 12Tokyo Medical University Hospital, Tokyo, Japan; 13Hospital ofthe University of Occupational and Environmental Health, Fukuoka,Japan; 14National Defense Medical College Hospital, Saitama, JapanCorrespondence: Junichi SasakiBurns & Trauma 2019, 7(Suppl 1):S65

BackgroundIn Japan, national burn registry (NBR) has been operated by the Aca-demic Committee of the Japanese Society for Burn Injuries (JSBI)since 2010. JSBI NBR is designed to improve the quality, outcomes,patient care, effectiveness by collecting and exchanging information.Materials and MethodsOutline of JSBI NBR: Collect data of patients hospitalized with burnsfrom the 111 burn centers certified by JSBI, 12542 cases betweenApril 2010 and March 2018 (8 years).ResultsAcute phase admission occupies approximately 90.6% (n=11359).Etiology of injuries: fire/flame (38.3%), scald (36.5%), contact (8.7%),explosion (4.8%), smoke/inhalation (4.1%), chemical (3.1%), electric(1.6%) others/unknown (2.8%). Inhalation injury is complicated with24.0% of all cases. The death including CPA is 1071 cases (9.4%). Eti-ology of death: shock/ organ failure (46.1%), infection (28.4%), COpoisoning (7.1%). Shock/organ failure is a cause of the top within

one week. It is revealed that a cause of the top changes in infectionafterwards. The mortality among cases with inhalation injuries wasapproximately 4 times of the non- complicated case.ConclusionsThe current state of Japan burn treatment was clarified by JSBI NBR.We will consider collaboration with international databases, e.g. WHOGlobal Burn Registry Form at designing the database.Limitations: Our data set is simple and include only basic items. Inparticular, the outcome of JSBI NBR is shown in survival, cause ofdeath and length of stay.


S66B-Flow Combined color Doppler ultrasound technical indwelling inextensive burn patients with has application effect of invasivearterial pressureWu Weiwei, Cai Duo, Zhang dandan, Cheng Dan, Zhang wuming , MayanDepartment of Burn Surgery, The First Hospital of Jilin University,Changchun city, Jilin , ChinaCorrespondence: Wu WeiweiBurns & Trauma 2019, 7(Suppl 1):S66

BackgroundTo investigate the application effect of two-dimensional gray-scaleflow imaging (B-Flow) in detaining invasive arterial pressure (IAP) inpatients with extensive burnsMaterials and MethodsRandomly divided the 67 patients with invasive arterial pressure fromJanuary 2017 to June 2018 into experimental group and controlgroup .There were 32 cases in the experimental group and 35 casesin the control group, the control group used the color Doppler ultra-sound technical and the experimental group used B-Flow combinedwith color Doppler ultrasound technology. To select the standard ar-tery blood detaining invasive arterial pressure, to compare the suc-cess rate of catheterization, catheter time and incidence of arterialthrombosis after intubation between the 2 groups;Resultsthere were 30 cases of successful catheterization in the experimentalgroup and 27 cases in the control group, which had statistically sig-nificant (P<0.05)of the success rate of catheterization between thetwo groups;The operation time of the experimental group was (18.23+ 1.08) min and the other was (11.45 + 1.13) min,which had a statisti-cally significant(P<0.05) of the difference between the two groups(P<0.05);There were 0 cases of thrombosis in the experimental groupand 6 cases in the control group,the incidence of thrombosis aftercatheterization in the two groups was(χ2=6.025, P<0.05),which thedifference had statistically significantConclusionsB-Flow combined with color Doppler ultrasound technique can im-prove the success rate of invasive arterial catheterization in patientswith extensive burn, shorten the catheterization time, and effectivelydetect the occurrence of arterial thrombosis.


S67The Impact of Fires Related to Personal Mobility Device andPower-Assisted Bicycle in SingaporeA. LIM1, J. KWEK2, L. ANG3, S. ARULANANDAM4, S. SHALI51Operations Branch, 3rd SCDF Division, Singapore Civil Defence Force,Singapore; 2Ang Mo Kio Fire Station, Singapore Civil Defence Force,Singapore; 3Fire Research Unit, Fire Safety and Shelter Department,Singapore Civil Defence Force, Singapore; 4Medical Department,Singapore Civil Defence Force, Singapore; 5Fire Investigation Unit,Operations Department, Singapore Civil Defence Force, SingaporeCorrespondence: J. KWEKBurns & Trauma 2019, 7(Suppl 1):S67


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BackgroundThere has been an increased use of personal mobility devices (PMD)and power-assisted bicycles (PAB) in Singapore as alternative trans-portation modes. However, such devices carry fire risks. This studyaims to investigate the impact of PMD/PAB-related fires to the healthof the users, and to describe some notable cases attended by theSingapore Civil Defence Force (SCDF) Emergency Medical Services(EMS) over the 2 year-period in 2017 and 2018.Materials and MethodsPMD/PAB-related fires attended by SCDF were identified through aretrospective review of fire investigation reports by SCDF Fire Re-search Unit (FRU). Where the fires resulted in injuries, the EMS pa-tient records were studied. Variables studied include injury type,severity, and injured body region. Three notable cases resulting withpartial thickness burns and classified as Patient Acuity Category 1(PAC 1) are described in this study.ResultsOut of 123 cases of PMD/PAB-related fire incidents, 17 cases resultedin 44 injured persons, with 7 cases involved multiple casualties. 34casualties were conveyed to the hospital, of which 7 (20.6%) wereclassified as PAC 1. 47.1% of the patients sustained only smoke inhal-ation injuries, and the remaining sustained burn injuries only or both.Most commonly, the upper limbs were injured. One notable case in-volved an adult patient who sustained smoke inhalation injury and50% partial thickness burn over the head, face, torso and all limbs.Two paediatric patients sustained 40% and 7% partial thickness burninjuries respectively, affecting mostly the torso and limbs. In all cases,the patients were in the same room where the devices were beingcharged when they caught fire.ConclusionsAlthough PMDs and PABs offer convenience and increased mobility,the fire risk, especially during the electrical charging process, carriessignificant impact on public health. Increased public education maybe needed to manage the fire hazards related to such devices.


S68The Use of ImageJ to Calculate Total Body Surface Area in BurnPatients: A Case SeriesAditya Wardhana, Rizta A. Widyana, Gammaditya A. Winarno, SanjayaFaisal T, Raihana Daisy ADivision of Plastic, Reconstructive, and Aesthetic Surgery, Department ofSurgery, Cipto Mangunkusumo Hospital Jakarta, IndonesiaCorrespondence: Rizta A. WidyanaBurns & Trauma 2019, 7(Suppl 1):S68

BackgroundAssessing the total body surface area (TBSA) of burn has been a mat-ter of clinical judgment even though some modalities now serve asadjunct tools to increase accuracy. We compared the result betweenclinical judgment from an experienced burn surgeon (>10 years inthe field) and manual calculations using ImageJ.Materials and MethodsWe conducted the study in the burn unit of Cipto MangunkusomoHospital, Jakarta. Using transparent dressing, we traced the border ofeach wound and the area is measured using “ROI Manager” in Ima-geJ. The overall BSA of each patient was calculated using the DuboisFormula as the denominator to determine the percentage of burn.The result from ImageJ calculation is then compared to the Rule ofNine.ResultsData was collected in the first day post injury of 3 patients, all withpartial to full-thickness burn. Patient A was a normoweight femalewith 36% burn clinically and 34.7% from ImageJ. Patient B was anobese female with 25% burn clinically and 32% from ImageJ. PatientC was an overweight female with 10% burn and 8.5% from ImageJ.In 2 patients, measurements are quite identical with <2% difference.The exception in 1 patient with 7% difference may be caused byobese proportion.

ImageJ provides detailed decimal number with a setback in circularbody parts such as arms. Dressing was unable to attach precisely foraccurate tracing. ImageJ is useful for non-circumferential wound orwhen an exact area of wound is needed for research.ConclusionsImageJ is an aid to calculate wound area but may not be reliable forburns with unpredictable and circumferential wound. An attempt tomeasure BSA using ImageJ, though not futile, is not more beneficialthan using the common rule of nine.


S69Reviving the Burn Scoring System: An Aid for Appropriate Patient’sCare in Cipto Mangunkusumo General Hospital, Jakarta, IndonesiaAditya Wardhana, Sanjaya F Tanjunga, Rizta A Widyana, Gammaditya AWinarnoDivision of Plastic, Reconstructive, and Aesthetic Surgery, Department ofSurgery, CIpto Mangunkusumo Hospital Jakarta, IndonesiaCorrespondence: Sanjaya F TanjungaBurns & Trauma 2019, 7(Suppl 1):S69

BackgroundPredictive scoring systems for burns are available to predict patient’sprognosis. Yet the complexity of injury, demographic of patients, andhospital standards may result to the outcome not always linear tothe supposed survival possibility.Materials and MethodsIn this retrospective cross-sectional study, we collected data fromhealth record, a total of 513 patients between 2013-2017 and ranthem into four scoring systems: Modified Baux, ABSI, BOBI, and RyanScore. The final results are probability of mortality or survival of eachpatients and we compare them into the real results during inpatienttreatment. Patients are classified as healed according to the dis-charge criteria in our hospital before being moved to outpatienttreatment. The exclusion criteria for this study are children (<18 yearsold), patients admitted >7 days post injury, chronic burns, electricaland chemical burns.ResultsThe cut-off value for ABSI is 8, Ryan is 1, BOBI is 4, and Modified Bauxis 93. For the ABSI score, the AUC is 0.772 (CI 95%, 0.725-0.819) withp-value of 0.000. For the Ryan Score, the AUC is 0.593 (CI 95%, 0.537-0.649) with p-value of 0.001. For the BOBI score, the AUC is 0.582 (CI95%, 0.527-0.638) with p-value of 0.003. For Modified Baux Score, theAUC is 0.755(CI 95%, 0.705-0.805) with p-value of 0.000.ConclusionsAll the scoring systems can be used in our unit based on the p-valuebut the best one is the ABSI score. Knowing this may be helpful todetermine the standard of care for each patient to maximize theavailable resource.


S70Thermal Imaging Device as an Aid to Determine Burn WoundDepth: a Case SeriesDhita Kurniasari, Akhmad Noviandi Syarif, R Aditya WardhanaPlastic Reconstructive and Aesthetic Surgery Division, Department ofSurgery, Cipto Mangunkusumo Hospital, Medical Faculty, UniversitasIndonesiaCorrespondence: Dhita KurniasariBurns & Trauma 2019, 7(Suppl 1):S70

BackgroundBurn injury is considered as one of major problem because ofhigh mortality and morbidity, not only due to improper treatmentof burn resuscitation during the first 24 hours, but also due tothe extent and depth of burns itself. The right depth of wounddetermines the next action whether the burn will be excised or


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not. Determining the depth of burns clinically is a learning curveand less accurate because it depends on the experience of thesurgeon. A method is needed to make clinical assessment moreobjective in determining burn wound depth.Materials and MethodsWe did clinical and thermography assessment using Flir One®thermal imager to determine the conversion of burn depth of pa-tient before and after the surgery. Subsequently, temperature dif-ferences between the burn wound and healthy skin (ΔT) weremeasure and compared before and after the excision.ResultsWe performed clinical and thermography assessment in 3 pa-tients, 2 male and 1 female patient, with age range 25-48 yearsold, and with burn size 7.5% - 41% TBSA. Two patients showedlow temperature (temperature of burn area: 34.2°C, ΔT: -2.2°C) onthe area of the burn wound so we decided to excised it. Afterthe surgery it shows that the ΔT narrower (temperature of burnarea: 32.7°C, ΔT: -0.5°C), that indicated the improvement of thecirculation. One patient showed an area of burns with an averagetemperature (temperature of burn area: 36.9°C, ΔT: 2.2°C). We de-cided not to excise and appear epithelialization on the 7th daypost burn.ConclusionsThermography assessment such as Flir One® thermal imager can beutilized to determine the depth of burns in addition to clinical assess-ment. It benefits not only for the functional purpose, but also afford-able price and practically used. In the future it may be useful to helpboth experienced surgeons and novices.



S71Establishment and effects of a method for wound repair inpatients with extensive deep burns using fresh skin allografts andautologous micrograftChuanan ShenDepartment of Burns and Plastic Surgery, The Fourth Medical Center ofChinese People’s Liberation Army General Hospital, Beijing, ChinaBurns & Trauma 2019, 7(Suppl 1):S71

BackgroundSkin allografting is an effective way to cover the wound in extensiveburns. However, cadaveric skin has been scarce in recent years inChina. This study tried to establish a method for wound repair in pa-tients with extensive deep burns using fresh allogeneic scalp and au-tologous micrograft.Materials and MethodsTwo patients with burn injuries involving 90% (3rd degree, 70%) and97% (3rd degree, 85%) total body surface area (TBSA) respectivelywere treated with fresh scalp allografts donated by 32 males aged(31.5 ± 8.2) years or autologous micrografting. The bilateral extrem-ities with third-degree burns were selected as treatment and controlgroups. Wounds in the treatment group were treated with fresh allo-geneic scalp and autologous micrograft, while wounds in the controlgroup received MEEK grafting. Preoperatively, the surgical area onthe extremities was calculated to estimate the necessary amount ofallogeneic scalp and MEEK grafts. Fresh scalps (0.30 - 0.35 mm) wereharvested from each donor to prepare a larger piece of skin allograft.Autologous micrografts were transported onto the epidermis of theskin allograft. The treatment and control group received grafting ac-cording to our protocol. The donors received follow-up visits after 3months to see if there is alopecia and scar hypertrophy. The woundcoverage rate was observed in both treatment and control groupson postoperative weeks 2, 3, 4 and 5.ResultsThe donor sites in all allogeneic skin donors healed within 10 dayspostoperatively. The scalp recovered well without any alopecia orscar hypertrophy during the follow-up visits. The wound coveragerate of the treatment group was approximate to or higher than thatof the control group.

ConclusionsSince allogeneic skin is scarce and expensive and the patient’s rela-tives are willing to help save the patient’s life by donating the scalp,this method may be a feasible option in clinical practice.

Abstract Topic: Paediatric/Electrical & ChemicalBurns

S72Acticoat Dressings In The Management Of Partial ThicknessPaediatric Burns : Our ExperienceVaibhav Bhisikar, Seema Rekha DeviPlastic surgery department, Gauhati Medical College & Hospital,Guwahati, Assam, IndiaCorrespondence: Vaibhav BhisikarBurns & Trauma 2019, 7(Suppl 1):S72

BackgroundBurns in the paediatric patients are accidental household burns dueto spillage of hot liquids & not child abuse.Small houses and openkitchen also contribute.20 % of all burn patients treated in our burnunit were children .These are usually partial thickness burns .In thepresent study efficacy of Acticoat dressing in paediatric burns wasanalysed.Materials and Methods30 children (6months - 16 years) with clean , upto 20 % total body sur-face area (TBSA) partial thickness burns who met the inclusion criteriawere included in a prospective study from september 2018 to february2019. The children received Acticoat derssing. Patients were analysedin terms of age and sex of patient,percentage of burns, duration of stayand complications.Measures of burn re-epithelialization,pain were re-corded until full re-epithelialization occurred.ResultsMean age of presentation was 8 years ,14 males 16 females.Averagehospital stay was 11 days , reduced dressing change frequency, re-duced need for pain medication during dressing change , reducedinfection rate and reduced average healing days.ConclusionsActicoat dressing is well tolerated because of ease of dressing appli-cation and removal. It is effective in terms of wound epithelialization.It reduces the pain during dressing change and hospital stay forclean <20 TBSA partial thickness burns. Reduces need for surgicalintervention.


S73The management of burn wounds in pediatric patientsYan liu, Yan Shi,Jian Zhang, Wenkui WangDepartment of Burns and Plastic Surgery, Ruijin Hospital Affiliated toShanghai JiaoTong University School of Medicine, Shanghai, ChinaCorrespondence: Yan liuBurns & Trauma 2019, 7(Suppl 1):S73

BackgroundMore than 6000 pediatric patients were treated in our burn centerevery year. The management of their burns wounds remains a chal-lenge for usMaterials and MethodsWe collected data from pediatric inpatients under the age of 14years in 2018 and analyzed the demographics data and wound man-agement methods.ResultsIn 2018, more than 6000 pediatric patients were treated in our burncenter. Among total of 314 inpatients, 178 received scar reductionsurgery and 136 were acute burn patients. The most common mech-anism of injury was scalds (120/136), followed by flame (13/136) andelectrical injury(2/136). The average burn area of inpatients was12.32±9.66%TBSA, and the average III degree burn area was7.96 ±


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8.95%TBSA . Among all pediatric acute burn patients, 97 of them re-ceived surgery; each patient had 1.5 surgeries in average. Among thepediatric patients with acute burn wounds but did not receive sur-gery, a large amount of their wounds were covered with various ofwound dressing, including alginate dressing, nanometer silver or sil-ver ions dressing, hydrocolloid dressings, alone or combination oftwo dressings. The treatments have achieved satisfying outcomes, inregard of healing time and the quality of healed wound.ConclusionsNon-surgical treatment remains the principal treatment for burnpediatric patients. Based on the characteristics of wounds, properwound dressing may accelerate wound healing and, to some extent,avoid surgical risks


S74Analysis of 6 Cases of Young Children with Facial-Neck Scald andUpper Airway InjuryYI JIPlastic and Burn Surgery Department, The Children’s Hospital Of NanjingMedical University, Nanjing, Jiangsu, ChinaBurns & Trauma 2019, 7(Suppl 1):S74

BackgroundThe purpose of this review is to emphasize timely treatment for thescald of facial-neck regions with young children, it is recommended touse laryngoscopy to detect upper respiratory injury which can bringbreathing difficulties, to avoid suffocation, respiratory cardiac arrest.Materials and MethodsReviewed six children (from 9 months to 18 months) of differentdegree scalds with facial-neck at our hospital in 2017, five patients be-tween 12 and 24 hours after admission had difficulty in breathing, oxy-gen desaturation. So with general anesthesia (intravenous ketamine 2mg/kg), endotracheal intubation with trachea cannula size from 3.5 to4.5 mm. Keeping the tube time was from 5 ~ 8 d, 6.5 d on average.One child had respiratory and cardiac arrest on the way to hospital,and he was given mechanical ventilation after cardiopulmonary resusci-tation after admission. Indications of tube withdrawal: regression offace and neck edema, no severe lung infection, significantly reductionof airway secretions and children were able to cough spontaneously.ResultsAll the 5 cases were cured without serious lung infection, pepticulcer and bleeding, and the wound was healed well. The child withcardiac and respiratory arrest before admission was requested by hisparents to transferred to another hospital for treatment after 21 daysof mechanical ventilation.ConclusionsIf it is sure that the upper airway has damaged by hot liquid, endo-tracheal intubation must be performed immediately. So, for childrenwith scald close to the mouth and neck, the laryngoscope can beused as a routine examination.


S75Epidemiology of pediatric burns injuries in Singapore: A pilotstudyAzman N, Goh JM, Cheng SHJJ, Hsieh MKHDepartment of Plastic, Reconstructive & Aesthetic Surgery, KK Women’s& Children’s Hospital, SingaporeCorrespondence: Azman NBurns & Trauma 2019, 7(Suppl 1):S75

BackgroundKK Women’s and Children’s Hospital is the referring pediatric hospitalin Singapore for a wide variation of pediatric burns and to date, noepidemiological review was done for pediatric burn injury in

Singapore. In 2017, our burns service at KK Women’s and Children’sHospital provide inpatient and outpatient treatment for 373 pediatricpatients.Materials and MethodsOur database was accessed to collate a retrospective data of all newcases managed by our Burns service from January 2018 to December2018 at KK Women’s and Children’s Hospital .Results89% of the patients were treated as outpatient, while 11% were in-patient. The most common mechanism of injury is scalding. Most ofthe pediatric patient had a TBSA of less than 5%.ConclusionsThe large number of burns injury in children prompted our depart-ment to collect comprehensive information of burn data. These datacan be used to establish new treatments, initiatives and programs.


S76Pediatric Burn injuries related to electric bike or electric scooterAzman N, Goh JM, Cheng SHJJ, Hsieh MKHDepartment of Plastic, Reconstructive & Aesthetic Surgery, KK Women’s& Children’s Hospital, SingaporeCorrespondence: Azman NBurns & Trauma 2019, 7(Suppl 1):S76

BackgroundIn 2018, Singapore Civil Defense Force (SCDF) reported 74 fire cases,involving 50 electric scooters and 22 electric bikes. The number ofburn injuries related to electric bike or electric scooter is an emer-ging problem in Singapore and the number of burn injuries involvingthese mobility devices is on a rise.Materials and MethodsOur database was accessed to retrieve a retrospective data of allburn injuries related to electric scooter or electric bike.Results9 burn injuries related to electric scooters or electric bikes were re-trieved from our database. 7 of these burn injuries were primarilycaused by the explosion of the batteries.ConclusionsElectric scooter or electric bike related burn injuries are an emergingmechanism of burn injury in Singapore. Severity of burns rangesfrom 0.5% to 40% TBSA without inhalational component. The primarysource of fire is related to the battery installed in these mobility de-vices. This novel form of thermal ignition burns needs to behighlighted for the prevention of future burns given the landscapeand uprising of personal mobility devices in Singapore


S77The efficacy of prophylactical probiotics administration in childrenwith severe burns: a retrospective studyZhiyuan Shi, Xianbo Ye, Minhui Zhu, Ming ZhangBurn & Plastic Surgery, The Sixth Medical Center of PLA General Hospital,Beijing, ChinaCorrespondence: Zhiyuan ShiBurns & Trauma 2019, 7(Suppl 1):S77

BackgroundIntestinal disorder is not rare in pediatric burn patients. This retro-spective study was intended to evaluate the effect of prophylacticalprobiotics administration in these patients.Materials and MethodsPatients with acute burns affecting >30% of total body surface area,deep areas >10% of TBSA, were enrolled. Between May 2012 andSeptember 2017, the datum of 31 pediatric patients, aged between2- 8 years, were screened out. Probiotics were administrated in 9 pa-tients before intestinal disorder occurred (Group A), and 22 patients


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after diarrhea (Group B). Clinical datum (infection, antibiotic, opera-tive times, intestinal disorder, and mortality) were compared be-tween two groups. Length of stay was modified with burn size.ResultsThere were no differences in age (5.3±1.8; 6.2±2.1), burn size (45.0±10.3; 40±9.8), operative times (2.5±0.7; 2.8±0.9) and intestinal disor-ders incidence (3/9, 9/22, p>0,05). The diarrhea periods were 2.7±2.3days in group A, which shorter than those in group B 5.3±3.7 days(p<0.05). The ratio inversion of cocci and bacilli were detected in 4and 12 patients in each group. The metronidazole was administratedin 5 patients in group B. Flatulence was observed in 6 and 20 pa-tients in each group. The time required to complete wound healingwas not significantly different between group.ConclusionsProphylactical probiotics administration could shorten the periods ofdiarrhea without reducing the incidence of intestinal disorders.


S78Surgical treatment of hand treadmill injuriesYanni Wang, Hongyan QiDepartment of Burn and Plastic Surgery, Beijing Children's Hospital,Capital Medical University, Beijing, ChinaCorrespondence: Yanni WangBurns & Trauma 2019, 7(Suppl 1):S78

BackgroundTo summarize the clinical effect of repairing hand injury tissue defectcaused by running machine.Materials and MethodsFrom July 2012 to January 2019, 28 cases of hand soft tissue defectcaused by treadmill were treated. According to the condition of handsoft tissue defect, groin full thickness skin graft (10 cases), VSD +split-thickness skin graft (3 cases), artificial dermis + autologous skin(3 cases), abdominal pedicled skin flap (8 cases), finger palmar ad-vancement skin flap (1 case), V- Y skin flap were used to repair thedefect.Results28 cases of skin wounds survived. The follow-up period was at least 6months and the longest was more than 1 year. Of them, 25 cases hadsatisfactory shape and function recovery, 3 cases had slight swelling ofskin flaps and 3 cases had second-stage operation.ConclusionsAppropriate methods for repairing soft tissue defects after hand traumacaused by running machine according to different soft tissue defectshave the advantages of low infection rate, short hospitalization timeand better recovery of hand shape.Cheng Guoliang, the role of foot flap in thumb and finger reconstruc-tion and repair. Chinese Journal of Microsurgery, 2005, 28:291-294Wang Shuhuan, Hand Surgery, 2nd Edition, Beijing: People's HealthPublishing House, 1999.181-194


S79Clinical observation of micropower negative pressure woundtherapy in pediatric deep II degree burn woundXiaopeng Zheng1,2, Xiaoyan Hu1, Tiansheng Chen1, Yaonan Jiang1,Xiangyang Xu2, Lie Zhu3, Shichu Xiao1, Zhaofan Xia11Burn and trauma center, Changhai Hospital, Second Military MedicalUniversity, Shanghai, China; 2Department of burn and plastic surgery,The 413th Hospital of PLA, Zhoushan, Zhejiang Province, China;3Department of plastic surgery, Changzheng Hospital, Second MilitaryMedical University, Shanghai, ChinaCorrespondence: Zhaofan XiaBurns & Trauma 2019, 7(Suppl 1):S79

BackgroundTo observe the clinical curative effect of the application of micro-power negative pressure wound therapy (mNPWT) in pediatric deepII degree burn wound.Materials and Methods48 cases of pediatric burn patients were selected who were admittedin Changhai Hospital of Shanghai from January 2014 to January2015. They were randomly divided into treatment group (mNPWT)and control group (routine dressing change). The wound healingrate, the positive bacterial culture rate and the surgical rate werecompared between the two groups. And all patients were followedup for 1 year to evaluate the formation of scar.Results2 and 3 weeks after injury, the wound healing rate in the treatmentgroup ((49.69 ± 2.59)%, (95.85 ± 2.26)%) was significantly higher thanthat in the control group ((39.82 ± 2.56)%, (75.23 ± 2.02)%) (P <0.01). While the positive bacterial culture rate in the treatment group(38.5%, 23.1%) was significantly lower than that in the control group(75.0%, 68.2%) (P < 0.01). After 3 weeks, the surgical ratio in thetreatment group (7.7%) was significantly lower than that in the con-trol group (36.4%) (P < 0.05). in the 3rd, 6th and 12th month afterwound healing, the VSS (Vancouver Scar Scale) scores in the treat-ment group (3.85 ± 1.69, 3.08 ± 1.44, 2.85 ± 1.12) were significantlylower than that in the control group (4.86 ± 1.25, 4.14 ± 1.67, 3.73 ±1.45) (P < 0.05).ConclusionsThe method of mNPWT in repairing pediatric deep II degree burnwound, compared with routine dressing change, can significantly im-prove the wound healing rate, decrease the wound infection and im-prove the quality of wound healing. Thus it is a new kind of simpleand effective method.


S80Transplantation of fresh scalp allograft in repairing extensive deepburn wounds in childrenChuanan ShenDepartment of Burns and Plastic Surgery, The Fourth Medical Center ofChinese People’s Liberation Army General Hospital, Beijing, ChinaBurns & Trauma 2019, 7(Suppl 1):S80

BackgroundIt is difficult to treat pediatric extensive burns, which contribute tohigh mortality rates, partly because of the lack of large allogeneicskin to close wound in China. Therefore, we innovatively used freshscalp as thin split thickness skin allografts to cover the burn woundsof pediatric patients.Materials and MethodsFresh scalp allografts were harvested from voluntary donors who werepatients’ relatives. The median total burn area in the major burns was40% TBSA, ranging from deep-second to third-degree injuries. Thefresh scalp allografts were transplanted on the wounds post tangentialexcision or escharectomy in the way of mere fresh scalp allograftscoverage or mixed coverage with autografts and fresh scalp allografts.ResultsAll the patients survived without serious complications during thetreatment period. The median healing time was 47 days; and theaverage healing time of the donors’ scalps was (7.6±1.08) days withno scar formation, alopecia areata or folliculitis post operation.ConclusionsThe use of fresh scalp allografts in the treatment of pediatric majorburns is an effective and feasible method in protecting wounds andpromoting wound healing as well as in reducing scar formation inthe donor sites of burned children. The high ratio of fresh scalp areasto pediatric burn wound areas ensures high efficiency of woundcoverage; and healthy relative skin donors have more initiatives andfavorable healing results.


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S81Alteration of pharmacokinetics of imipenem in severe burnpatientsAnh Quang Luong, Lam Nhu NguyenVietnam National Burns Hospital, Military Medical University, Hanoi,VietnamCorrespondence: Anh Quang LuongBurns & Trauma 2019, 7(Suppl 1):S81

BackgroundBurn is complex injury with high risk of hospital resistant organisminfection. The use of broad spectrum antibiotics such as imipenemiscommon. Nevertheless, substantial change in physiopathology in-cluding augmented renal clearance (ARC) observed in severe burnpatients results in high pharmacokineticvariability. Toxicity or sub-therapeutics may occur. This study aimed to estimate pharmacoki-netic (PK) parameters of imipenem and those potential covariates.Materials and MethodsBurn patients with body surface area injured > 20% and imipenemindication were recruited. Two set of plasma samples (30 min post-dose and 1-2 hours before next dose) were obtained at imipeneminitiation and before the end of imipenem use. ARC was defined if8h-urinary creatinine clearance (8hClcr) was above 130 mL.min-1173m2. PK samples were quantified by validated HPLC method. Popula-tion pharmacokinetic analysis were performed using Monolix2016R1.ResultsA total of47 sets with 94 plasma samples were collected from 24 pa-tients. Of which 18 sets were obtainedat ARC time. One compart-mental model with proportional error fitted the data best. Theinclusion of inter-individual (IIV) and inter-occasion variation (IOV) im-proved the goodness of fit of the model. Population volume of distri-bution was 33.5 L with IIV and IOV of 18.2 % and 15.6%, respectively.Population clearance and the respective IIV and IOV were 18.8L.h-1,27.0 % and 28.1 %. Age and ARC showed to besignificant covariates(p<0.001). Targeted PK/PD attainment appeared to be affected as aconsequent.ConclusionsImipenem pharmacokinetics had significant IIV and IOV on burn pa-tient and the ARC may influence the targeted PK/PD attainment.

Abstract Topic: Pharmacology/ Renal Replacement

S82Effects of simvastatin on iNOS and caspase-3 levels and oxidativestress after smoke inhalation injuryZheng Jun Cui1, Rong Qiang Yang21Department of burn and repair reconstruction surgeryThe First Affiliated Hospital of Zhengzhou University Henan, People'sRepublic of China; 2Department of Plastic surgery Zhengzhou CentralHospital Affiliated to Zhengzhou University Henan, People's Republic ofChina.Correspondence: Zheng Jun CuiBurns & Trauma 2019, 7(Suppl 1):S82

BackgroundThe overexpression of iNOS induces cell apoptosis through varioussignal transduction pathways and aggravates lung injury. Caspase-3is an important protein in the apoptotic pathway, and its activationcan aggravate apoptosis. Simvastatin, a hydroxymethyl glutaryl-A(HMG-COA) reductase inhibitor, protects against smoke inhalation in-jury by inhibiting the generation and release of inflammatory factorsand reduce the apoptosis of cells.Materials and MethodsAfter Generation of an animal model of smoke inhalation injury, lungtissue and serum were taken at different time points, and the proteinand mRNA expression of iNOS and caspase-3 in lung tissue, contentof MDA and activity of SOD in lung tissue and serum were detected

by different experimental methods. The results were statisticallyanalyzed.ResultsCompared with the rats in the control group, pathological scores oflung tissue samples obtained from other four groups had signifi-cantly higher mRNA and protein expression levels of iNOS andcaspase-3 (P<0.05), significantly lower SOD activity and a higher MDAcontent (P<0.05). Compared with the saline group, the low-, middle-and high-dose groups, had significantly lower pathological scores(P<0.05), significantly lower mRNA and protein expression levels ofiNOS and caspase-3 and MDA contents in lung tissues (P<0.05), andsignificantly higher SOD activity in both lung tissues and serum andthe same result was occurred when compared the low-dose groupwith the middle- and high-dose groups (P<0.05). With the exceptionof SOD activity in lung tissues at 24 and 72 h and MDA content inserum at 48 h, showed no significant differences between the mid-dle- and high-dose groups.ConclusionsIn rats with smoke inhalation injury, simvastatin inhibits iNOS andcaspase-3 expression in lung tissues and oxidative stress, and therebyexerts a protective effect, and the effect and dose are positively cor-related within a definitive range.

Abstract Topic: Pharmacology/ Renal Replacement

S83A systematic review of nebulized heparin doses in adults withinhalation injuryChuan Poh Lim, Xiu Yun AngDepartment of Pharmacy, Singapore General Hospital, SingaporeCorrespondence: Chuan Poh LimBurns & Trauma 2019, 7(Suppl 1):S83

BackgroundThe aim of this review was to compare the efficacy and safety of dif-ferent nebulized heparin doses used in adults with inhalation injury.Materials and MethodsAll potential studies were identified from four databases (PubMed,Embase, Scopus, Web of Science). All potential studies were screenedusing title and abstract by two independent reviewers. Full-textscreening was done for identified studies that fulfilled the initialscreening criteria. Studies that fulfilled the full-text screening werethen selected for full-text review. Criteria for full-text review werestudies that involved adults with inhalation injury and heparin vianebulization route. Main outcomes assessed were duration of mech-anical ventilation, incidence of unplanned re-intubation, pneumoniaand bleeding risk.ResultsSeven out of 176 potential studies were included in this review. Neb-ulized heparin doses used in these studies were 5000 (Hep5) or10000 (Hep10) units given every 4 hours. There were four Hep5 stud-ies, two Hep10 studies and one study comparing Hep5 with Hep10(Hep5/Hep10). Two out of 6 studies reported significant reduction inthe duration of mechanical ventilation. In the Hep5/Hep10 study,Hep10 group showed significantly shorter mechanical ventilationcompared to Hep5 group. In the two Hep5 studies that reported inci-dence of unplanned intubation, there was no significance comparedto control. Two out of 6 studies that looked into pneumonia inci-dence reported significance compared to control. There were 5 stud-ies that reported bleeding complications, of which three Hep5, oneHep10 and one Hep5/Hep10 studies. No increased in bleeding com-plications were noted.Overall quality of the studies was poor due to no control of con-founders, no blinding, unclear treatment duration, poor documenta-tion of missing data/loss to follow-up.ConclusionsOur findings suggest both nebulized heparin doses may be beneficialand safe. Due to the poor study quality, a large well-designed pro-spective study will be needed to validate its use in adults with inhal-ation injury.


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Abstract Topic: Psycho-Social Care

S84Using the ecological perspective and strengths perspective todevelop psychosocial interventions in burns – The case of a femalemajor burn clientYu-Chieh Wu, Yuh-Jen KuangTaipei Rehabilitation Center, Sunshine Social Welfare Foundation, Taipei,TaiwanCorrespondence: Yu-Chieh WuBurns & Trauma 2019, 7(Suppl 1):S84

BackgroundPhysical problems following severe burns are often compounded byother intrinsic and extrinsic factors, which require comprehensivepsychosocial interventions.Materials and MethodsWe present the case of a 30 year old female with 97% 2nd-3rd degreeburns, severe left hand contracture and right hand finger amputation.Absence of family support and income led to major self-care problems.Other issues included poor body image, emotional distress and adjust-ment difficulties affecting interpersonal relations and social participa-tion. The ecological and strengths perspectives served as a theoreticalframework to identify needs and develop psychosocial interventions.ResultsThe client had major self-care problems and anxiety caused bythe absence of family support and income, as well as a feeling ofisolation due to her different appearance. Using the ecologicalperspective, which helps understand how the individual and thesocial systems mutually influence each other, interventionsadopted include financial aid and short-term housing with dailycare to ensure that rehabilitation continued uninterrupted, lever-aging peer support in the environment of the rehabilitation cen-ter and short-term housing facility to address isolation, anddesigning social participation activities to help the client progres-sively learn how to meet people and accept her new self. Emo-tional distress of the client included powerlessness andhopelessness. Using the strengths perspective, which emphasizesidentifying and using the person’s inner resources to addressproblems, the client was actively involved in the elaboration ofher rehabilitation plan and within defined parameters, decidedgoals and interventions, thus regaining a sense of agency andseeing herself as someone with capabilities, which furtherstrengthened her rehabilitation motivation.ConclusionsThe ecological and strengths perspectives are useful frameworks toexamine issues affecting burn survivors from a macro/social perspec-tive (as opposed to micro/individual), as well as identifying outsideand inner resources which can be leveraged to support recovery.Informed consent to publish has been obtained from this patient.


S85Avoidant coping strategy positively correlates with post-traumaticdisorder and negatively correlates with post-traumatic growth andquality of life in patients with burns: a longitudinal studyTing-Chia Wang1,21Burn Rehabilitation and Post-Acute Care Center, New Taipei CityHospital, New Taipei City, Taiwan; 2Department of Psychiatry, New TaipeiCity Hospital, New Taipei City, TaiwanBurns & Trauma 2019, 7(Suppl 1):S85

BackgroundThe aim of the study was to examine the relations among avoidantcoping strategy, post-traumatic stress disorder (PTSD), post-traumaticgrowth (PTG) and quality of life (QoL) in burn survivors from a massburn casualty event occurred in Taiwan.Materials and Methods77 burn survivors from the incident were enrolled. Questionnaires in-cluding Brief COPE scale and Impact Event Scale (IES) were adminis-tered at 6 months and 2 years after the incident. Post TraumaticGrowth Inventory (PTGI), Burn Specific Health Scale (BSHS) were ad-ministered at 2 years after the incident. Pearson’s correlations werecalculated for 3 dimensional indexes of Brief COPE, total scores and 2dimensional indexes of IES, total scores and 5 dimensional indexes ofPTGI and total scores of BSHS and other 9 indexes.ResultsThe avoidant emotional coping index has significantly positivecorrelation with total score and other 2 indexes of IES at 6months (r= 0.50, 0.44, and 0.52, p<0.01) and 2 years (r= 0.53,0.51, and 0.65, p<0.01). On the other hand, avoidant emotionalcoping index has significantly negative correlation with totalscore and other 5 indexes of PTGI (r= -0.35, -0.32, -0.41, -0.31,-0.34 and -0.31, p<0.05) and significantly negative correlate withtotal score and other 6 indexes of BSHS (r= -0.40, -0.33, -0.32,-0.49, -0.42, -0.40 and -0.55, p<0.05).ConclusionsBurn survivors who used avoidant emotional coping strategiestended to develop more severe PTSD symptoms since 6 months afteraccident and it might last for 2 years. And these survivors tended tohave lower level of PTG and lower satisfaction of QoL. Therefore,Early identifications of using avoidant coping strategies might be im-portant to prevent PTSD and improve PTG and QoL.


S86Quality of life and performance of return to work in recoveredburn survivors: association with anxiety and depressionTing-Chia Wang1,2, Yun-Yi Lin3, Te-Yu Gu1, Zhi-Hao Su1, Pei-Shan Liu11Burn Rehabilitation and Post-Acute Care Center, New Taipei CityHospital, New Taipei City, Taiwan; 2Department of Psychiatry, New TaipeiCity Hospital, New Taipei City, Taiwan; 3Department of Physical Medicineand Rehabilitation, National Taiwan University Hospital, Taipei, TaiwanCorrespondence: Ting-Chia WangBurns & Trauma 2019, 7(Suppl 1):S86

BackgroundThe aim of the study was to examine the relations among anxiety, de-pression, quality of life (QoL) and performance of Return to Work (RTW)in burn survivors from a mass burn casualty event occurred in Taiwan.Materials and Methods77 burn survivors from the incident were enrolled. Questionnaires in-cluding Hospital Anxiety and Depression Scale (HADS) and Burn Spe-cific Health Scale (BSHS) were administered at about 2 years after theincident. Pearson’s correlations were calculated for 3 indexes of HADS(total score, severity of anxiety (SA), severity of depression (SD)) and2 indexes of BSHS (total score and work satisfaction).ResultsThe total score of BSHS has significant negative correlations withtotal score, SA and SD index of HADS (r= -0.46, -0.44 and -0.42, p<0.01). The work satisfaction index of BSHS has significant negativecorrelations with total scores, SA and SD index of HADS (r= -0.44,-0.38 and -0.45, p<0.01).


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ConclusionsAmong the burn survivors from this mass burn casualty event, thosewho has more severe anxiety and depressive symptoms tend to havelower satisfaction of QoL and RTW. Early psychological interventionsin reducing severity of anxiety and depression might improve QoLand RTW of burn survivors.

Abstract Topic: Reconstruction

S87The optimal functional and aesthetic results of Burn Handreconstruction after Formosa Dust explosion - Total Handreconstruction with one skin piece in one stage reconstructionShiow Shuh Chuang1, Yen Chang Hsiao1, Shu Yin Chang1, Hung ChangChen1, Shih Yi Yang1, Katie Pei-Hsuan Wu21Burn Center, Department of Plastic Surgery and Reconstruction, LinkouChang Gung Memorial Hospital, Taoyuan, Taiwan; 2Department ofPhysical Medicine and Rehabilitation, Linkou Chang Gung MemorialHospital, Taoyuan, TaiwanCorrespondence: Shiow Shuh ChuangBurns & Trauma 2019, 7(Suppl 1):S87

BackgroundDisaster of Formosa dust explosive, the average injury of TBSA is44%. The reconstruction of the burn hands is a key challenge task forplastic surgeon. The goal of our work is to reconstruction the extrem-ities in less procedure, to obtain the maximum of function and aes-thetics outcome [1]. Like to the face exposure to outside of clothing,in these areas, psychological problems produced by scar deformitiesare not less than the functional defect [2].Materials and Methods75 hands of 40 patients were undertook the reconstruction in CGMHin the past 3 years.The standard protocol of the hand reconstruction:1. Visual inspection and assess the hand scar contracture, and X-Rayreferent to judge the condition of joints.2. Skin resurface with FTSG and close in primary.3. Excide the scar at hand dorsum, to excide the contractive scar overthe joint, proximal side is always prior to the distal side.[3] [4]4. The web space were created as well in meanwhile.Results74 in 75 hands were performed with FTSG, 70 hands performed inOne stage operation, 69 in 75 performed with One piece skin recon-struction at dorsal side. 39 in 74 disfiguration finger were undertakenhemisection tendon lengthening.ConclusionsThe FTSG grafting could provide wide range of reconstruction andresults with optimal functional and aesthetic satisfaction.


S88Patient–physician shared decision making in reconstructive burnsurgeryYaw-Sheng Lin1, Lei-Peng Ng21Department of Psychology, National Taiwan University, Taipei, Taiwan;2R&D Department, Sunshine Social Welfare Foundation, Taipei, TaiwanCorrespondence: Lei-Peng NgBurns & Trauma 2019, 7(Suppl 1):S88

BackgroundShared decision making is a key component of patient-centeredhealth care. This study investigated shared decision making in recon-structive burn surgery to describe the process and identify the per-spectives of physicians and patients.Materials and MethodsIn-depth interviews were conducted from July to September 2018with 4 burn physicians and 4 burn survivors with TBSA ranging from60% to 90%. Thematic analysis was used to analyze the data.

ResultsThe need for reconstructive surgery is normally raised by physicians, al-lied health professionals or patients themselves in response to prob-lems that limit progress of rehabilitation. In the shared decision makingprocess, (1) problems are identified and treatment options are pro-posed; (2) options are prioritized and selected; (3) final decision is madeby the patient. Physicians tend to look at problems from a “disease”perspective, with clear treatment options for abnormalities of structuresand functions that are backed by scientific evidence and clinical reason-ing, while patients tend to look at problems from an “illness” perspec-tive, with the subjective response of being unwell and its impact ondaily life guiding their preferences as opposed to medical knowledge.Despite these different perspectives, physicians and patients share thevalues of emphasizing the functional purpose of surgery over the cos-metic purpose, as well as setting functional independence and returnto society and work as the ultimate goal of surgery. Also, despite aknowledge deficit, patients will trust physician expertise on how bestto address their preferences.ConclusionsBased on these findings, we propose that tools be developed (ex: listof questions to clarify needs) and that allied health professionals playa role in preparing patients (ex: providing knowledge and patienteducation) to further bridge the gap between physicians’ “disease”perspective and patients’ “illness” perspective.


S89Functional outcomes of hand after full thickness burn of upperlimb.Ayesha Hanna, Mohd Zakir Hossain, Md Shoeb Ur RashidDepartment of Plastic surgery, Sir Salimullah Medical College & MitfordHospital, Dhaka, Bangladesh.Correspondence: Ayesha HannaBurns & Trauma 2019, 7(Suppl 1):S89

BackgroundThe hand, forearm and arm are a physiological kinetic unit jointedtogether functionally, biologically and mechanically from the finger-tips to the shoulder. Full thickness burn injuries at any area of upperlimb may affect hand functions. Fourth degree burn injuries involvingtendons, joint capsules or bone are considered uncommon. Loss ofhand functions negatively impact on occupation, activities of living &social interaction.Materials and MethodsObjective: This study was conducted to measure hand functional per-formance after salvageable upper limb following full thickness burn.Methods: Prospective observational study was conducted in the depart-ment of plastic surgery, SSMC & MH, Dhaka. Volunteer sample of burnsurvivors with salvageable upper limb following full thickness burnfrom June 2016 to June 2018 with one year follow up were included inthe study with some inclusion & exclusion criteria. Hand functions wereassessed by seven objective test criteria described BY Jebson.ResultsTotal number of 13 burned upper limb in 10 patients were includedin the study with a mean age 23.9 years, mechanism of injury wasflame, electric and machinery burn. All patients required surgicalintervention. 7 needed different types of flap coverage.6 needed splitthickness skin graft. Physiotherapy & splintage were provided to thepatient (for 6 months to 12 months) A long term physiotherapy wasprovided to all patients, then they achieved the specific goals withlimitation despite residual deformities.ConclusionsBasic trauma principles are followed. If escharotomies, fasciotomieswere completed without delay if indicated. Elevation of the affectedlimb was maintained. The study was limited to patients presenting toour burn center include 3rd degree & 4th degree burn , did not in-clude gangrene of finger, hands & different parts of upper limb & re-sidual deformities.


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S90Release of web contracture of hand: V-M plus side graft VSwebgraftD. K. SeoDepartment of Plastic and Reconstructive Surgery, Hangang SacredHeart Hospital, Hallym University, Seoul, KoreaBurns & Trauma 2019, 7(Suppl 1):S90

BackgroundBurn scar contracture of fingers always combine the webbing. To cor-rect this problem, surgeons do the scar release and the full-thicknessskin graft. Someone do the V-M plasty at the web and graft to thefinger sides, and someone do whole graft at the web. Graft to theweb is a complicated work, so surgeons often exhausted, alsohematoma develop frequently than fingers. So V-M plus side graftseems attractive, but in most cases,, the whole web graft is more ef-fective to release the contracture. The purpose of this study is tocompare clinical outcomes of contracture treatment between the V-M plus side graft and the whole webgraft.Materials and MethodsWe analyzed the retrospective clinical and photographic records of20 patients with burn scar contracture with webbing. We performed10 cases of V-M plasty and full-thickness skin graft at the finger sidesand 10 cases of whole web and finger graft.ResultsThe overall take rate was about 95%, and focal graft loss was devel-oped at the web graft cases. Mean follow up was 7 years. And the V-M plus side graft group show more early recontracture than webgraft group especially in hard scarConclusionsThe V-M c side graft looks good immediate postoperative period.And in the soft scar, it is true and the long term results was good.But in the hard scar, we think the whole web graft is better in viewof recontracture and long term results.


S91Reconstructive experience of multiple joint scar contracturedeformity of limb in the simultaneous operationPihong Zhang, Licheng Ren, Jie Zhou, Pengfei LiangDepartment of Burn Reconstructive Surgery, Xiangya Hospital, CentralSouth University, Changsha, Hunan, ChinaCorrespondence: Pihong ZhangBurns & Trauma 2019, 7(Suppl 1):S91

BackgroundTo investigate reconstructive means of multiple joint scar contracturedeformity of limbs in the simultaneous operation.Materials and MethodsFrom January 2010 to June 2018, the team performed simultaneoussurgical repair on 24 patients of scar contracture deformity at mul-tiple joints of the same limb, including 15 cases of upper limbs and 9cases of lower limbs. After the release of various joint scar contrac-ture, autologous medium-thickness or full-thickness skin graft wereused in 11 cases, skin graft combined with local skin flap in 9 cases,allogeneic acellular dermal matrix and autologous thin skin graft in 4cases. Comprehensive rehabilitation treatment was taken after theoperation.ResultsAll flaps and skin grafts survived after operation in 22 patients. Twocases of partial skin necrosis occurred, of which one healed after asecondary skin graft, and the other healed after dressing changes.The deformity of scar contracture at each repaired joint was com-pletely or basically corrected. 24 cases received 6-72 months’ follow-up after treatment, in addition, the range of motion of joints is basic-ally normal. The upper limbs function of 15 cases was excellent in 12cases and good in 3 cases. In the 9 cases of lower limbs, except onecase of recurrence of scar contracture on the medial side of the knee,

all joints functions were basically restored to normal with satisfactoryresults.ConclusionsFor continuous scar contracture deformity of multiple joints of thesame limb, simultaneous surgical release and skin graft can reduceoperation frequency and obtain better efficacy of surgical operation.


S92Comparison of the effect of superficial iliac circumflex skin flapand medial plantar skin flap in the repair of thumb annular electricburnHaiping Di, Chengde Xia, Peipeng Xing, Jidong Xue, Haina Guo, Lei Liu,Dayong CaoDepartment of burns surgery, The first people’s hospital of ZhengzhouCity, Zhengzhou, ChinaCorrespondence: Chengde XiaBurns & Trauma 2019, 7(Suppl 1):S92

BackgroundThe fingers play an important role in the body, especially the thumbwhich accounts for 50% of the function of the hand. The aim of thisstudy was to compare the clinical effects of superficial circumflex iliacskin flap and medial plantar skin flap in the repair of thumb annularelectric burn.Materials and MethodsThe clinical data of 30 patients with thumb ring electric burn admit-ted to our hospital from June 2015 to September 2017 were retro-spectively analyzed. Among them, 15 patients with superficialcircumflex iliac skin flaps were included in Group A and 15 patientswith medial plantar skin flaps were included in Group B. The survivalrate, wound healing rate, skin appearance, thumb function and sen-sation were compared between the two groups.ResultsThe survival rate of superficial circumflex iliac skin flaps in both groupswas 100.00%. The primary healing rate of wounds in group A andgroup B was 96.65%and 100%, respectively. There was no significantdifference (P>0.05). In group A and group B, the excellent rate of skinflap appearance and finger function were 93.33% and 100.00%, 80.00%and 93.33% respectively 6 months after operation. There was no signifi-cant difference in the excellent rate of skin flap appearance and fingerfunction between the two groups (P>0.05). The sensory function of skinflaps in group B was significantly better than that in group A at 6months after operation (P>0.05).ConclusionsThe survival rate of superficial circumflex iliac skin flap and medialplantar skin flap for repair of thumb annular electric burn skin flap,the excellent appearance rate of skin flap and the excellent functionrate of finger are similar, and the sensory function of the latter is bet-ter than the former.


S93The effect of extracorporeal shock wave therapy on the gripstrength of adult hand skin grafting for burnsWu Weiwei, XU XiaochuanDepartment of Burn Surgery, The First Hospital of Jilin University,Changchun city ,Jilin provinces, ChinaCorrespondence: Wu WeiweiBurns & Trauma 2019, 7(Suppl 1):S93

BackgroundTo observe the effect of extracorporeal shock wave therapy on theimprovement of grip strength for the adult hand skin grafting forburns.Materials and MethodsThere are 60 cases with the third degree burn of hand are selectedwho are treated after the skin grafting in the rehabilitation center


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treatment from May 2017 to November 2018. And there are equallydivided into the control group and the observation group by the ran-dom digital table method. When the hand skin graft is fully alive, thecontrol group is given conventional joint stretching and exercisetherapy, and the observation group is additionally increased extracor-poreal shock wave therapy. Then, the Jamar hydraulic meter is usedto measure the grip strength after three weeks.ResultsThe grip strength of the observation group is significantly higherthan that of the control group (P<0.05).ConclusionsExtracorporeal shock wave therapy is beneficial to improve the gripstrength after the hand skin grafting for burns and is worthpromoting.


S94One-step approach for full-thickness skin defect reconstruction inrats using minced split-thickness skin grafts with Pelnac overlayTong Liu1, Chao Qiu2, Chi Ben1, Haihang Li1, Shihui Zhu11Department of Burn Surgery, Institute of Burns, The First AffiliatedHospital, Naval Medical University, Shanghai 200433, China; 2EmergencyDepartment, The First Affiliated Hospital, Naval Medical University,Shanghai 200433, ChinaCorrespondence: Shihui ZhuBurns & Trauma 2019, 7(Suppl 1):S94

BackgroundSplit-thickness skin grafting is the current gold standard for the treat-ment of traumatic skin loss. However, for patients with extensiveburns, split-thickness skin grafting is limited by donor skin availabil-ity. Grafting split-thickness skin minced into micrografts increases theexpansion ratio but may reduce wound repair quality. Dermal substi-tutes such as Pelnac can enhance the healing of full-thickness skinwounds, but their application currently requires two surgeries. Thepresent study investigated whether it is possible to repair full-thickness skin defects and improve wound healing quality in a singlesurgery using Pelnac as an overlay of minced split-thickness skingrafts in a rat model.Materials and MethodsA full-thickness skin defect model was established using Male Spra-gue Dawley rats (10 weeks old). The animals were randomly dividedinto control and experimental groups in which Vaseline gauze andPelnac, respectively, were overlaid on minced split-thickness skingrafts to repair the defects. Wound healing rate and quality werecompared between the two groups.ResultsWe found that using Pelnac as an overlay for minced split-thicknessskin grafts accelerated wound closure and stimulated cell prolifera-tion and tissue angiogenesis. In addition, this approach enhancedcollagen synthesis and increased the formation of basement mem-brane and dermis as well as the expression of growth factors relatedto wound healing while reducing scar formation.ConclusionsUsing minced split-thickness skin grafts overlaid with Pelnac enablesthe reconstruction of full-thickness skin defects in a single step andcan increase the rate while improving the quality of wound healing.


S95Anterior Neck Contracture Reconstruction Using SuperchargedSkin Pedicled FlapsEimi Kodama, Yoshihiro Noda, Mio Tsuchiya, Rei OgawaDepartment of Plastic, Reconstructive and Aesthetic Surgery, NipponMedical School Hospital, Tokyo, JapanCorrespondence: Eimi KodamaBurns & Trauma 2019, 7(Suppl 1):S95

BackgroundReconstruction of the anterior neck requires attention to both aes-thetic and functional outcomes. In general, skin grafts are not suit-able for anterior neck reconstruction in Asian patients, even whenartificial dermis is used prior to skin grafting. Employing various typesof thin flaps, we found that skin pedicle must be sufficiently wide toachieve full release of neck contractures leading to neck extension.Here we describe two cases who presented with deteriorating neckcontracture after extensive burns, treated by wide, thin, and longflaps harvested from the anterior chest wall.Materials and MethodsThe first patient was a 71-year-old man who sustained extensiveburn injuries from a gas explosion 2 years before visiting our clinic.The second patient was a 19-year-old man who sustained extensiveflamed burn injuries from a suicide attempt. Both cases underwentinitial treatment including a split thickness skin graft (STSG) for theiranterior neck. Before surgery, we confirmed the existence of internalmammary artery perforators (IMAPs) using Multi-Detector ComputedTomography (MDCT). The neck contractures were reconstructed byIMAP supercharged skin pedicled transposition flaps harvested fromtheir anterior chest walls. IMAPs were anastomosed with facial arter-ies and veins. The contractures were released almost completely. Sixmonths after surgery, the aesthetic results were also good.ConclusionsMany methods for reconstructing neck contractures have beenchosen: free flaps, local flaps, and free skin grafts. Along with obtain-ing good aesthetic outcomes, reconstruction of anterior neck scarcontractions should also aim for full neck extension . In the presentcases, we ensured almost complete release of the scar contractureand normalization of neck movement. Another advantage of rela-tively wide IMAP-based perforator-supercharged transposition flapsfrom the anterior chest is their high extendability which further alle-viates tension on the flap edges. This reduces the risk of contracturerecurrence and development of hypertrophic scars.Informed consent to publish has been obtained from this patient.

Abstract Topic: Scars Management and PainControl

S96The changes of immunoreactivity of mechanosensitive moleculesupon pressure therapyYuting Zhang1, Cecilia Li21Department of Rehabilitation Medicine, West China Hospital, SichuanUniversity, Chengdu, Sichuan, China; 2Department of RehabilitationSciences, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR,ChinaCorrespondence: Yuting ZhangBurns & Trauma 2019, 7(Suppl 1):S96

BackgroundPressure therapy has long been the frontline conservative treatment ofmassive hypertrophic scars. Mechanotransduction was found to play acritical role in scar formation, while the effect of pressure therapy onmechanotransduction remains unknown. Therefore, a preliminary studywas conducted to investigate the changes of immunoreactivity ofmechanosensitive molecules upon pressure therapy.Materials and MethodsA pretest-posttest was conducted to examine the clinical and histologicalmanifestation of hypertrophic scars before and after 3-month standard-ized pressure therapy. Vancouver Scar Scale and ultrasound system wereused to assess general scar condition and scar thickness. 3-mm scar bi-opsy was obtained from subjects, with analyzing the immunoreactivity ofFAK, integrin- β1 and ERK in epidermis and dermis. Wilcoxon signed ranktest and paired sample t test was used to compare VSS scores and scarthickness before and after pressure therapy. One-way repeated measureMANOVA was used to examined the influence of time on the change ofthe immunoreactivity of mechanosensitive molecules. Multiple regressionanalysis was used to contribution of post injury days and scar thicknesson the change of immunoreactivity of mechanosensitive molecules.


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ResultsThirty-one subjects with forty-three hypertrophic scars were enrolled. Scarthickness before (Mean=2.90, SD=1.28) and after (Mean=2.89, SD=1.36)pressure therapy did not show significance difference (t=0.05, p=0.96).Time had significant effect on the mean immunoreactivity of dermalintegrin-β1 (F(1,39)=15.54, p<0.001), FAK (F(1,39)=7.51, p= .009), and ERK(F(1,39)= .636, p= .016). Post injury days negatively contributed to the vari-ation in the change of immunoreactivity in dermal integrin-β1 and FAK.ConclusionsDermal immunoreactivity of mechanosensitive molecules was foundto downregulated after 3-month pressure therapy, and time after in-jury is critical for treatment implementation.


S97Management of Burn Conversion : A Literature ReviewAditya Wardhana1, Adi Basuki2, Lady Aurora3, Jessica Marsigit41Department of Plastic, Reconstructive, and Aesthetic Surgery,Department of Surgery, Faculty of Medicine Universitas Indonesia, CiptoMangunkusumo National Hospital, Indonesia; 2General Practitioner, BiakGeneral Hospital, Biak, Papua, Indonesia; 3Internship Doctor, HerminaSukabumi Hospital, Sukabumi, West Java, Indonesia; 4Internship Doctor,Koja General Hospital, North Jakarta, Jakarta, IndonesiaCorrespondence: Lady AuroraBurns & Trauma 2019, 7(Suppl 1):S97

BackgroundBurn conversion is the conversion of stasis zone into both greaterburn area and burn depth. It may hamper the patients’ conditionsince morbidity and mortality are expected to be higher with the in-crease of burn size. To gain a comprehensive perception about theburn conversion, this study aims to collect the latest update about itstherapy, diagnosis, etiology, and prognosis.Materials and MethodsLiterature searching was done on online databases, which werePubMed, SCOPUS, and PROQUEST. The keywords “Burns AND (Con-version OR Progression OR Expansion)” was formulated. The inclusionand exclusion criteria were applied.ResultsTwenty-six articles were found, which were divided into diagnosis of burnconversion (11%), aetiology of burn conversion (8%), prognosis of burnconversion (0%), and therapy of burn conversion (81%). All of the researchwas performed on animals. One of the best tools to diagnose burn conver-sion was the forward-looking infrared imaging (FLIR), having sensitivity upto 96% and specificity up to 100% to predict scar depth ≥3 mm. The mainaetiology was ischemia, reactive oxygen species and inflammation. Mostof the research regarding the therapy showed benefit on preventing burnconversion. However, there were no side effect investigated and not all ofthe research was statistically significant.ConclusionsMore prognosis research and the treatment’s side effect about burn con-version should be conducted. Further research, which found effective, sta-tistically significant, and safe, should be tested in human trial, since theanimal trial and human trial may differ.


S98Signal Transduction Mechanisms of Renin-Angiotensin SystemPromoting Formation of KeloidJunjie Chen, Ying CenDepartment of Burns and Plastic Surgery, West China Hospital, SichuanUniversity, Chengdu, Sichuan, ChinaCorrespondence: Ying CenBurns & Trauma 2019, 7(Suppl 1):S98

BackgroundAs one kind of pathological healing result from skin trauma, keloid be-comes a difficult task to dermatology, plastic surgery and even all of themedicine. Its etiology remains unclear. And none of treatment to keloid isconsistently effective. Recent studies have found that the local renin-angiotensin system (RAS) could play an important role in many fibrosis dis-eases. Based on the above studies and our previous investigative results,this project attempted to explore the mechanism of RAS influencing thesignal conduction pathway of ERK and JNK in keloid fibroblast cells, andelucidate the mechanism that AngII may promote synthesizing ECM andsecreting fibrosis factors of keloid fibroblast cells.Materials and Methods1. The immunohistochemistry and Western blotting were used to de-tect the protein expression of JNK、pJNK、ERK、pERK and collagen;2. Fibroblasts were freshly isolated from normal skin and keloid andwere cultured.3. The PD98059 and SP600125 were adopted respectively to blockERK and JNK pathway.ResultsThe results of the experiment demonstrated: ①The expression ofJNK、pJNK、 ERKand pERK were high in tissues and cells of keloid.②By AngII interfering keloid fibroblast cells, their expression wereobviously increasing, and the increasing expression could be effect-ively suppressed by selective angiotensin receptor antagonist. ③Theresults of further experiment of specifically blocking ERK or JNK sig-nal conduction pathway demonstrated that the effect of AngII pro-moting collagen synthesis by ERK or JNK could be suppressed atcertain degree.ConclusionsThe above results could show that the ERK and JNK signal conduc-tion pathways were important in the RAS promoting keloid forma-tion. The results of our investigation could help us institute the newtherapeutic regimen of keloid aiming to AngII and serial signal con-duction pathways.


S99The aesthetic effect of the repair of face and neck scar contracturewith expanded frontotemporal flapChengde Xia, Jidong Xue, Haiping Di, Dayong CaoDepartment of Burns,The First People's Hospital of Zhengzhou, Henanprovince, ChinaCorrespondence: Chengde XiaBurns & Trauma 2019, 7(Suppl 1):S99

BackgroundTo explore aesthetic effect of the repair of face-neck scar contracturedeformity with expanded frontotemporal posterior axis flapMaterials and MethodsFrom January 2013 to June 2018, twelve male patients with severe face-neck scar proliferation and contracture deformity, which were distributedon the front ear, cheek, chin and neck were repaired by expanded fronto-temporal flap with bilateral superficial temporal arteriovenous pedicle,which was formed by the method of frontotemporal scalp simultaneousexpansion. The operation consisted of 3 stages:In stageI,one 400 - 600mlcylindrical dilator was implanted in frontal parietal, and two 100ml cylin-drical dilator were respectively implanted in Bilateral temporal region. InstageII, the expanded flap with bilateral superficial temporal vessels wasdissected to repair the wound after scar resection and contracture release.The neck curve was reshaped and the donor site was closed with saline.In stage III, flap pedicles were divided and prunedResultsSeven patients underwent the operation of expanded frontotemporalflap transplantation and cervical skin dilatation. The duration of dila-tion was 4-6 months. Flap sizes ranged from 38 cm×9 cm - 45cm×15cm. All flaps survived with healing of wounds. 12 patientswere followed up for 4 -20 months, and the shape of the flaps were


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satisfactory with good appearance, no bloated appearance, and thecolor and texture were similar to facial skin, and the activity of theneck were obviously improvedConclusionsThe expanded frontotemporal skin can provide relatively large areaof thin flap, with reliable blood supply and good appearance afteroperation, and it is a better method to repair the scar contracture ofthe face and neck


S100Observation on the effect of medium frequency electrotherapy onburn scarYang Ruqian, Wang Xue, Yang Qin, Geng Kang, Yan HongDepartment of plastic and burn surgery, the Affiliated Hospital ofSouthwest Medical University, Luzhou, Sichuan, 646000, P.R.ChinaCorrespondence: Yan HongBurns & Trauma 2019, 7(Suppl 1):S100

BackgroundTo observe the prevention and treatment effect of medium fre-quency electrotherapy on hypertrophic scar.Materials and MethodsSubjects are selected form deep II and III degrees burn patients in our de-partment between January 2016 and December 2018, and are randomlydivided into control and observation groups .Subjects in the control groupwere treated with conventional antiscar therapy instead of medium fre-quency electrotherapy,meanwhile subjects in the observation groupbegan to receive conventional antiscar therapy and medium frequencyelectrotherapy after the burn wound healing.The vancouver scar scale wasused to assess the scar condition of patients in each group, and the soft-ness of scar was measured with the shaw hardness scale. The scar volumewas measured with 3D camera, and the thickness and gray scale of thescar were measured by skin ultrasound. the arrangement of scar collagenwas observed through H&E staining. And itching and pain of scar were ob-served by Visual Analogue Scale (VAS). All the above tests were performedafter wound healing, 3 months, 6 months and 9 months.ResultsThe volume, thickness, softness,the score of VAS and itch and pain ofhypertrophic scar in the observation group were significantly im-proved, which were lower than these in the control group. The re-sults of paraffin section through light microscope showed that thestructure of scar tissue in the observation group was rearranged andthe collagen was changed.ConclusionsMedium frequency electrotherapy can effectively inhibit scar hyper-plasia and soften hypertrophic scar, promote the rearrangement ofscar tissue structure, and reduce itching and pain caused by scar.


S101Numerical Simulation and Experimental Verification ofTemperature Field on Frozen Skin Tissue Stabbed by CryoprobeShiyuan Chen1, Xun Zhuge1, Li Wang1, Mengling Chang2, ZhinanZhang1, Feng Guo3, Jingning Huan21School of Mechanical Engineering, Shanghai Jiao Tong University,Shanghai, China; 2Department of Burn and Plastic Surgery, Rui JinHospital, School of Medicine, Shanghai Jiao Tong University, Shanghai,China; 3Department of Plastic Surgery, The Sixth People's Hospital,Shanghai Jiaotong University, Shanghai, ChinaCorrespondence: Zhinan Zhang; Feng GuoBurns & Trauma 2019, 7(Suppl 1):S101

BackgroundLiquid nitrogen freezing treatment applies low temperature onthe lesion to make necrosis and shedding for treatment, causingless bleeding and pain. Therefore, liquid nitrogen cryotherapy iswidely used in cryosurgery. This study is to study thetemperature field characteristics of frozen skin tissue stabbed bycryosurgery probe.Materials and MethodsA three-dimensional model of skin is built based on the Pennes Bio-heat Equation. The model takes blood perfusion rate, metabolic heatgeneration values, the phase change of skin tissue etc. into account.The simulation of temperature field was performed with the finiteelement analysis software ANSYS, and the feasibility of the simulationmethod was verified by animal experiments.ResultsAn effective cure scope and temperature distribution of thecryoprobe frozen by liquid nitrogen were gained was given. Themaximum effective scope was 2.11mm from the surface ofcryoprobe on skin surface, and it is 1.12mm underneath thecryoprobe inside the skin tissue, which corresponds well withverified experiment.ConclusionsWhen using the cryoprobe in clinical application, the effective curescope concluded in this paper should be considered to ensure a pre-cision treatment.


S102Activated platelet-rich plasma therapy for second and third degreeburns: a case seriesKarina1, Ayu P.B. Sarena2, Tommy Toar21Hayandra Clinic, Central Jakarta, Jakarta, Indonesia; 2Faculty of Medicine,Universitas Indonesia, Jakarta, IndonesiaCorrespondence: KarinaBurns & Trauma 2019, 7(Suppl 1):S102

BackgroundBurn injuries tend to be really painful and leaves a bad scar result,even after being treated by the current standard treatment.[1] Acti-vated platelet-rich plasma (PRP) contains various growth factors inhigh concentration. PRP treatment in burns might accelerate woundhealing, reduce pain, and leave a better scar result compared to theskin graft.[2]Materials and MethodsThis study reports 2 burn patients with second and third degreeburns that were given platelet-rich plasma treatment. One patienthad 18% TBSA with deep partial thickness and full thickness burns,while the other had deep partial thickness burns with 8% TBSA. Theactivated PRP was injected intravenously and intralesional to the pa-tient after debridement procedure was done. The wounds wascleansed conventionally and no skin graft procedures were appliedto all of the patients. We follow up these patients every week in 4consecutive week after treatment.ResultsThe patients reported they felt a great amount of pain reductionafter receiving PRP treatment. All of the patients had 100% epitheli-zation in 23 and 19 days post-treatment. After 1 months, no hyper-trophic scar, pliability, or itchiness were reported.ConclusionsTreatment by injection of intravenous and intralesional PRP, forsecond and third degree burn wounds, was found to be able toalleviate pain and give a better scar appearance. This therapywould be a great consideration to replace skin graft as the stand-ard therapy.

http://dict.youdao.com/w/paraffin%20section/%20/l%20keyfrom=E2Ctranslation%20


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Abstract Topic: Surmounting Challenges inRehabilitation

S103Functional Transition after Axillary Burn InjuriesYasutaka Shii¹, Yasuharu Matushita¹, Takaaki Aoki², Haruhiko Akiyama²¹Department of Rehabilitation Medicine, Gifu University School ofMedicine, Gifu city, Gifu ken, Japan; ²Department of OrthopaedicSurgery, Gifu University, Gifu city, Gifu ken, JapanCorrespondence: Yasutaka ShiiBurns & Trauma 2019, 7(Suppl 1):S103

BackgroundAxillary burns have a major effect on upper limb function. After theaxillary burns, there are reports on life-saving rate, daily life level,upper limb function score. However, there are few reports thatclearly describe the treatment outcome of upper limb function overtime. The purpose of this study was to examine the recovery processof upper limb function after axillary burns.Materials and MethodsThe research period is from October 2013 to October 2015. We eval-uated 7 patients (7 males) who underwent axillary burns and skingraft surgery at our hospital. Constant score and the Disabilities ofthe Arm, Shoulder and Hand scale (DASH) were assessed at 3months, 6 months, 1 year and 2 years after injury. Statistical analysiswas performed using Tukey test. The level of significance was set atp < 0.05.ResultsThe average value of each of the Constant score was calculated andexpressed in (3 months, 6 months, 1 year, and 2 years). Pain (10.3,12, 14, 15), Activities of daily living (12.7, 18.6, 19, 20), Range ofmovement (28.2, 37.2, 38.8, 40), Power (5.7, 6.4, 10.2, 10). Constantscore improved until one year after injury. The transition of DASH isalso expressed in the same way. Disability (45, 43, 31.1, 20.4), Sports(75, 75, 31.2, 25), Work (100, 66.6, 43.7, 12.5). DASH improved untiltwo years later.ConclusionsUpper limb function after axillary burns was evaluated using Con-stant score and DASH. Constant score improved over time from 3months to 1 year after injury. DASH improved until two years later.


S104Empowering caregivers: A positioning poster for burn patients andtheir familyFlorence ChiangOccupational Therapy Department, Singapore General Hospital,SingaporeBurns & Trauma 2019, 7(Suppl 1):S104

BackgroundIn 2017, a multi-disciplinary team from Singapore GeneralHospital commenced a long-term project (funded by SingHealthand Temasek Foundation International) to enhance the Dhaka(Bangladesh) healthcare team’s capacity in burns management.Prevention of contractures is one of the core tenets in burnsrehabilitation, as burn contractures can lead to substantialdeformities with devastating dysfunction. However, during theproject period, it was observed that burn patients were not main-tained in the optimal anti-contracture positioning. The objectiveof this project is to reduce the risk of contractures with the lim-ited resources available.Materials and MethodsA poster that illustrates various anti-contracture positioning was con-ceptualised. It used strong visuals and clear, succinct text in Bengali

to convey the message, taking into consideration the wide variancein literacy level of the target audience. The posters were placedacross burn wards in the Dhaka Medical College Hospital. Data wascollected on the number of joints correctly positioned in nine pa-tients before and after the posters were displayed. Seven caregiversand nine healthcare staff were interviewed to assess the level of theirawareness of the poster and the usefulness of its content.ResultsOut of 34 joint positions observed, 3 were noted to have improved.Out of seven caregivers interviewed, four reported that they under-stood the poster content and attempted to follow but two verbaliseddifficulty following through as the patient was in pain. Among thenine healthcare staff interviewed, all agreed it was useful.ConclusionsThe poster has kick started initial changes to prevent contractures inburn patients. In the next phase of the project, we will focus on train-ing the healthcare staff to use the posters to explain to caregivers.Strategies will also be taught to caregivers on how to position a pa-tient with pain. Data will be collected to evaluate its impact.


S105Defining Burn Contractures: can we and should we?RuthAnn Fanstone, Tom Potokar, Patricia PriceCentre for Global Burn Injury Policy and Research, Swansea University,Swansea, Wales, UKCorrespondence: RuthAnn FanstoneBurns & Trauma 2019, 7(Suppl 1):S105

BackgroundLiterature suggests that burn contractures are preventable yet, at thesame time, studies report a prevalence of 38% - 54%. Is this conflict-ing evidence as a result of a lack of consensus about the definitionof a ‘contracture’ or how prevalence is calculated? Can we reportwith any certainty that contractures are, indeed, preventable if wehaven’t yet fully understood risk factors associated with their devel-opment? This study aimed to investigate the current understandingof a burn contracture and how experts in the area use the term.Materials and MethodsA comprehensive literature review and expert interviews (n=15) wereconducted: experts were required to have more than 10 years clinicalexperience in the field.ResultsThe majority of the literature is based on research and commentaryfrom high-income countries. Whilst technical definitions of a burncontracture exist, there is limited evidence of a consensus or a stan-dardized, operational definition of a contraction, how it should bemeasured, why a contracture should be measured or, indeed, when.Furthermore, classification of contracture severity varies. The expertsstated that their working definitions of ‘contractures’ was based pri-marily on their own clinical experience, rather than the literature.Given the majority of literature in this area consists of clinical reportsand opinion, this is understandable. Neither sources focused on de-tailed, operational definitions, which makes it difficult to build an evi-dence base for prevention or treatment based on standardizedmeasurement protocols. Despite the lack of this operational defin-ition, clinicians were confident of their ability to identify and measurea contraction.ConclusionsWithout a valid and reliable definition and measure of contracture, itis challenging to measure prevalence of burn contracture and ex-plore risk and protective factors in burn contracture formation. Canand should the burn care community settle the question of what acontracture is and how to measure one?


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Abstract Topic: Tissue Banking

106A review of skin banking guidelines and standards worldwide:Towards the harmonisation of guidelines for skin banking intherapeutic applications for the regions under the Asia-PacificBurns Association (APBA)Wee Ling Heng 1, Alvin Wen Choong Chua1,2, and Si Jack Chong31Transplant Tissue Centre, Singapore Health Services, Singapore;2Department of Plastic, Reconstructive and Aesthetic Surgery, SingaporeGeneral Hospital, Singapore; 3Asia Pacific Burn Association, Bali,IndonesiaCorrespondence: Alvin Wen Choong ChuaBurns & Trauma 2019, 7(Suppl 1):106

BackgroundCurrently, there is no harmonised standard to govern skin banking inthe Asia-Pacific region. Therefore, skin banks are either unregulated,or rely on their nations’ legislation or international accreditation touphold their banks’ quality standards.Materials and MethodsA new set of prescriptive skin banking guidelines was developedthrough a comprehensive review and collation of best practices forAsia-Pacific Burns Association members, from donor screening andtesting, to skin recovery, processing, storage and distribution, andquality assurance. National regulatory requirements reviewed includethe European Directives, India’s Transplantation of Human OrgansAct, Therapeutic Goods Administration (TGA), Japanese Society of Tis-sue Transplantation and Singapore’s guidelines for tissue banking.These legislations are modified from international standards, whichoffer further technical and quality recommendations. These includethe American Association of Tissue Banks (AATB), United States Foodand Drug Administration Current Good Tissue Practice (CGTP), theEuropean Good Tissue Practices (EuroGTP) Guide, and Asia-Pacific As-sociation of Surgical Tissue Banking (APASTB).ResultsAdapted mainly from the AATB standards, these guidelines offer a com-prehensive manual, addressing: governance and contracts; staff respon-sibilities; quality management; facilities, equipment and suppliesmanagement; donor consent and testing; recommendations of goodpractices pertaining to skin recovery, processing, storage and distribu-tion. Besides complementing current generic regulations, they providespecifications of major aspects unaddressed in most legislations: (1)dis-eases and infections contraindicated for donation; (2)accreditation oftesting laboratories; (3)archiving of donors’ serums; (4)corrective-and-preventive-actions (CAPA) investigations of not only post-operative ad-verse outcomes, but also errors and accidents; (5)recall procedure;(6)environmental monitoring of skin-processing facilities; (7)process val-idations prior to implementation of critical processes and revalidations.ConclusionsA harmonised standard provides similar quality allografts among mem-ber states. It also eliminates the need to maintain exorbitant internationalaccreditation and mandatory compliance to guidelines incompatible toour Asian context. This can also simplify the importation process whenan exchange of allografts between transnational jurisdictions is required.


S107Knowledge and views of nurses on tissue donationQi Wei Bibi Wang1, Wen Ning Ho1, Yik Cheong Khoo1, Alvin WenChoong Chua21Transplant Tissue Centre, SingHealth, Singapore; 2Skin Bank Unit,Singapore General HospitalCorrespondence: Qi Wei Bibi WangBurns & Trauma 2019, 7(Suppl 1):S107

BackgroundOf the Singapore population, only 3% pledged for donation, resultingin a shortage of tissues, such as heart valves, skin and vessels, avail-able for transplantation.

As tissue donations are executed in hospitals and hospices, Trans-plant Coordinators work closely with nurses to facilitate theprocess. Nurses are often the first line of care for patients receiv-ing treatment prior to their demise. Therefore, they can play animportant role in donation by identifying potential donors or ad-vocating for donation.This study aims to gather a baseline regarding nurses’ attitudes andknowledge towards tissue donation, and how these deficits can beaddressed to empower nurses to take a proactive role in the tissuedonation process.Materials and MethodsA survey was conducted from 2014 to 2017 with 1293 nurses work-ing in two tertiary hospitals in Singapore before they attended anone-hour tissue donation awareness talk. Data collected includeddemographics and information on knowledge and attitudes towardstissue donation.ResultsOf the 1293 nurses surveyed, 59.7% of them were in favor of tissuedonation although only 32.4% of the nurses had heard of the tissuedonation legislation in Singapore. 874 nurses stated that they are un-comfortable approaching the deceased’s family for tissue donation;76% of them felt that doing so would add distress to the family, p <0.05, while only 5.6% (n = 49) felt that tissue donation is not part oftheir nursing responsibility, p < 0.05.ConclusionsThe analysis reflects that more than half of the nurses surveyed weresupportive of tissue donation but education seems to be severelylacking. Therefore, healthcare professionals including nurses need tobe enriched on donation education catered to their needs (e.g. chan-ging their perception and family approach). This might empowerthem to play a proactive role in tissue donation in hopes of increas-ing the tissue donation rates in Singapore.


S108The Refinement of Decontamination Regimen of Skin Allografts inSingapore General HospitalZubaidah Binte Dadlani1, Si Xuan Tan 2, Tze Peng Lim 2, Jialin Yick 1,Wing Yue Chan1, Alvin Wen Choong Chua11 Skin Bank Unit, Singapore General Hospital, Singapore; 2 Departmentof Pharmacy, Singapore General Hospital, SingaporeCorrespondence: Zubaidah Binte DadlaniBurns & Trauma 2019, 7(Suppl 1):S108

BackgroundThe Skin Bank Unit (SBU) in SGH decontaminates donated skin by in-cubation in Dulbecco’s Modified Eagle Medium (DMEM) containingVancomycin and Amikacin (V+A). While effective against bacteria, thissolution lacks an antifungal; thus, any fungal contaminated skin isunsuitable for transplant. In efforts to reduce tissue discard, SBU hastested Amphotericin B (AMB) – a cytotoxic but cost-effective antifun-gal with low Minimum Inhibitory Concentrations (MICs) and high sus-ceptibility rates across a wide range of fungi – against keratinocytesand fibroblasts, finding that the highest tolerable concentration ofthe drug against skin is 1.0μg/ml. This study investigates the potencyand fungicidal efficacy of 1.0μg/ml AMB to determine its suitabilityas an addition to SBU’s decontamination regimen.Materials and MethodsDMEM containing AMB (1.0μg/ml), V+A (50μg/ml, 100μg/ml) wasprepared and stored in dark conditions at 4°C. Solutions were ali-quoted from this cocktail and frozen at various time-points. Thesesolutions were tested by well-diffusion assay using C. albicans(C.A.), and their percentage potency was calculated by compari-son to the 0-hour sample. In a separate test, the fungicidal activ-ity of the cocktail was determined using a 96-hour in-vitro TimeKill Assay (TKA) model against C.A..ResultsAMB in the cocktail maintained an average of 46.8% potency at48-hours (letting 0-hour concentration=100%); potencies at 72and 96-hour time-points were below 37% (n=3). TKAs carried out


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against initial inocula of 3.48~3.86, 4.60~5.03 and 5.88~6.06 logColony Forming Units/ml C.A. showed mean reductions of 99.0%(n=7), 99.7% (n=10) and 99.3% (n=4) respectively at 96 hours.Conclusions1.0μg/ml AMB can be incorporated into SBU’s decontamination regi-men to potentially reduce the discard of tissues contaminated withC.A. and fungi with similar MICs. For optimal decontamination, skinshould be incubated for 96 hours with media change at 48 hours. Ifimplemented, microbiological trends in skin recovered must be mon-itored to validate AMB’s efficiency against clinical fungal strains.


S109Studying the effects of Platelet Rich Plasma (PRP) and Adipose -Derived Mesenchymal Stem Cells (ADSCs) on chronic woundtreatmentTuan Ngoc Nguyen, Dzung Tien Nguyen1Vietnam National Burns Hospital, Military Medical University, Hanoi,VietnamCorrespondence: Tuan Ngoc NguyenBurns & Trauma 2019, 7(Suppl 1):S109

BackgroundChronic wound are breaks in the skin that do not heal, or require along time to heal, and frequently recur. Autologous platelet-richplasma (PRP) and Adipose – Derived Mesenchymal Stem Cells(ADSCs) are potential wound healing treatments in vitro and in vivo.In this study, we evaluated synergic effects of PRP and ADSCs onchronic wound treatment.Materials and MethodsThirty patients with chronic wounds treated at Wound Healing Cen-ter, National Institute of Burns from March 2016 to July 2017 were re-cruited for study. These patients were injected the combination ofPRP and ADSCs at wound bed around. After one and two weeks ofPRP and ADSCs injection, these patients were re-injected PRP. We es-timated some clinical signals of wound bed and evaluated Periodicacid – Schiff (PAS) response before and after therapyResultsPRP and ADSCs helped to improve the wound healing process: re-duced exudate, promoted the epithelialization, granulation tissue; in-creased sample number of PAS response at epiderma and basementmembrane, reduced MMP-12 after therapyConclusionsThe combination of PRP and ADSCs stimulated wound healingprocess by improvement of wound edge and wound bed


S110Analysis on efficacy of rhGM - CSF in deep partial thickness burnwound healing and its underlying mechanismYuhui Dongye1,2, Dongyu Li3, Kaipan Qu4, Chenghao Hu1,2, Xing Yang1,2, Haibo Zhang2,5, Jiani Wu2, Weifeng Li2, Huibin Li21School of Clinical Medicine, Weifang Medical University, Weifang,Shandong 261000; 2Department of Burns and Plastic Surgery, People'sHospital of Linyi, Linyi, Shandong 276000, P.R. China; 3Department ofGenetics, College of Agricultural and Life Science, University ofWisconsin‑Madison, Madison, WI 53706, USA; 4Department of Burns andPlastic Surgery, Shandong Provincial Third Hospital, Shandong,Jinan,250000; 5School of Clinical Medicine, Binzhou Medical University,Yantai, Shandong, 256600, China.Correspondence: Huibin LiBurns & Trauma 2019, 7(Suppl 1):S110

BackgroundManagement of deep II°burn is a challenge for physicians. rhGM-CSFhas been proved to be effective in wound healing. However, theunderlying mechanisms haven’t been fully comprehended. It ismeaningful to investigate the mechanisms that promote woundhealing.

Materials and MethodsFrom 2015 to 2016, 96 cases of deep II° burn wound wounds in LinyiPeople’s hospital were randomly divided into experimental groupand controlled group. The experimental group was treated by rhGM-CSF hydrogel, the control group received traditional treatment ofVaseline gauze bandage. The whole experimental period was 28days. Wound healing time and wound healing rate, total effectiverate at the 7th,14th and 21th day after treatment were observed andrecorded. The tissue samples(n=6) harvested from burn wound at dif-ferent time point were obtained for detecting the expression of TGF-β1 and TβRII through immunohistochemical method.ResultsThe average wound healing time in the experimental groups was sig-nificantly shorter than that in the controlled group(p<0.05).Thewound healing rate and efficacy in the experimental groups was sig-nificantly higher than that in the controlled group (p<0.05). The totaleffective rates in the experimental groups respectively at 7th,14th and21st after remedy was also significantly higher than the control group(p<0.05). The expression of TGF-β1 and TβRII in the experimentgroup at 7th, 14th, 21st was significantly much more than that in con-trol group, respectively(p<0.05).ConclusionsTopical application of rhGM-CSF hydrogel can significantly promotethe expression of TGF-β1 and TβRII in wound tissue, accelerating andenhancing the healing process of deep II°burn wound.


S111An in vitro and in vivo study of antimicrobial effect of a gallium-loaded artificial dermal scaffoldZhaorong Xu1, Zhaofan Xia21Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou,Fujian, China; 2Department of Burn Surgery, Changhai Hospital, SecondMilitary Medical University, Shanghai, ChinaCorrespondence: Zhaofan XiaBurns & Trauma 2019, 7(Suppl 1):S111

BackgroundCurrently, artificial dermal scaffolds are widely used for the treatmentof full-thickness skin defects, but the problem that biomaterial-associated infections frequently occur with their use, as it greatly af-fects the survival of the scaffolds, must be addressed. The gallium(Ga), which has broad-spectrum antimicrobial effect, is a promisingcandidate to prevent implant-associated infections.Materials and MethodsThe gallium-loaded antimicrobial artificial dermal scaffold was pre-pared by gallium ions and a collagen solution, followed by materialcharacterization. The antibacterial rate of the scaffold was evaluatedby a direct contact assay using standardized cultures of S. aureus andP. aeruginosa, and cytological evaluation was conducted using L929cells. Then the full-thickness wounds on both sides of the back of SDrats, which were added with a certain amount of P. aeruginosa sus-pension, were used for the evaluation of antimicrobial activity onwounds in vivo.ResultsThe characterization results showed a porous structure and a ap-propriate enzymatic degradation rate, as well as a sustaining re-leasing of gallium ions. In vitro antimicrobial testing revealed thatthe 1 h antibacterial rate against S. aureus and P. aeruginosa wasclose to 90%, which indicated its great antimicrobial activity. Theresults of the cytological evaluation showed no cytotoxicity. Fur-thermore, the in vivo antimicrobial evaluation showed the suc-cessful prevention of wound infections in SD rats, and the HEstaining also demonstrated its great biocompatibility.ConclusionsThis gallium-loaded antimicrobial artificial dermal scaffold exertedexcellent antimicrobial activity and no cytotoxicity in vitro. Fur-thermore, it could effectively prevent the infection of woundsand implants, which warrants further research for future clinicalapplications.


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S112The application of dermal regeneration templates in full-thicknessskin defects reconstructionZhaohong Chen, Zhaorong Xu, Shun Chen, Haihui Li, Wei Liu, JianchangLin, Zi’en Wang, Shaohua Wang, Changdan Jin, Yichao Xu, JianjunZheng, Linwen ZhengFujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou,Fujian, ChinaCorrespondence: Zhaohong ChenBurns & Trauma 2019, 7(Suppl 1):S112

BackgroundDermal regeneration templates (DRTs), such as Integra® introducedas a new alternative to our surgical arsenal and applied in varioustypes of wound cases, have gained great importance. They havebeen widely used in reconstructive surgery around the world. Here,we decribe the approving results of full-thickness skin defects recon-struction with DRTs.Materials and MethodsThe data of patients with full-thickness skin defects who were treatedwith DRTs, was collected from Fujian Burn Institute in China. Woundbed preparation (debridement or negtive pressure wound therapy)were received previous to DRTs, and second-stage split thickness skingraft (STSG) were performed two weeks after DRTs transplatation.Wound healing rate, clinical and photographic evaluations, and com-plications related to their use were analyzed.ResultsPatients with different cases were treated with DRTs, some withacute burn wound, while others with chronic wound, soft tissue de-fect with exposed tendon or wound due to scar excison. No signifi-cant infection was observed after surgery, and the donor sitemorbidity was minimal. All patients healed with STSG take rate over90%, and flexible skin coverage were obtained. Most cases hadachieved smooth surface and satisfied articular movement, as theywere all followed up for three months to more than one year.ConclusionsDRTs offer a convenient and efficient operative procedure with min-imal morbidity, demonstrating excellent aesthetic and functionalhealing effect. Thus, DRTs may offer an alternative option with lowrisk for full-thickness skin defects reconstruction.


S113The growth of diced cartilage and the role of fibrin glue scaffoldand platelet rich plasma in subcutaneous implantation and tissueengineering using vascularized perforated tubeNyoman P Riasa1, I Putu Astawa2, I Nyoman Mantik-Astawa3, I NyomanAgus-Bagiada41Department of Plastic Reconstructive and Aesthetic Surgery, Faculty ofMedicine Udayana University-Sanglah Hospital, Denpasar Bali, Indonesia;2Department of Orthopaedic and Traumatology, Faculty of MedicineUdayana University-Sanglah Hospital, Denpasar Bali, Indonesia;3Department of Pathology, Faculty of Veterinary Udayana University,Denpasar Bali, Indonesia; 4Department of Biochemistry, Faculty ofMedicine Udayana University, Denpasar Bali, IndonesiaCorrespondence: Nyoman P Riasa1

Burns & Trauma 2019, 7(Suppl 1):S113

BackgroundIn plastic surgery, cartilage could be used as diced cartilage (DC)graft. Fibrin glue scaffold (FGS) and platelet rich plasma (PRP) hadbeen added in grafting process but its role need to be elucidated.This study aimed to explore DC growth and the role of FGS and PRPin subcutaneous DC implantation and to use DC as cell source to de-veloped larger construct using vascularized perforated tube (VPT).

Materials and MethodsIn each of eight rabbits, two dorsal subcutaneous pockets and twoVPT on superficial epigastric vessels were created. VPT was made ofperforated silicone tube containing superficial epigastric pedicle. Mix-ture of FGS_PRP were made by retrieving PRP from centrifugation of2 ml autologous blood in citrate natrium and activated with calciumchloride and thrombin during mixing process with DC. DC as well asDC + FGS_PRP were implanted on VPT and subcutaneous pocket.Subcutaneous pockets DC implantation were use as control group.ResultsEight weeks after implantation all specimens shows glossy cartilage. VPTgroups show larger construct with higher tissue weight (p < 0.05) andvascularized tissue flap containing cartilage could be created. DC withnew chondrocytes island formations was noted, and connective tissuescontaining blood vessels fill the space in between. ANOVA test show nodifference for viable DC and positive GFAP staining in all groups (p >0.05), but chondrocytes viability were higher compare to the controlgroup (p < 0.05). Formation of new chondrocytes islands was higher insubcutaneous DC + PRP_FGS group and in VPT DC only group but withlower vascularity compare to the control group (p < 0.05).ConclusionsIt can be concluded that PRP_FGS has positive effect on subcutane-ous DC implantation and to use DC only in creating larger constructof vascularized tissue flap containing cartilage.


S114Construction and in vitro evaluation of VEGF gene activated PLGAknitted mesh-reinforced collagen/chitosan dermal scaffoldTingting Weng, Pan Wu, Wei Zhang, Xingang WangDepartment of Burns & Wound Care Center, Second Affiliated Hospitalof Medical College, Zhejiang University, Hangzhou 310009, ChinaCorrespondence: Wei ZhangBurns & Trauma 2019, 7(Suppl 1):S114

BackgroundDermal substitutes play an important role in dermis reconstruction/regeneration. However, there is still the problem of insufficientvascularization. The process of angiogenesis is precisely regulated byvarious cytokines/growth factors. The introduction of pro-angiogenicfactors into dermal scaffolds in gene form to positively regulate thevascularization process is a hot spot in vascularization research. VEGFis one of the main regulators of neovascularization. VEGF can specif-ically combine with VEGFR-2 receptor on the surface of endothelialcells to promote the migration, proliferation and primary lumen for-mation of endothelial cells.Materials and MethodsA cationic gene delivery vector, N,N,N-trimethyl chitosan chloride(TMC), was used to form complexes with the plasmid DNA encodingVEGF. Then, the TMC/pDNA–VEGF was incorporated into the dermalscaffold to construct VEGF gene activated dermal scaffold. Next, thescaffold was physically characterized. Subsequently, TMC/pDNA–EGFP,naked pDNA–VEGF and blank PLGAm/CCS were loaded respectively ascontrols. The effect of VEGF gene-activated PLGAm/CCS dermal scaffoldon cell proliferation was investigated by vaccinating HUVEC in vitro.ResultsWe have successfully prepared VEGF gene-activated PLGAm/CCS der-mal scaffold. The scaffolds have a good pore structure and a certainsustained release capacity. The sustained release of TMC/pDNA–VEGFhas an ideal cell transfection efficiency. HUVECs transfected withTMC/pDNA-VEGF can maintain good proliferative activity and secreteVEGF protein.ConclusionsThe results show that the VEGF gene activated PLGAm/CCS dermalscaffold is expected to become a new functional tissue engineeringskin for promoting vascularization. Its vascularization propertiesin vivo can be further confirmed through in vivo research.


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S115Collagen-based dermal substitute with stable fibroblast growthfactor 2 (FGF2): ex ovo and in vivo impact on neovascularizationBretislav Lipovy1,2, Lucy Vojtova3, Jakub Holoubek1,2, Jan Zidek3, MartinKnoz1,2,4, Johana Babrnakova3, Veronika Pavlinakova3, Lucie Vistejnova5,Veronika Stepankova 6, Eva Filova 7, Zdenek Pavlovsky8, Martin Faldyna9,Eduard Göpfert9, Jiri Damborsky10, Vanessa Hearnden111Department of Burns and Plastic Surgery, University Hospital Brno,Czech Republic; 2Faculty of Medicine, Masaryk University Brno, CzechRepublic; 3CEITEC – Central European Institute of Technology, BrnoUniversity of Technology, Brno, Czech Republic; 4Department of Plasticand Aesthetic Surgery, St. Ann‘s University Hospital, Brno, CzechRepublic; 5Biomedical Center, Faculty of Medicine in Pilsen, CharlesUniversity, Czech Republic; 6Enantis s.r.o, Brno, Czech Republic; 7Instituteof Experimental Medicine, Academy of Science of the Czech Republic,Prague; 8Department of Pathology, University Hospital Brno, CzechRepublic; 9Veterinary Research Institute, Brno, Czech Republic; 10Instituteof Experimental Biology and Recetox, Masaryk University, Brno, CzechRepublic; 11Department of Materials Science and Engineering,Department, University of Sheffield, UKCorrespondence: Bretislav LipovyBurns & Trauma 2019, 7(Suppl 1):S115

BackgroundDermal substitutes play important roles in the treatment of deep der-mal and full thickness wound in both phases (acute and long-term).Neovascularization is very important within whole wound healingprocedure (improve metabolic and oxygen ratio in the tissue, facili-tate of transmigration other growth factors, etc.)Materials and MethodsUnique bi-layer dermal substitute consists of porous biopolymerfoam coated with polymeric nanofibers and highly stable fibroblastgrowth factor (FGF2). For measurement of impact on neovasculariza-tion two different methods were used. First ex ovo methodology wasprovided in terms of Chick Chorioallantoic Membrane (CAM) assay,second method was provided via mathematical establishingcapillarydensity in histological samples stained with α-SMA (α-smooth muscleactin) and anti-FVIII (neovascularization) markers from large whitepigs.ResultsFirstly, in both experiments, we have proven that our tested materialhas demonstrated full biological compatibility. As confirmed by CAMassay and animal model testing, stable FGF2 enhanced bi-layer neo-vascularization efficiency. Positive influence of FGF2 was proved aswell by neovascularization and fibroproliferation with autologous col-lagen production in the entire animal model defect.ConclusionsStable FGF2 demonstrated positive biological activity in relation toneovascularization in both the CAM assay and the animal model.

AcknowledgementThis research was supported by the Ministry of Education, Youth and Sportsof the Czech Republic under the projects CEITEC 2020 (LQ1601), LO1503 andLO1218 as well as by Ministry of Health of the Czech Republic, grant Nr. 17-29874A. All rights reserve


S116The properties of collagen-chitosan nanosilver antibacterialdressing and its effect on the healing of full-thickness burnwoundsXiaodong Chen, Rongfu Li, Zhaorong Xu, Qiong Jiang, Zhaohong ChenFujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou,Fujian, ChinaCorrespondence: Xiaodong ChenBurns & Trauma 2019, 7(Suppl 1):S116

BackgroundFor dressings, how to prevent wound infection and promotewound healing is a key issue to be solved. Chitosan and collagenhave been widely studied and applied as biological dressings,while nano-silver has a good broad-spectrum antibacterial effect,and has fixation, stability and antibacterial properties on the sur-face of the dressing.Materials and MethodsIn this study, HUVECs were cultured in vitro to evaluate the effects ofthe main components of collagen chitosan nano-silver dressing onthe proliferation of cells and the secretion of growth factors and in-flammatory factors. A dressing was prepared and tested for its prop-erties and antibacterial properties. By further establishing a full-thickness skin burn model in rats, the effects of dressing on woundhealing in rats and the effects of tissue growth factors and inflamma-tory factors on wounds were observed.ResultsThe composition of the dressings with different molecular weightcollagen and chitosan solution and their mixed solution can pro-mote the proliferation of HUVECs, and promote the secretion ofcell growth factors in vitro. The chitosan solution and collagenchitosan mixture can inhibit the secretion of inflammatory cyto-kines from HUVECs. When the concentration of nano-silver was2.5 mg/L or less, it did not affect the proliferation of HUVECs andthe secretion of cell growth factors and inflammatory factors.Nano-silver can be stably combined with collagen chitosan whichreleases lower, and it has good water absorption. It has certainantibacterial activity against Pseudomonas aeruginosa, Escherichiacoli and Staphylococcus aureus, and the inhibition rate is over99%. Dressing can significantly promote growth factors, and regu-late inflammatory factors in wound tissue in rat and can signifi-cantly promote wound healing.ConclusionsCollagen chitosan nano-silver dressing has certain antibacterial prop-erties, can promote wound healing, and regulate wound tissuegrowth factor production and inflammatory response.


S117Clinical Experience of Calcium Alginate Dressing in Burn WoundsHsueh-Yin ChangBurn Center, Tri-Service General, Taipei, Taiwan, R.O.CBurns & Trauma 2019, 7(Suppl 1):S117

BackgroundCalcium alginate dressings are a strong, versatile, and naturalwound care dressing. The application of calcium alginate dressingon wounds has been widely recognized. It maintain a physiolo-gically moist microenvironment that promotes wound healingand the formation of granulation tissue. Calcium alginate is read-ily removed with saline irrigation, making dressing changes virtu-ally painless.Materials and MethodsUse normal saline solution to clean the wound area, then pat thearea around the wound dry. Place the alginate dressing over thewound, and Secure a secondary dressing over the alginate dress-ing to hold it in place. Change the dressing every one to threedays, according to the progress of the wound change the dress-ing or when fluid starts to seep out from the edges of the dress-ings. Before removing the alginate during a dressing change, usesaline to dampen it in order to lower the risk of damaging thesurrounding skin.ResultsCalcium alginate has a staggering effect and can promote tissue pro-liferation. It is an effective haemostat, it well tolerated by body tis-sues. Good epidermal healing was seen on all wounds althoughcellular reactions could be provoked in full thickness wounds withoutocclusion.


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ConclusionsCalcium alginate can be used on acute burn wounds, traumaticwounds, partial- or full-thickness wounds, any wound with somedrainage or exudate. Calcium alginate turns into a gel when exposedto the exudate to provide an ideal healing environment, making theremoval of the dressing virtually painless. Calcium alginate is an im-portant part of the wound care dressings.

Abstract Topic: Wound Care Chronic Dressing

S118Evaluation of biological activity of new temporary biopolymerhydrogel for selected growth factors in partial skin defects on theanimal modelBartošková1, Holoubek J.1,2, Lipový B.1,2 , Nedomova E.3, Ruzicka F.4,Vacek L.4 , Knoz M.1,2,5, Stepankova V.6, Pavlovsky Z.7, Faldyna M.8,Göpfert E.8, Damborsky J.9, Vojtova L.31Department of Burns and Plastic Surgery, University Hospital Brno,Czech Republic; 2Faculty of Medicine, Masaryk University Brno, CzechRepublic; 3CEITEC – Central European Institute of Technology, BrnoUniversity of Technology, Brno, Czech Republic; 4Department of ClinicalMicrobiology, St. Ann’s University Hospital, Brno, Czech Republic;5Department of Plastic and Aesthetic Surgery, St. Ann‘s UniversityHospital, Brno, Czech Republic; 6Enantis, Brno, Czech Republic;7Department of Pathology, University Hospital Brno, Czech Republic;8Veterinary Research Institute, Brno, Czech Republic; 9Institute ofExperimental Biology and RECETOX, Masaryk University, Brno, CzechRepublicCorrespondence: Bartošková; Holoubek J.Burns & Trauma 2019, 7(Suppl 1):S118

BackgroundNowadays, the demand for utilization of new technologies in clinicalmedicine is on rise. The same situation is in field of wound healingand there is a great opportunity for applying advanced biopolymermaterials in clinical practice.. The aim of the treatment of acute andchronic defects caused by high energy, such as burn trauma ormechanical trauma, is not only survival but also the achievement ofthe best quality of life.Materials and MethodsWe present a unique antibacterial hydrogel for wound healing basedon natural Gum karaya polysaccharide (GK) containing upgradedstable forms of growth factor for fibroblasts (FGF2). In preliminaryin vitro testing, we verified the viability of colonized mouse monoclo-nal B lymphocytes (containing receptor for FGF2) on the developedmaterial. The antimicrobial potential of the carrier was then verifiedusing a disk diffusion assay followed by a measurement of thegrowth curves at OD 600 nm. Based on laboratory tests, in vivo ex-periments on the animal model were then performed.ResultsThe results of the in vitro tests have demonstrated the biological ac-tivity of both mouse B lymphocytes and fibroblasts under the syner-gic effect of all key components on the tested material. The resultsof the antimicrobial tests showed a very promising antibacterial ac-tivity against wide spectrum of pathogen, especially against G+spectrum.In vivo test on animals brought a positive and successful result; allsubjects survive and fully healed.ConclusionsIn vitro on eukaryotic cells and prokaryotic bacteria have shown avery promising result of GK based hydrogels. The histological andclinical outcome obtained showed a great potentials and support fur-ther development and testing.


S119Characteristics of Diabetic foot ulcer in Northern Vietnam: Analysisof Database from Wound Healing Center, Vietnam National BurnHospital from 2013 to 2018Dzung Tien Nguyen, Han Van Dinh, Dzung Thi BuiWound Healing Center, Vietnam National Burns Hospital, MilitaryMedical University, Hanoi, VietnamCorrespondence: Dzung Tien NguyenBurns & Trauma 2019, 7(Suppl 1):S119

BackgroundIncidence of Diabetic foot ulcer has been arising unexpectedly in re-cent years in Vietnam. We will review data of patients with Diabeticfoot ulcer in Northern Vietnam in this retrospective cohort study.Materials and MethodsIn this retrospective cohort study at Wound Healing Center, NationalInstitute of Burns in Hanoi, Vietnam, we analyzed the electrical dataof 469 patients with Diabetic foot ulcer, who hospitalized at WoundHealing Center from 2013 to 2018.ResultsAmong 469 patients recruited for this study,76.75% were males and23.24% were females. 68% of patients came from rural areas. Dia-betic foot ulcers were most prevalent in age group from 40 to 60years old (52.7%) and least prevalent in the age group from 20-30years old (3.2%). Most patients had type 2 diabetes mellitus (92.3%)and required multidrug therapy or insulin (84.4%). 84% of patientsdidn't know how to recognize a problem with their feet before it be-comes a major issue. 65% of them didn't find out they had diabetesuntil the ulcer appeared. Neuropathy was present in 70 % patients.Absent or diminished peripheral pulses was observed in 83% cases.Highest percentages of cases (54.58%) had grade 3 diabetic foot (ac-cording to Wagner's classification). 51.6% of cases had Osteomyelitis.96% of patients had been closed wound by surgical intervention(skin graft (55.11%), flap (23.11%) or amputation (21.78%)).ConclusionsIn Northern Vietnam, all most patients with Diabetic foot ulcerhaven't any understands about Diabetic foot ulcer risks and preven-tion methods. Many of them has peripheral neuropathy, peripheralarterial disease, osteomyelitis and require surgical intervention.


S120To observe the clinical effect of platelet rich fibrin in chronic sinuswoundDing Xiaobin, Liu Ligang, Jiang Bo, Tang Rui1, Wu Xunlian, ZhengDanyu, Yan HongDepartment of Plastic and Burn Surgery, the Affiliated Hospital ofSouthwest Medical University, Luzhou, Sichuan, 646000, P.R.ChinaCorrespondence: Ding XiaobinBurns & Trauma 2019, 7(Suppl 1):S120

BackgroundThere is an increasing number of bone exposure caused bychronic wound, as well as the proportion of patients calling foramputation or demanding skin flap graft. Amputation surgery isdifficult to carry on. Meanwhile, the financial burden and lowquality of life after amputation cannot be afforded for many pa-tients. Due to the reasons above, we investigate the feasibilityand prospect of using CO2 laser debridement combined withcomplex PRF wound cover after bone ablation


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Materials and MethodsWe use CO2 laser to produce multiple ablation points of different ap-ertures and even lead to bleeding. To debride the surrounding tissuearound bone exposure with CO2 laser, and use PRF to cover the ex-posed part timely in the meantime, to observe the recovery out-comes of woundsResultsFollowing this treatment, the ablated bone tissue grew out majorgranulations and formed new granulation combined with PRF in alarge number of patients. Since the treatment could be done out-patient, it could not only avoid the risk of amputation caused byosteonecrosis or skin flap transplantation, but also save medical re-sources as well as easing patients’ burdenConclusionsThis treatment could protect bone tissue and repair wound fairlywell, which is worthy of being widely applied in clinic


S121Effects of Electrical Stimulation on Wound Healing andAngiogenesis in Diabetic RatsGeng Kang, Wang Xue, Yang Yuting, Liu Lan, Yan HongDepartment of Plastic and Burn Surgery, the Affiliated Hospital ofSouthwest Medical University, Luzhou, Sichuan, 646000, P.R.ChinaCorrespondence: Geng KangBurns & Trauma 2019, 7(Suppl 1):S121

BackgroundTo investigate the effects of electrical stimulation therapy on woundhealing and angiogenesis in diabetic rats and its potential mechanismMaterials and MethodsDiabetic model rats were induced by a single tail vein injection ofSTZ (50 mg/kg) and a full-thickness skin defect of 1 cm2 was formedon the back. The model rats were randomly divided into two groups:the model group and the electrical stimulation treatment group, andthe normal rats were used to cause the back wounds as a blank con-trol group. The treatment group was treated with electrical stimula-tion (Bidirectional asymmetric pulse current, frequency: 100Hz, risetime: 3s, fall time: 3s, pulse width: 150us, duration: 3s, rest time:9s)for 21 days. The control group and the model group were fed nor-mally. The wound healing was evaluated on the 3rd, 7th, 14th and21st day after treatment. The pathological morphology of rat woundswas observed by HE staining. The contents of serum eNOS, Ang-1and VEGF were detected by enzyme-linked immunosorbent assay.The expression levels of Tie-2 and VEGFR2 protein were detected byimmunohistochemistry and Western-blottingResultsAfter electrical stimulation, the wound healing rate of diabetic ratswas close to 90% on the 14th day, while the model group was lessthan 60%. The serum eNOS, Ang-1 and VEGF levels were significantlyhigher than the model group (P<0.05 or P<0.01). Meanwhile, thetreatment group had more neovascularization, larger vascular lumen,high expression of Tie-2 and VEGFR2 around the blood vessels, andthe expression of Tie-2 and VEGFR2 protein in the wound tissue wasalso significantly increased, which was statistically different frommodel group (P<0.05 or P<0.01) .ConclusionsElectrostimulation therapy can significantly promote wound healingand neovascularization in diabetic rats, its mechanism is related tothe increase of eNOS, VEGF, Ang-1 content and up-regulation ofVEGFR2 and Tie-2 levels


S122Application of Ulcer Dressing in Superficial Second Degree BurnWoundsHua-Xi Niu, Li-Ying Wang, GuanLong YangFirst People’s hospital of Zhengzhou, Zhengzhou, Henan, ChinaCorrespondence: Hua-Xi NiuBurns & Trauma 2019, 7(Suppl 1):S122

BackgroundObserve the clinical efficacy of Ulcer Dressing in superficial seconddegree burnsMaterials and MethodsFrom January 2016 to December 2018, 102 patients were treated inour department, including 76 males and 26 females; aged 3-56 years,with an average of 21.3 years. The burn area was between 0.5% and13%, with an average of 4.6%. The hospitalized patients were evalu-ated to determine that the burn was a shallow second degreewound. After cleaning and disinfection, the skin was cut off and theUlcer Dressing was protected. The yarn is fixed and replaced accord-ing to the exudation condition. It is usually replaced within 3 days to5 daysResultsThe wounds in 102 cases were all within 7-10 days. The number ofdressings was 2-3 times, and the pain was relieved obviouslyConclusionsUlcer Dressings can be used as skin protection burn wounds, shortenwound healing time, reduce the number of dressings, reduce pain,and have satisfactory treatment results.


S123Case Report : Treatment of 3rd degree burn of the hand usingKaloderm® (cultured allogenic keratinocyte)Jangyoun Choi, Jin Tae Cho, Sung-No JungDepartment of Plastic and Reconstructive Surgery, Uijeongbu St. Mary’sHospital, College of Medicine, The Catholic University of Korea,Uijeongbu, Republic of KoreaCorrespondence: Sung-No JungBurns & Trauma 2019, 7(Suppl 1):S123

BackgroundAllogenic keratinocyte application is known as an effective methodfor treating 1st to 2nd degree burns. However, there is only little lit-erature reporting the application of allogenic keratinocyte on 3rd de-gree burns. For some 3rd degree burns where definitive surgicalreconstruction is precluded due to medical comorbidity of the pa-tient, we investigated the possibility of allogenic keratinocyte as atreatment modality to deep burns that might allow us to avoid high-risk anesthesia and surgery.Materials and MethodsA 85 year old female patient visited our burn center due to a contactburn on her left hand. A 10 x 15 cm sized deep 2nd to 3rd degreeburn wound was noted on the dorsoradial aspect of the left-handdorsum. Considering the surface area and wound depth, surgery wasindicated but her medical condition and age exhibited a very highrisk for a lengthy operation. Therefore, a chemical escharectomy, ser-ial bedside debridement, and allogenic keratinocyte (Kaloderm®,Tegoscience, Seoul, Korea) was applied.


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ResultsChemical escharolysis was undertaken with silver sulfadiazine. Mech-anical eschar debridement was performed serially as well. Aftercomplete wound bed preparation, Kaloderm® was applied to thewound bed. Kaloderm was changed every three days, consideringthe engraftment period of keratinocytes to the wound bed. Thewound was completely epithelialized after four rounds of Kaloderm®application.ConclusionsIn most cases, treatment of burn wound using allogenic keratino-cyte is limited to deep 2nd degree burns. Surgical intervention iswidely accepted as the mainstay of treatment for 3rd degreeburns. However, for circumstances where sharp debridement anddefinitive reconstruction is impossible due to patient’s medicalcondition, serial debridement and escharolysis followed by allo-genic keratinocyte therapy can be a safe and reliable option for3rd degree burns.Informed consent to publish has been obtained from this patient.


S124Prevention Oriented Burns Epidemiology: The First Hospital BasedStudy from BangladeshTanveer Ahmed1, Md. Abul Kalam2, Md., Rayhana Awwal3, HossainImam4

1Assistant Professor of Plastic Surgery, Dhaka Medical College andHospital, Dhaka, Bangladesh; 2Professor of Plastic Surgery, Dhaka MedicalCollege and Hospital, Dhaka, Bangladesh; 3Professor and Head of PlasticSurgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh;4Assistant Professor of Plastic Surgery, Dhaka Medical College andHospital, Dhaka, BangladeshCorrespondence: Tanveer AhmedBurns & Trauma 2019, 7(Suppl 1):S124

BackgroundBangladesh is a developing country with a 180 million people wherethe burn incidence is increasing very sharp due to rapid urbanization.The aim of the study was to determine the epidemiology of burnsleading to hospitalization in a resource-poor country like Bangladeshwith a focus on the pre-event phase of injury.Materials and MethodsIn 2017, total 6913 victims were hospitalized from 52100 who ap-peared in the emergency and OPD of the only Burn & Plastic SurgeryInstitute and all of them were enrolled in a descriptive study. A sim-ple data sheet was created to supply with every admitted patient fo-cusing on to obtain burn injury related information necessary forprevention purposes.ResultsMales constituted 56% of victims, mean age was 22 years. The mostsevere burns occurred between the ages of 18 and 32 years mainlyflame related (47%). However, scalds representing 45% of burnscases. Irrespective of types, women suffered more severe burns &mortality than men and the severe cases in children were under theage of 5 years. More than 80% of burns occurred at home where thekitchen was the main place of injury in 47% of cases, followed by liv-ing rooms in 28%. The main container was the rice cooking pot in37%, followed by water kettles in 32% cases. The difference betweena flame and non-flame burns in the distribution of burns in extrem-ities was not statistically significant, but head and neck burns were3.7 times more likely to be caused by flame.ConclusionsSo, the devastation of burn can be reduced by adopting a good pre-vention program.


S125A first regional study on the efficacy of a protocol : radiotherapytreatment after excision of keloid scarsTeh Hui Yin1, Janna Joethy2, Chong Si Jack31Ministry of Health Holdings, Singapore; 2Department of Plastic,Reconstructive and Aesthetics Surgery, Singapore General Hospital,Singapore; 3Asia Pacific Burn Association, Bali, IndonesiaCorrespondence: Teh Hui YinBurns & Trauma 2019, 7(Suppl 1):S125

BackgroundThe combination of surgery and post-operative irradiation is the besttreatment for keloid scars. Ogawa describes that the post-operativeradiation response rate in terms of significantly reducing the rate ofkeloid recurrence ranges between 67-98%.Materials and MethodsWe present the first regional ( south east Asia) cohort study on interms of improvement in scar appearance following a protocol in anational centre where radiation therapy treatment is deliveredafter keloidectomyResults11 consecutive patients in a single centre had excision of keloidscars followed by radiotherapy as part of a new protocol in ourinstitution at various body sites were recruited in this IRB ap-proved study. 7 out of 11 patients received radiation therapy ofvarying doses and fractions post-operatively while the rest optedout after surgery.The post-operative irradiated scars were given scores based onthe Vancouver Scar Scale by a single investigator at least 1 yearafter completion of radiation therapy. The Vancouver Scar Scalescore ranges from 0 to 13 of which a score of 0 represents nor-mal skin. Patients whom received post-operative radiotherapy hada score of </= 4 with a mean score of 2 as compared to patientswho only had surgical excision with a score of >/= 5 with amean score of 8.The highest score of 12 belonged to a patient who had only surgeryand the lowest score of 0 was rated in a patient who received post-operative radiation therapy. All patients who received radiotherapypost-keloidectomy have lower VSS score as compared to those whoonly have had surgical excision.ConclusionThis first regional study concludes that all patients with keloidscars who received post-operative radiotherapy treatment resulted in abetter scar appearance which more closely resembles normal skin ascompared to surgical excision only.


S126Classification of Electrical Burns Injuries of the Upper Limb: TheDhaka ExperienceTanveer Ahmed1, Barbara Jemec2, Rob Staruch3, Mahbub Hasan11Plastic Surgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh;2The Royal Free Hospital (London), UK; 3Defense Deanery, Burns andPlastics, DPhil Candidate University of OxfordCorrespondence: Tanveer AhmedBurns & Trauma 2019, 7(Suppl 1):S126

BackgroundElectrical burns of the upper limb are devastating injuries. To datethere is no specific classifications of electrical burns in the upperlimb.


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Due to the high number of electrical burn injuries treated in our in-stitute we offer a classification and treatment algorithm for the im-mediate reanimation with tendon transfers after soft tissue cover inelectrical burns of the upper limb.Materials and MethodsPatient data was collected over one year and analysed with regardsto sex distribution, high and low voltage burns, the areas of theupper limb affected, nerves, tendons and bones involved, amputa-tion levels and soft tissue reconstructions including tendon transfers.ResultsOver 6000 burns are admitted to our institute each year. 27% aredue to electrical injuries and 29% include the upper limb. Electricalburns cause 42% of the deaths in our burns patient population. Thevast majority of electrical burns are due to High Voltage electricity inmales. 60% are admitted in the first 2 days post injury, but admis-sions continue up to 4 weeks post burn.The most common place of injury was the workplace, followed bythe home, road side, educational institutes and the playground. Theaverage Total Body Surface Area involved was 15% (range 1-50%):mostly 2nd and 4th degrees. Nearly half necessitate amputationswith nearly a third below elbow amputations. 20% include nerve in-juries and include loss of tendons. Surgical debridement was usuallyperformed piecemeal and defects covered successfully with localflap. Tendons were buddied, transferred depending on availabilityand need.ConclusionBased on our data we offer an upper limb electrical burns classifica-tion, which facilitates surgical treatment and reconstruction.

PosterAbstract Topic: Surmounting Challenges inRehabilitation

P1Effectiveness of Rehabilitation Aide Memoire in NursingPopulationPei Fen Seah1 ,Florence Chiang2, Wei Xiang Er1, Masroor ur Rahman3, SiJack Chong41Department of Physiotherapy, Singapore General Hospital, Singapore;2Department of Occupational Therapy, Singapore General Hospital,Singapore; 3Burn & Plastic Surgery Unit, Dhaka Medical College Hospital& Sheikh Hasina Burn Institute, Bangladesh; 4The Association for BurnInjuries, SingaporeCorrespondence: Pei Fen SeahBurns & Trauma 2019, 7(Suppl 1):P1

BackgroundDue to insufficient rehabilitation manpower in Bangladesh, the nurs-ing community in Dhaka Medical College Hospital (DMCH) Burn Unitand Sheikh Hasina National Institute of Burn and Plastic Surgery(SHNIBPS) tend to provide only limited basic rehabilitation for theirpatients. Within this context of an environment lacking professionalrehabilitation therapists, an aide memoire would be helpful to guidenurses to provide appropriate and effective rehabilitation for post-burn patients.Materials and MethodsA rehabilitation aide memoire was developed by the SingHealth re-habilitation team and implemented as a standard text for rehabilita-tion in the DMCH Burn Unit and SHNIBPS in Bangladesh in 2019. Toreview the usefulness of the aide memoire in improving the know-ledge and confidence level of nurses involved in the rehabilitativecare of burns patients, nurses who attended the SingHealth TemasekFoundation International Capacity Enhancement for Burn SpecialistsTraining Programme in April 2019 were surveyed before and afterreading the rehabilitation aide memoire.ResultsA total of 45 nurses were surveyed. 20% of the nurses had ≤1 year ofexperience in managing burns patients, 64% had >1 to 3 years of ex-perience, 5% had >3 to 5 years of experience and 11% had >5 yearsof experience. There were statistically significant (p<0.0001)

improvements in both knowledge and confidence scores after train-ing, with mean improvements of 1.3 and 1.4 points respectively(range 0-10).ConclusionsThe results highlighted that all participants who had read the re-habilitation aide memoire gained better theoretical knowledge ofand confidence in performing rehabilitative interventions for patientswith burn injuries. We recommend implementing such aide mem-oires in centres with no or insufficient professional rehabilitationtherapists.


P2Launching The First Burn Prevention and Awareness Campaign inBangladeshAndrew Cheah1, Tzuemn Ling Low1, Chong Xin Ying2, Tanveer Ahmed3,Chong Si Jack21Dept. of Plastic & Reconstructive Surgery, Singapore General Hospital,Singapore; 2The Association for Burn Injuries, Singapore; 3Burn & PlasticSurgery Unit\ Sheikh Hasina Burn Institute, BangladeshCorrespondence: Andrew CheahBurns & Trauma 2019, 7(Suppl 1):P2

Background: The burden of Burn injury in Bangladesh is significant,every year approximately 800000 people in Bangladesh sustain Burninjuries 1 including 173,000 children2. Since 2016, Sing-Health andthe Bangladesh authorities have been conducting an education pro-gram to train and educate specialists and nurses in management ofburn injuries. Throughout the program we have conducted studiesfrom these health-care professionals with the aim of launching thefirst burns nationwide prevention and awareness campaign.Materials & Methods: In an effort to raise awareness effectively, weconducted 2 studies from 2017- 2019 to identify risks for Burn injuryspecific to the country and their feedback on the material to be usedfor the campaign. The surveys were conducted in English on Burnshealth-care professionals.Results: 160 health-care professionals were surveyed, 50% were nurses,34% were doctors, and 16% were allied-health. 45% of the health-careprofessionals surveyed have had 1 to 2 years of experience managingBurns patients, 25% had 3 to 5 years of experience and 30% had morethan 5 years of experience. 90% of health-care professionals agreedthat there was no Burns awareness programme in Bangladesh. 5 dan-gers for Burn injury were identified, from highest risk to lowest risk: hotwater, oil lamps, overloaded power-sockets, exposed overhead elec-trical cables and kitchen fires.Conclusion: Burn awareness and prevention is key to reducing theincidence and severity of program. Having solicited the feedbackand necessary improvements, the team is confident in assisting theBangladesh authorities in launching a relevant and successful cam-paign in late 2019.


P3Perception and challenges to establishing the first skin bank inBangladeshAndrew Cheah1, Alvin Chua1, Chong Xin Ying2, Mahbub Hasan3, ChongSi Jack21Dept. of Plastic & Reconstructive Surgery, Singapore General Hospital,Singapore; 2The Association for Burn Injuries, Singapore; 3Burn & PlasticSurgery Unit, Dhaka Medical College Hospital & Sheikh Hasina BurnInstitute, BangladeshCorrespondence: Andrew CheahBurns & Trauma 2019, 7(Suppl 1):P3

Background: Skin banks are a vital element of a Burn units’ arma-mentarium. Clinical utility of allograft skin for wound coverage wasdescribed in 19811 and it has been shown to help in the manage-ment of severe burns by facilitating early excision and allografting2.In Bangladesh, burn injuries are significant with more than 800000


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injuries per year3 and burn mortality rates are on the rise4.Bangladesh has a population of over 160 million but has only onetertiary burn care centre. The set-up of a skin bank would be a usefultool, but issues related to legislation, methods, equipment, storageand distribution need to be addressed. We aim to identify these is-sues to streamline the successful establishment of the first skin bankin Bangladesh.Materials & Methods: Surveys were conducted in English, onhealth-care professionals and hospital managers. 5 key areas forthe set-up of a skin bank were identified: screening, harvestingor recovery of skin, processing of skin, storage and finally the dis-tribution of skin.Results: The surveys had 40 respondents. 80% of respondents wereDoctors. 95% of respondents felt that there was a role for a skin bankin Bangladesh. 80% of those surveyed cited lack of equipment as amain issue of skin banking in Bangladesh. 25% felt there were legalissues that needed to be addressed first. Religious or cultural issueswere identified as issues by 50% and 25% of respondents respect-ively. When asked about the 5 key areas individually, lack of equip-ment was again cited as a main issue when it came to the screening,processing, storage and distribution of skin. Religious or cultural is-sues were cited as issues in the harvesting or recovery of skin.Conclusion: The successful establishment of a skin bank raises sev-eral pertinent issues related to legislation, religion, culture and theneed for specialized training and equipment.


P4Knowledge on Burn Prevention and First Aid for burn injuriesamongst Airport FirefightersChong Xin Ying2, Andrew Cheah1, Kok Yee Onn1, Janna Joethy1, ChongSi Jack21Department of Plastic & Reconstructive Surgery, Singapore GeneralHospital, Singapore; 2The Association for Burn Injuries, SingaporeCorrespondence: Andrew CheahBurns & Trauma 2019, 7(Suppl 1):P4

BackgroundThe Changi Airport firefighters are a group of skilled professionals ,whose core responsibilities lies with swift and responsive action tomitigate fires in the airport, extricate and provide first aid for victimsin large scale incidents. The authors conducted professional trainingin burns injuries management for this 250 strong gorup. They con-ducted a cohort study to understand the firefighters’ knowledge ofburns prevention and exmained if a simple acronym BURNS can helpthe firefighters remember the key steps for burn first aidMethodologyA total of 250 firefighters took part in this study. This voluntary studywas conducted electronically via an online survery system and theresults were analysed.ResultsThere was an improvement in burns prevention awareness followingexposure to the simple burns prevention awareness poster. The sim-ple acronym of BURNS (Back Away, Uncover, Rinse under runningwater, eNclose the wound with a clean dressing and Seek medicalhelp) helped (statistically significantly) the firefighters remember thecrucial 5 steps in burn first aidConclusionAn electronic online survery system is a simple , environmentally-friendly system which facilitated the conduct of the study. A simpleburn prevention awareness programme refreshed the firefighters’memory of the common causes of burns injuries. A uncomplicatedacronym (BURNS) helped them significantly to remember the crucialsteps for first aid. This can be part of all uniformed groups trainingprogrammes.


P5Burn Aid: Improving Burn first aid knowledge and practice inBangladeshAndrew Cheah1, Luther Chung2, Nurunnahar Lata3, Chong Xin Ying4,Chong Si Jack41Department of Plastic & Reconstructive Surgery, Singapore GeneralHospital, Singapore; 2School of Medicine, Monash University, Australia;3Burn & Plastic Surgery Unit, Dhaka Medical College Hospital & SheikhHasina Burn Institute, Bangladesh; 4The Association for Burn Injuries,SingaporeCorrespondence: Andrew CheahBurns & Trauma 2019, 7(Suppl 1):P5

BackgroundBurns first aid is a crucial step in the management of Burn injuries. It limitsthermal or chemical damage, reduces subsequent inflammation and delaysburn progression or conversion1. The burden of Burn injury in Bangladeshis significant, with approximately 800000 burn injuries per year2. Successfultreatment starts with effective first aid. We aim to assess healthcare profes-sionals’ knowledge of first aid and improve practice in Bangladesh byimplementing simple mnemonic posters to help guide initial management.MethodsIn conjunction with our regional Burn prevention and managementtraining program, we conducted surveys in English, on burns health-care professionals. The survey was performed pre and post imple-mentation of a Burns First-Aid Mnemonic poster.ResultsA total of 125 healthcare professionals were surveyed over a 2-year timeframe. 40% of respondents were Doctors, 48% were Nurses and 12%were Allied-Health. Majority had 1 to 2 years of experience managingburns patients. 92% were not aware of any first aid guidelines, 8%quoted the rudimentary “stop, drop and roll” as a first aid guideline. Com-mon problems with Burns first aid that were highlighted included delayin seeking treatment, poor accessibility to healthcare and enclosingwounds with traditional medicines. Pre-implementation of our mnemonicposters, 60% of respondents were able successfully identify first aid inthe correct order. Post-implementation, 97% of respondents were able tocorrectly identify Burns first aid in the correct order. 96% of respondentsfelt the poster was useful in guiding first aid management.ConclusionBurns first aid is a crucial step to the management of Burn injuries. Theinitial step to decreasing the morbidity and burden of burn injuries isto increase awareness of appropriate first aid. Posters and simple edu-cation steps have been shown to be helpful.


P6A descriptive, cross-sectional study investigating the knowledgeand perception regarding infection prevention and control amongdoctors and nurses in Dhaka National Institute of Burns and PlasticSurgery, BangladeshDarshini Devi Rajasegeran1, Lee Lay Eng1, Maitra Jhuma2, Bristi MitraKundu2, Tanveer Ahmed Himon21Singapore General Hospital, Singapore; 2Dhaka National Institute ofBurns and Plastic Surgery, BangladeshCorrespondence: Darshini Devi RajasegeranBurns & Trauma 2019, 7(Suppl 1):P6

BackgroundInfection is the foremost cause of morbidity and mortality inDhaka National Institute of Burns and Plastic Surgery, Bangladesh.With the construction of a new institute, a key initiative is todevelop their first infection control unit. As infection control


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requires conscious effort and practice, understanding the know-ledge and perception of healthcare professionals is crucialMaterials and MethodsThis is a descriptive, cross-sectional study investigating the knowledgeand perception regarding infection prevention and control amongdoctors and nurses. A self-administered questionnaire was drawn fromresearch and WHO Perception Survey for Healthcare Workers. It con-sisted of closed, Likert scale and open-ended questions on knowledge,perception, obstacles and possible solutions.ResultsWhile all participants (n=33) agreed that infection control reducesmortality, 28.6% of doctors (n=7) reported that hand hygiene(HH) was not the best measure for infection control. 73.1% ofnurses (n=26) and only 28.6% doctors reported that HH requireda lot of effort. However, 53.8% nurses reported being able to per-form HH during recommended situations, while doctors (100%)

reported not being able to do so. Nonetheless, nurses (73.1%)and doctors (57.1%) reported that fulfilling tasks was more im-portant than HH when busy. Nurses (100%) reported that it wasimportant for management and fellow healthcare professionalsthat they perform optimal HH. Two- fifths of doctors reportedthat it was not important. Out of products, product not in con-venient locations were top responses for not practicing HH. Sup-portive management, education, clear and simple instructions,feedback or audits and hand rubs made available at all point ofcare were reported as effective measures.ConclusionsThere is a prevailing notion that fulfilling duties takes precedenceover infection control. There are also differing viewpoints on howmanagement and healthcare professionals perceive infection control.Personal ownership, management’s stance, education and adequateamenities are suggested solutions for current obstacles
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Abstracts from the 12th Asia Pacific Burn Congress

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