Assessing the Effects of COVID-19 Infection in Hospitalized Burn Patients Undergoing Split-Thickness Skin Graft Surgery

Keshavarzi, A; Hashempour, M; Hassani, AH; Ghadimi, T; Zardosht, M; Dehbozorgi, M; Mortazavi, M

Assessing the Effects of COVID-19 Infection in Hospitalized Burn Patients Undergoing Split-Thickness Skin Graft Surgery

Authors

A Keshavarzi ¹

M Hashempour ²

AH Hassani ²

T Ghadimi ³

M Zardosht ⁴

M Dehbozorgi ⁵

M Mortazavi ⁶

¹ Assistant Professor of General Surgery, Shiraz University of Medical Sciences, Burn & Wound Healing Research Center, Amir-Al-Momenin Burn Hospital, Shiraz, Iran

² Medical Student, Shiraz University of Medical Sciences, Burn and Wound Healing Research Center, Amiralmomenin Hospital (AS)

³ Associate Professor, Department of Plastic and Cosmetic Surgery, Faculty of Medicine, Iran University of Medical Sciences

⁴ Master of Science in Microbiology, Shiraz University of Medical Sciences, Burn and Wound Healing Research Center, Amiralmomenin Hospital (AS)

⁵ Assistant Professor, Department of Plastic and Cosmetic Surgery, Shiraz University of Medical Sciences, Burn and Wound Healing Research Center

⁶ Associate Professor, Department of Biotechnology, Institute of Advanced Science and Technology and Environmental Sciences, Kerman University of Advanced Technology

Abstract

Introduction & Objective: COVID-19 induces a systemic inflammation in the body and predisposes thromboembolic events in the patients. Consequently, skin autografting in burn patients might be affected by this disease. Materials & Methods: In this cross-sectional study, 41 burn patients with COVID-19 were evaluated regarding the rejection of the graft, and the size of the wound and the graft, as well as COVID-19 symptoms and past medical history. The association of autograft rejection with these parameters was evaluated. Results: The study included 41 patients, with 24.4% being female and 75.6% male. The patients had a mean age of 36.63±15.951 years. One patient experienced autograft rejection, which was not higher than expected in non-COVID-19 patients. Autograft rejection was not associated with age, COVID-19 severity, burn wound size, or graft size. Unfortunately, 14 patients passed away. Mortality was associated with COVID-19 symptoms and burn rate (P = 0.004 and P < 0.001, respectively). Conclusions: In COVID patients who received skin grafts for burns, the severity of COVID symptoms, gender, burn mechanism, degree of burn, and amount of grafted skin were not linked to graft rejection. The only factor directly related to patient mortality before and after surgery was the extent of the burn. COVID-19 symptoms were found to be associated with mortality in COVID-19 burn patients, but this association may be overestimated. The results also indicated that COVID-19 was not associated with autograft rejection in these patients.

Keywords

Skin Autograft

Covid-19

Rejection

Burn Patients

1. Chilamakuri R, Agarwal S. COVID-19: Characteristics and Therapeutics. Cells. 2021 Jan 21; 10(2): 206. doi: 10.3390/cells10020206. PMID: 33494237; PMCID: PMC7909801.

2. Gómez-Mesa JE, Galindo-Coral S, Montes MC, Muñoz Martin AJ. Thrombosis and Coagulopathy in COVID-19. Curr Probl Cardiol. 2021 Mar; 46(3): 100742. doi: 10.1016/j.cpcardiol.2020.100742. Epub 2020 Nov 2. PMID: 33243440; PMCID: PMC7605852.

3. Merad M, Blish CA, Sallusto F, Iwasaki A. The immunology and immunopathology of COVID-19. Science. 2022 Mar 11; 375 (6585): 1122-1127. doi: 10.1126/science.abm8108. Epub 2022 Mar 10. PMID: 35271343.

4. Li N, Liu T, Chen H, Liao J, Li H, Luo Q, Song H, Xiang F, Tan J, Zhou J, Hu G, Yuan Z, Peng Y, Luo G. Management strategies for the burn ward during COVID-19 pandemic. Burns. 2020 Jun; 46(4):
756-761. doi: 10.1016/j.burns.2020.03.013. Epub 2020 Apr 2. PMID: 32381449; PMCID: PMC7127442.

5. Ladhani HA, Yowler CJ, Claridge JA. Burn Wound Colonization, Infection, and Sepsis. Surg Infect (Larchmt). 2021 Feb; 22(1): 44-48. doi: 10.1089/sur.2020.346. Epub 2020 Oct 20. PMID: 33085576.

6. Liu A, Minasian RA, Maniago E, Justin Gillenwater T, Garner WL, Yenikomshian HA. Venous Thromboembolism Chemoprophylaxis in Burn Patients: A Literature Review and Single-Institution Experience. J Burn Care Res. 2021 Feb 3; 42(1):
18-22. doi: 10.1093/jbcr/iraa143. PMID: 32842151.

7. Poor HD. Pulmonary Thrombosis and Thromboembolism in COVID-19. Chest. 2021 Oct; 160(4): 1471-1480. doi: 10.1016/j.chest.2021.06.016. Epub 2021 Jun 19. PMID: 34153340; PMCID: PMC8213519.

8. Gallaher J, Abid M, Kayange L, Purcell L, Charles A. The effect of COVID-19 on burn management and outcomes in a resource-limited setting. Burns. 2022 Nov; 48(7): 1584-1589. doi: 10.1016/j.burns.2022.08.004. Epub 2022 Aug 13. PMID: 36038452; PMCID: PMC9375248.

9. Fayazov AD, Shukurov SI, Shukurov BI, Sultanov BC, Namazov AN, Ruzimuratov DA. Disorders of the immune system in severely burned patients. Ann Burns Fire Disasters. 2009 Sep 30; 22(3): 121-30. PMID: 21991166; PMCID: PMC3188142.

10. Davitt E, Davitt C, Mazer MB, Areti SS, Hotchkiss RS, Remy KE. COVID-19 disease and immune dysregulation. Best Pract Res Clin Haematol. 2022 Sep; 35(3): 101401. doi: 10.1016/j.beha.2022.101401. Epub 2022 Oct 15. PMID: 36494149; PMCID: PMC9568269.

11. Foncerrada G, Culnan DM, Capek KD,
González-Trejo S, Cambiaso-Daniel J, Woodson LC, Herndon DN, Finnerty CC, Lee JO. Inhalation Injury in the Burned Patient. Ann Plast Surg. 2018
Mar; 80 (3 Suppl 2): S98-S105. doi: 10.1097/SAP.0000000000001377. PMID: 29461292; PMCID: PMC5825291.

12. Keshavarzi A, Mohammadi AA, Ayaz M, Javanmardi F, Hoghoughi MA, Shirazi Yeganeh B, Emami A, Mackie M, Akrami R, Iranpak S. Cutaneous Vesicular of COVID-19 in Two Burn Patients. World J Plast Surg. 2020 Sep; 9(3):
331-338. doi: 10.29252/wjps.9.3.331. PMID: 33330012; PMCID: PMC7734937.

13. Otaghvar HA, Rouzbahani AK, Mahmoudvand G, Moghaddam S, Afkham SA, Razavi ZS. A Brief Report on the Effect of Covid 19 Pandemic on Patients Undergoing Skin Graft Surgery in a Burns Hospital from March 2019 to March 2020. J Case Rep Med Hist. 2022; 2(8).

14. Elfiah U, Perdanakusuma DS, Dososaputra I, Riasa IN, Lumintang LM, Naufal MF. Skin graft as a modality reconstruction of post-burn contractures during pandemic area: case series. Bali Medical Journal. 2023 Jan 11; 12(1): 244-8.