Epidemiology of isolated foot burns in children presenting to a Queensland paediatric burns centre—a two-year study in warmer climate

Background: European studies of paediatric foot burns report scalds as the leading cause. Mechanisms of injury are different in warmer climates. We sought to characterize the mechanisms and outcomes of isolated foot burns in our population. Methods: Retrospective review of a prospectively collected database of all children aged 0–15 years presenting to a Queensland paediatric burns centre over a 26-month period. Non-parametric analyses such as the Mann-Whitney U and Pearson Chi-square were used. Results: There were 218 children with foot burns treated over a period of 2 years and 2 months of which 214 had complete records. There were significantly more boys than girls (n=134, 62.6% cf. n=80, 37.4%, p<0.0001). The leading mechanism of injury was a contact burn accounting for 63.1% (n=135) followed by scalds (23.8%, n=51). Friction, flame and chemical burns were a minority but were significantly deeper (p=0.03) and significantly more likely to require grafting (p=0.04) and scar management (p<0.0001) compared to contact and scald burns. Conclusions: In our population, contact burns are the most common mechanism of injury causing burns to the feet. The leading aetiology is campfire burns, which account for one-third of all burns to the feet. Prevention campaigns targeted at this population could significantly reduce the burden of morbidity from these burns. Friction, flame and chemical burns constitute a minority of patients but are deeper and more likely to require skin grafting and scar management.

Comparative effectiveness of Biobrane^(■),RECELL^(■)Autologous skin Cell suspension and Silver dressings in partial thickness paediatric burns:BRACS randomised trial protocol

Background:Mixed partial thickness burns are the most common depth of burn injury managed at a large Australian paediatric hospital specialty burns unit.Prolonged time until re-epithelialisation is associated with increased burn depth and scar formation.Whilst current wound management approaches have benefits such as anti-microbial cover,these are not without inherent limitations including multiple dressing changes.The Biobrane^(■)RECELL^(■)Autologous skin Cell suspension and Silver dressings(BRACS)trial aims to identify the most effective wound management approach for mixed partial thickness injuries in children.Methods:All children presenting with an acute burn injury to the study site will be screened for eligibility.This is a single-centre,three-arm,parallel group,randomised trial.Children younger than 16 years,with burns≥5%total body surface area involving any anatomical location,up to 48 h after the burn injury,and of a superficial partial to mid-dermal depth,will be included.A sample size of 84 participants will be randomised to standard silver dressing or a Regenerative Epithelial Suspension(RES^(TM))with Biobrane^(■)or Biobrane^(■)alone.The first dressing will be applied under general anaesthesia and subsequent dressings will be changed every 3 to 5 days until the wound is≥95%re-epithelialised,with re-epithelialisation time the primary outcome.Secondary outcomes of acute pain,acute itch,scar severity,health-related quality of life,treatment satisfaction,dressing application ease and healthcare resource use will be assessed at each dressing change and 3,6 and 12 months post-burn injury.Discussion:The findings of this study can potentially change the wound management approach for superficial partial to mid-dermal burns in children locally and worldwide.Trial registration:The Australian New Zealand Clinical Trials Registry(ACTRN12618000245291)approved prospective registration on 15 February 2018.Registration details can be viewed at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374272&isReview=true.

Systematic literature review of topical local anaesthesia or analgesia to donor site wounds

Background:Topical local analgesic and anaesthetic agents have been used both pre-and imme-diately post-harvest on split-thickness skin graft(STSG)donor site wounds(DSW).There is no systematic review of their effectiveness in providing post-harvest analgesia,or of the possible toxic effects of systemic absorption.This study is designed to address the question of which agent,if any,is favoured over the others and whether there are any safety data regarding their use.Methods:Systematic literature review of randomised controlled trials of topical agents applied to STSG DSWs,with a view to providing analgesia.Studies identified via search of Cochrane and EBSCO databases.No restrictions on language or publication year.Primary outcomes:pain at the time of(awake)STSG,and post-harvest pain(up to first dressing change).Secondary outcome was serum medication levels relative to published data on toxic doses.Cochrane risk of bias assessment tool utilised in assessment of included studies.At least 2 reviewers screened and reviewed included studies.A narrative review is presented.Results:There were 11 studies meeting inclusion criteria.Overall methodological quality and patient numbers were low.Topical eutectic mixture of lidocaine and prilocaine pre-harvest affords good local anaesthesia in awake STSG harvesting.Topical bupivacaine(5 studies)or lidocaine(1 study)gave significantly better post-harvest anaesthesia/analgesia than placebo.Topical morphine performs no better than placebo.Topical local anaesthetic agents at reported doses were all well below toxic serum levels.Conclusions:Topical local anaesthetics(lidocaine or bupivacaine)provide good analgesia,both during and after STSG harvest,at well below toxic serum levels,but there are no good data determining the best local anaesthetic agent to use.There is no evidence morphine performs better than placebo.

Prospective randomised controlled trial of Algisite^(TM) M, Cuticerin^(TM), and Sorbact■ as donor site dressings in paediatric split-thickness skin grafts

Background:This is a parallel three-arm prospective randomised controlled trial (RCT) comparing Algisite?M, Cuticerin?, and Sorbact? as donor site dressings in paediatric split-thickness skin grafts (STSG). All three were in current use within the Pegg Leditschke Children's Burn centre (PLCBC), the largest paediatric burns centre in Queensland, Australia. Our objective was to find the best performing dressing, following on from previous trials designed to rationalise dressings for the burn wound itself. Methods:All children for STSG, with thigh donor sites, were considered for enrolment in the trial. Primary outcome measures were days to re-epithelialisation, and pain. Secondary measures were cost, itch, and scarring at 3 and 6 months. Patients and parents were blinded to group assignment. Blinding of assessors was possible with the dressing in situ, with partial blinding following first dressing change. Blinded photographic assessments of re-epithelialisation were used. Scar assessment was blinded. Covariates for analysis were sex, age, and graft thickness (as measured from a central biopsy). Results:There were 101 patients randomised to the Algisite?M (33), Cuticerin?(32), and Sorbact? (36) arms between April 2015 and July 2016. All were analysed for time to re-epithelialisation. Pain scores were not available for all time points in all patients. There were no significant differences between the three arms regarding pain, or time to re-epithelialisation. There were no significant differences for the secondary outcomes of itch, scarring, or cost. Regression analyses demonstrated faster re-epithelialisation in younger patients and decreased donor site scarring at 3 and 6 months with thinner STSG. There were no adverse effects noted. Conclusions:There are no data supporting a preference for one trial dressing over the others, in donor site wounds (DSW) in children. Thinner skin grafts lead to less donor site scarring in children. Younger patients have faster donor site wound healing. Trial registration:Australia and New Zealand Clinical Trials Register (ACTRN12614000380695). Royal Children's Hospital Human Research Ethics Committee (HREC/14/QRCH/36). University of Queensland Medical Research Ethics Committee (#2014000447).