MILAN (ITALPRESS) – Burns are one of the most serious and complex forms of trauma: not only involve a skin injury, but they can compromise the balance of the whole organism. They occur when tissues are exposed to heat sources, chemicals, electricity or radiation, causing injuries of different depth and extension: the skin is the first defense of the body and performs essential functions of protection, thermoregulation and barrier against infections. When affected by a burn these functions are altered or lost, opening the way to local and general complications: in the most severe forms the burn becomes a real systemic disease, with a generalized inflammatory response, possible respiratory problems and a great infectious risk. According to the data of the health records, every year in Italy there are about 4 thousand shelters for burns: are instead about 100 thousand people who report less worrying burns, but that however require medical treatments.
“When the cutaneous cloak suffers a lesion other organs which do not seem affected suffer a serious injury: This is explained by the fact that there are a series of problems related to the permeability of the vessels”, said Franz Wilhelm Baruffaldi Preis, director of the Center of burns of the hospital Niguarda of Milan, interviewed by Marco Klinger for Top Medicine, TV format of the news agency Italpress.
The first organs to suffer, explains Baruffaldi Preis, “are the lungs, because the permeability of the pulmonary circle is altered and they fill with water; then there is the subcute, where also this space is filled by different liquids; then we pass to the kidneys, which are affected by the injury; you also get to the intestine, for which there is greater permeability to the microorganisms that are part of it, and from there begins to propagate the infection. There is then a syndrome that if not treated is even lethal: is hepatorenal syndrome, which occurs when from the kidney the pathology passes to the liver and all metabolisms are affected. When there is a burn the problems are not only related to heat: we see it for example in the boys involved in Crans-Montana, who also suffered a very important inhalation of poisons that destroyed part of the lung; young people will probably have the opportunity to regenerate part of the lung, but the destroyed ones will no longer be reached by vascularization and oxygen. The inflammatory response is very important for the patient’s condition: the first thing we see is how permeability changes at the alveolar level, it takes 24-48 hours to recover; inflammation can be protective of the organism, but long-term use of the burnt patient becomes immunodepressant and this leads to risk from reactivity to the microbiological stimuli to which it is encountered”.
An important role is played by the Bank of Niguarda Fabrics: it, tells the director of the Center burns, “disrupts the fact that there are donors, of course unfortunately deceased, who also left their skin: this, when there is a donation, is taken as the last organ and subjected to a cold cycle that allows to preserve it in the banks: ours is the only bank of this type in northern Italy, the skin is then made available in the operating room when the patient has to be ‘reconstructed’. If there is no tissue bank to preserve it there are dermal substitutes that, for a couple of weeks, allow us to cover and repair burnt patients, waiting for them to be reoperable with skin: at this moment there are several laboratories that have resumed an old research on the cultures of keratin”.
At fifteen days from a great burn, adds Baruffaldi Preis, “it happens that the bank’s triggers are rejected, so you have to repair them: to do this we have dermal substitutes, which have the possibility to create a neo-derm on which then grow the skin taken from the patient. There are systems that allow to expand the skin taken even by magnifying it on the net; then there are techniques such as the Mic, which consists in making a network and putting small confetti of the skin in the patient in the middle of this network, which then expands. Sometimes burn scars are very rigid: when they are subjected to hypofills, not only for a volumetric problem but for the ability to regenerate that has adipose tissue, we record important improvements.”.
The director of the Burning Center then dwells on the paradigm shift in addressing the problem: “Once the necrotic tissue was removed immediately, doing very demanding surgery and with large bleeding of the patient: it was a surprise to find a substance based on bromelin, called Nexobrid, which if placed on the skin of the burnt patient manages to differentiate the necrotic tissues from the vital ones and in the four hours in which it is applied respects healthy tissues; This allows us to avoid a major trauma and have a linear reconstruction. Today all medications are done in sedation, so the patient no longer suffers: we also have the cult of keeping the patients on flows beds so as to avoid decubits, loss of liquids or medications that remain humid for a long time.”.
Baruffaldi Preis concludes with a reflection on the events of Crans-Montana and the effects they had on medical staff: “I have seen in my colleagues a great solidarity: It is very important to have a center where there are not only plastic surgeons but also a physiotherapy, psychology and psychiatry service that takes into consideration not only patients but also their relatives and health care, which are exposed to the risk of going into burnout. For healing from skin injury it takes a couple of months, while for rehabilitation it takes years: psychological healing is a question, because it does not always happen”.
– Photos from Top Medicine –
(ITALPRESS).
