Children's Hospital Burns Research Institute
An Evaluation of Methods of First-aid for Burns in a Porcine Model
Dr Camille Wu, Dr Hugh Martin, Dr Erik La Hei, Dr John Harvey, Dr Craig Godfrey
A burn accident in a child has lifelong consequences. Appropriate early treatment may avoid multiple operations and/or unsightly scarring. First aid (in the form of immediate cooling) has been shown to be effective in limiting the extent of thermal injury. It stops the progression towards a deep burn, decreasing the probability of need for skin grafting. The wounds heal more quickly, with fewer interventions and a superior final cosmetic result - a better outcome for the patient and the health care system.
Running tap water is the commonest form of first aid given by parents, and is recommended by the Australia and New Zealand Burn Association and the NSW Department of Health. There is no study that compares the efficacy of running tap water with other common first aid methods readily available to the general public, which may be used during the transport of the child. The project compares three easily available and practical methods of cold water application, to determine their suitability for general use in the community, by ambulance officers and in emergency departments. We will be comparing cold running tap water with more portable forms of cooling (mist spray bottles and wet compresses) that may be used to continue the cooling process during transport of the patient.
The aim of this project is to compare practical methods of applying cold water to a standardised burn wound in order to identify the best method of carrying out first aid to reduce the depth of the burn. We propose the use of a porcine model for this because of the similarity of porcine skin to human skin.
We hope to determine the comparative efficacy of the aforementioned methods in order to provide evidence-based advice about optimal first aid. Our aim is to develop a protocol for burn wound cooling from the scene of the injury, through the transportation phase, to a health care facility, and for the rest of the acute phase.
Are Fibrocytes Present in Burn Wounds?
A/Prof Andrew Holland, Dr Heather Medbury and Dr Ann Guiffre
The fibrocyte is a monocyte that accounts for <1% of the circulating leucocyte population. They rapidly migrate to injury sites where they have a role in wound healing. Fibrocytes have unique set of cell surface markers that include CD13 and CD34. Fibrocytes adopt a spindle-shape appearance in culture. The production of Type I collagen by fibrocytes appears to be regulated by Transforming Growth Factor (TGF-ß1) that is increased in the plasma of burn patients. Fibrocytes have not yet been demonstrated in burn wounds.
At time of surgery, children with acute burns have blood collected for measurement of serum TGF-ß1. One or more biopsies are taken of the burn wound prior to debridement, together with a piece of split skin graft as the control. Immunohistochemistry is performed for TGF-ß1, CD13 and CD34.
Between February and August 2004 17 patients were enrolled. Twenty burn wounds were sampled and 15 controls obtained between five and 21 days post burn. Provisional analysis has revealed TGF-ß1 and CD34 in burn wounds. CD34 was also present in controls. Further analysis may reveal if these cells represent fibrocytes and what impact they may have on burn wound healing.
Day 6 post-burn biopsy of burn wound. Note large numbers of dark brown staining CD34+ cells concentrated around sweat glands. Could these cells be the precursors of hypertrophic scarring following burns?
This document was published on Friday, 13 May, 2005