Burns in Zimbabwe. Epidemiology, Immunosuppression, Infection and Surgical Management

Sammanfattning: Background: The burden of burn injuries is in developing countries, the majority of deaths (98%) related to fire burns are in developing countries.These injuries are associated with poverty and are mainly related to accidents with fires in the home environment. Aims: The aims of the thesis were to record the risk factors, causes, magnitude and outcome of burn treatment as well as establish circumstances leading to attempted suicide; to study the impact of HIV infection on skin graft healing; to compare surface swab cultures and quantitative tissue biopsy cultures in predicting sepsis in burns patients; to evaluate terlipressin compared with a placebo in reducing the need for blood transfusion during early excision and grafting. Material and Methods: Four hundred and fifty one patients were included in a prospective epidemiological study. Forty-seven patients were prospectively included in a study to establish circumstances leading to attempted suicide. A wound healing model was used to determine the impact of HIV infection in 54 burn patients. Thirteen healthy volunteers and 15 HIV infected non burnt volunteers acted as controls. CD4+ and CD8+lymphocytes as well as pro- and anti-inflammatory cytokine levels were studied. A comparison of surface swab cultures and quantitative tissue biopsy cultures to predict sepsis in burns was studied in fifty patients. Fifty one patients were prospectively included in a double blind randomized study comparing terlipressin and a placebo in reducing the need for blood transfusion during early excision and skin grafting. Results and Conclusions: Flame and scalds were the major causes of burns. Minors younger than 6 years accounted for 51% of the patients. Seventy-one percent of the patients were managed non-surgically and 29% were managed surgically. Satisfactory healing was noted in 70% of the patients All patients with burns exceeding 65% TBSA died. Attempted suicide was noted mainly among young women married according to customary law with a mortality of 73%. HIV infection was noted in 28% of burns patients. Skin graft healing in HIV infected patients was 22% compared to 69% in non-HIV infected patients (p <0.05). Hospital stay was prolonged (p <0.05). Sepsis was better correlated to quantitative tissue biopsy cultures than surface swab cultures, but the time needed for processing limits its predictive and therapeutic value. Six out of 21 patients exposed to terlipressin were transfused with 11 units of blood. Eight out of the seventeen patients exposed to the placebo were transfused with 22 units of blood. Terlipressin reduced the need for blood transfusion by a factor of 2.5 during early excision and skin grafting (p<0.05).