Purpose Burn debridement surgery relies on surgeon experience to remove non-viable tissue. Both excessive and inadequate debridement can have significant consequences, however there are a paucity of tools available to guide intra-operative decision making. Rapid evaporative ionization mass spectrometry (REIMS) links a diathermy electrode to real-time mass spectrometry, providing a continuous molecular profile of tissue being cut. This study investigates if REIMS has the potential to guide burns debridement. Method A single-center, ex-vivo study was performed. Skin samples were obtained from patients undergoing elective and burn debridement surgery. Both normal and burnt tissue samples were analysed using a standardised methodology. Data was visualised with principal component analysis (PCA), and orthogonal projections to latent structures-discriminant analysis (OPLS-DA) was used to interpret variation between groups. Results 11 patients were included, yielding 44 normal tissue data points and 36 burnt tissue data points. Two separate models were generated, one for epidermal and another for dermal depth cuts. Both epidermal and dermal models were significant, with epidermal Q2(cum) = 0.152 and dermal Q2(cum) = 0.147, suggesting promising differentiation between burn and normal tissue. 255 of 900 metabolites were statistically significant at differentiating burnt and non-burnt tissue. For lower m/z features, non-burnt tissue had higher relative abundance; whilst at higher m/z features, burnt tissue had higher relative abundance. In burnt tissue, below 700m/z relative metabolite abundance tends to decrease as burn depth increases. Above 700m/z, metabolite abundance tends to increase as burn depth increases. Conclusion This study demonstrated REIMS has promising ability to differentiate burnt and non-burnt tissue, and identified a number of metabolite trends which contribute to this. It also provides preliminary evidence to support REIMS as a tool to differentiate burn depth.

Purpose: The lethal triad of trauma (acidemia, coagulopathy and hypothermia) is associated with substantial morbidity and mortality. Patients with severe burn injuries are one group of patients at risk of developing this triad. The aim of this study was to evaluate the prevalence of the lethal triad and factors associated with the lethal triad in severe burn patients on arrival to an adult tertiary burns service hospital. Methodology: A 5-year retrospective cohort study was conducted of adult patients (>18 years of age) with severe burns (>20% total body surface area, TBSA) admitted to a burns service hospital. The Burns Registry of Australia and New Zealand (BRANZ) was used in combination with electronic medical records to extract relevant data. Hypothermia was defined as a body temperature ≤35.5°C, coagulopathy was defined as an international normalised ratio (INR)>1.2 and acidemia was defined as pH≤7.25. Results: From 158 patients identified, 142 patients met inclusion criteria. Among 106 patients with available data, the lethal triad was present on arrival to hospital in 6 patients (5.7%; 95%CI: 2.1-11.9%). Acidemia was present in 58 of 116 (50.0%; 95%CI: 40.6-59.4), coagulopathy in 18 of 125 (14.4%; 95%CI: 8.8-21.8) and hypothermia in 53 of 140 (37.9%; 95%CI: 29.8-46.4). Among patients with the lethal triad, all 6 patients (100%) died, compared to 27 patients (27.0%) without the lethal triad (odds ratio 21.0; 95%CI: 2.91->99.9). Individuals presenting with the lethal triad were more likely to have a larger %TBSA (p < 0.001) and presence of inhalation injury (p < 0.001). Conclusion: A small proportion of patients with severe burns presented to hospital with all three components of the lethal triad of trauma. Acidemia and hypothermia were more commonly observed when compared to coagulopathy. Recognition, prevention and early management may result in improved outcomes.

Introduction: NovoSorb MTX is a fully synthetic, biodegradable polyurethane matrix similar to BTM but without a sealing membrane.[2]There are currently no published case reports describing its use in acute burn reconstruction. Case: A 72 years old man presented with flame burns to both hands and lower limbs after his clothing caught fire. His medical history included nephrectomy for renal cell carcinoma, hypertension, gout, and type 2 diabetes mellitus. Examination revealed a full-thickness burn over the left popliteal fossa with surrounding partial-thickness injury, and dermal burns to the right thigh, knee, and both hands. Following initial wound care and referral to the burns service, he underwent tangential excision of the full-thickness burn on day five post-injury. MTX was applied and secured with staples, covered with antimicrobial dressings, and immobilised. Other burn wounds were debrided and dressed. At 18 days, the MTX demonstrated good integration, and STSG from the ipsilateral thigh was meshed and secured to the wound bed. Approximately 95% graft take was observed at five days. Discussion: Although BTM has established efficacy in burn reconstruction, data on MTX remain limited. The absence of a sealing membrane removes the need for delamination and may improve conformability and contact in anatomically challenging and mobile areas. Conclusion: At 10-week follow-up, all wounds were fully healed with no joint contracture or significant scarring. This case suggests MTX is a promising dermal substitute for burn reconstruction over mobile joints, with excellent graft take and functional outcomes. References: 1.Greenwood, J. E, et. al. (2018). Experience with a synthetic bilayer Biodegradable Temporising Matrix in significant burn injury. Burns Open : An International Open Access Journal for Burn Injuries, 2(1), 17–34. https://doi.org/10.1016/j.burnso.2017.08.001 2.PolyNovo, ‘ASX announcement’ NovoSorb MTX product portfolio update (Announcement, 19 March 2025)