Pietermaritzburg Burn Service, Pietermaritzburg Metropolitan Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa; Developing Research, Innovation, Localization and Leadership (DRILL), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Pietermaritzburg Burn Service, Pietermaritzburg Metropolitan Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa.
Injury. 2022 May;53(5):1716-1721. doi: 10.1016/j.injury.2021.12.035. Epub 2021 Dec 26.
Amputations are a devastating consequence of severe burns. Amputations in a resource-limited setting are challenging as rehabilitation services available to these patients are inconsistent and often fragmented. Epileptic patients are a particularly vulnerable group when it comes to burn-injuries and often sustain deeper burns. The aim of this study is to analyse amputations secondary to burn injuries. We seek to identify vulnerable groups as a means for advocacy efforts to reduce the devastation of an amputation secondary to a burn injury. This paper highlights the burden of these injuries on the healthcare system and emphasizes the need for additional trained therapists for the rehabilitation of these patients.
A retrospective database review was conducted. All burns admissions who underwent an amputation between 1 February 2016 and 31 January 2019 were considered.
A total of 1575 patients were admitted during the study period. Fifty-four percent of the admissions were paediatric patients. The amputation rate in the paediatric population was 1.5% (13/850) while in the adult population it was 4.8% (35/724) . Most paediatric amputations were as a result of electrical injuries. Flame burns were most likely to result in amputations in the adult group and convulsions were the leading circumstance leading to the injury. There was no significant difference in sepsis or length of stay between the groups. There were no mortalities in the paediatric group but there was an 11% mortality rate in the adult group.
The incidence of amputations in burns is low, however, it remains a devastating morbidity. Epileptics are a vulnerable group and these patients account for the most amputations among adult burns patients. Education interventions are needed regarding their diagnosis, administration of their medication and the importance of compliance. Advocacy efforts to ensure constant supply of anti-epileptic drugs at the clinics and other district level health facilities is also essential. Electrical injuries in children are not as common as hot water scalds, however, they are more likely to result in amputation. Communities need to be informed of the risk associated with illegal electrical connections and initiatives need to drive the safe provision of affordable electricity to these under-privileged, vulnerable communities.
截肢是严重烧伤的灾难性后果。在资源有限的环境中进行截肢是具有挑战性的，因为可获得这些患者的康复服务不一致且往往分散。癫痫患者在烧伤损伤方面是一个特别脆弱的群体，他们往往会受到更深的烧伤。本研究旨在分析因烧伤导致的截肢。我们旨在确定弱势群体，作为减少因烧伤导致截肢的破坏性的宣传努力的一种手段。本文强调了这些伤害对医疗保健系统的负担，并强调需要为这些患者的康复提供更多经过培训的治疗师。
对数据库进行回顾性分析。考虑了在 2016 年 2 月 1 日至 2019 年 1 月 31 日期间接受截肢的所有烧伤住院患者。
在研究期间，共有 1575 名患者入院。54%的入院患者为儿科患者。儿科人群的截肢率为 1.5%（13/850），而成年人群的截肢率为 4.8%（35/724）。大多数儿科截肢是由于电击伤。火焰烧伤最有可能导致成年组截肢，而抽搐是导致受伤的主要原因。两组之间在败血症或住院时间方面没有显著差异。儿科组没有死亡，但成年组有 11%的死亡率。
烧伤截肢的发生率较低，但仍是一种破坏性的发病率。癫痫患者是一个弱势群体，他们在成年烧伤患者中占截肢最多。需要针对他们的诊断、药物管理以及遵守药物治疗的重要性开展教育干预。还需要努力确保在诊所和其他地区一级卫生设施中持续供应抗癫痫药物，以确保这一弱势群体的利益。儿童电击伤不如热水烫伤常见，但更有可能导致截肢。需要让社区了解与非法用电连接相关的风险，并需要推动为这些贫困、弱势社区提供负担得起的安全电力供应。
