The Tokyo Metropolitan Burn unit association collects and analyzes data from participating facilities, and conducts activities to raise awareness about burns. We analyzed the data of 9,698 cases for 30 years from 1991 to 2020 and examined the tendency of burn cases.
 The total number of cases did not change. The main causes of burn were flame burn, scald burn, and Inhalation injury in that order. The average burn area and mortality rate decreased. The prognostic burn index（PBI）of the deceased cases remained unchanged（a mortality rate of 60% or higher when the PBI exceeded 100）.
 As for the number of patients by age, at a young age（0-14 years old）, scald burn caused by hot water from a pot increased, and flame burns caused by fire decreased. In an older group（15-64 years）, flame burn caused by fire and suicide decreased. In an old age group（65 years and older）, flame burn caused by fire and the stove, hot food, and scald burn caused by hot water in a pot increased. In the future, as the elderly population increases, it will be important to promote induction heating stoves, recommend flame-retardant clothing, and raise awareness of burns caused by hot cooking utensils such as pots.

View full abstract

 We present a case where a low-temperature burn ulcer of a diabetic foot was successfully treated by performing lumbar sympathetic nerve block (LSNB) . LSNB can improve blood flow in the lower limbs and relieve pain related to the sympathetic afferent tract. In the present case, it was used to relieve diabetic neuropathy, and good wound contraction was observed after the operation. It is considered that the improvement of blood flow in the lower limbs may have indirectly contributed to the improvement of diabetic neuropathy; thus, achieving adequate treatment. LSNB may be a new treatment option for diabetic foot burn ulcers, which tend to be refractory.

View full abstract

 Child abuse is a major social problem. The number of child abuse consultations at child guidance centers is increasing markedly. We examined five infants with burns, who were suspected to have been abused, at their initial presentation to our hospital. The burn area was 3-23.5% of the total body surface area. The burns were caused by hot liquids. The explanations provided by their parents for the burns were characteristically not credible. In clinical practice, not all cases are suggestive of apparent child abuse, and many cases fall into a grey zone where it is difficult to recognize the abuse with certainty. Moreover, no specific clinical indices exist and abuse recognition is affected by evaluators’ perceptions. Furthermore, reporting of abuse may interfere with the parent-physician relationship; thus, physicians often hesitate to report child abuse. Cases of infants with burns require not only evaluation of the wounds but also other observations such as evaluating the credibility of the families’ explanations, inconsistency with local findings, and responses of the families. Physicians should intensify efforts to form an abuse response team that can promptly report cases of suspected abuse, sufficiently treat local wounds, and properly manage cases where child abuse is suspected.

View full abstract

 A 67-year-old woman was admitted to our institution for surgical treatment. Five days earlier, she was found collapsed in her room due to hot air exposure while using a hair dryer. Two weeks after the injury, she underwent debridement and right cervical reconstruction by superficial cervical artery flap and skin graft. The patient was discharged from the hospital on the 14^th postoperative day.
 To date, few burn cases have been reported that were caused by a hair dryer. In the present case,the patient was exposed to hot air for a long period due to impaired consciousness resulting in a deep burn injury. Although hair dryer is considered to be a safe tool for daily use, improper use can cause serious burn injuries that may require reconstruction and should be considered by plastic surgeons.

View full abstract

 The patient was a 66-year-old man. He had deep dermal burns on his face, back, palms, and soles from a fire at home (burn area: 17%) . His nasal hair was burnt, and soot was observed in the oral cavity and larynx. There was no laryngeal edema. The patient was admitted to the intensive care unit for observation without tracheal intubation. On the second sick day, the patient became insufficiently ventilated due to a large amount of mucus in the airway, and tracheal intubation was performed. Bronchoscopy showed a large amount of soot and mild pallor of the tracheal mucosa. Heparin and N-acetyl cysteine inhalation were started to cope with the large amount of tracheal secretions and mucus plugs. Respiratory physiotherapy and expectorant treatment were continued. The patient was extubated on the 7th sick day and discharged from the intensive care unit on the 13th sick day.
 Inhalation of heparin and N-acetylcysteine is weakly recommended in the third edition of the Burn Care Guidelines. Multicenter studies and randomized controlled trials are needed.
 We report a case of inhalation injury treated with heparin and N-acetylcysteine nebulization with good outcome for ventilatory failure caused by obstruction of airway secretions and mucus plugs.

View full abstract

 This study aimed to elucidate the current state of family nursing care for burn patients based on domestic Japanese literature. We searched online versions of major medical journals for original articles using Japanese keywords for “burn injury”, “family”, and “nursing”, with no restriction for publication year, and found 28 articles eligible for analysis. These articles were classified by publication year, journal, research method, and patient developmental stage. We then performed qualitative descriptive analysis on statements related to family nursing care for burn patients. Included articles were published between 1990 and 2013, and the most common journal was the Japanese Journal of Burn Injuries. We extracted 189 context units from statements related to family nursing care for burn patients, and analysis generated 20 subcategories and six categories, including “emotional responses from family and adjusting family functioning beginning immediately after burn injury”, and “fostering and supporting the development of attachment between family and hospitalized children”. We found continuing support appropriate to the extended treatment period from burn injury to hospital discharge being provided as family nursing care for burn patients. Moreover, support for families accompanying child patients and support requiring special consideration for burn wounds in terminal patients had distinctive characteristics.

View full abstract