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Thorfinn, Johan
Publications (10 of 23) Show all publications
Pompermaier, L., Steinvall, I., Elmasry, M., Thorfinn, J. & Sjöberg, F. (2018). Burned patients who die from causes other than the burn affect the model used to predict mortality: a national exploratory study. Burns, 44(2), 280-287
Open this publication in new window or tab >>Burned patients who die from causes other than the burn affect the model used to predict mortality: a national exploratory study
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2018 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 44, no 2, p. 280-287Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The Baux score - the sum of age and total body surface area burned (TBSA %) - is a good predictor of mortality has a high specificity but low sensitivity. Our aim was to examine the causes of death in patients who die with Baux scores of <100, which may explain the lower sensitivity and possibly affect the prediction of mortality.

METHODS: All patients admitted to our centre for burn care from 1993 to 2015 (n=1946) were included in this retrospective, descriptive, exploratory study. The study group comprised those patients who died with Baux scores of <100 (n=23), and their medical charts were examined for the cause of death and for coexisting diseases.

RESULTS: Crude mortality was 5% (93/1946) for the overall cohort, and a quarter of the patients who died (23/93) had Baux scores of less than 100 (range 64-99). In this latter group, flame burns were the most common (18/23), the median (10th-90th centile) age was 70 (46-86) years and for TBSA 21 (5.0-40.5) %, of which 7 (0-27.0) % of the area was full thickness. The main causes of death in 17 of the 23 were classified as "other than burn", being cerebral disease (n=9), cardiovascular disease (n=6), and respiratory failure (n=2). Among the remaining six (burn-related) deaths, multiple organ failure (predominantly renal failure) was responsible. When we excluded the cases in which the cause of death was not related to the burn, the Baux mortality prediction value improved (receiver operating characteristics area under the curve, AUC) from 0.9733 (95% CI 0.9633-0.9834) to 0.9888 (95% CI 0.9839-0.9936) and the sensitivity estimate increased from 45.2% to 53.9%.

CONCLUSION: Patients with burns who died with a Baux score <100 were a quarter of all the patients who died. An important finding is that most of these deaths were caused by reasons other than the burn, usually cerebrovascular disease. This may be the explanation why the sensitivity of the Baux score is low, as factors other than age and TBSA % explain the fatal outcome.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Baux score, Burns, Cause of death, Mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-142898 (URN)10.1016/j.burns.2017.07.014 (DOI)000427535000006 ()28830698 (PubMedID)2-s2.0-85027674409 (Scopus ID)
Note

Funding agencies: Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Region Ostergotland; Linkoping University, Linkoping, Sweden

Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2019-04-12Bibliographically approved
Karlsson, M., Elmasry, M., Steinvall, I., Sjöberg, F., Olofsson, P. & Thorfinn, J. (2018). Scarring At Donor Sites After Split-Thickness Skin Graft: A Prospective, Longitudinal, Randomized Trial. Advances in Skin & Wound Care, 3(4), 183-188
Open this publication in new window or tab >>Scarring At Donor Sites After Split-Thickness Skin Graft: A Prospective, Longitudinal, Randomized Trial
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2018 (English)In: Advances in Skin & Wound Care, ISSN 1527-7941, E-ISSN 1538-8654, Vol. 3, no 4, p. 183-188Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to evaluate scarring at split-thickness skin graft donor sites 8 years after surgery.

METHODS: At surgery, 67 patients were randomized to hydrofiber, polyurethane foam, or porcine xenograft treatment. Scars were evaluated with the Patient and Observer Scar Assessment Scale.

RESULTS: Results showed significant differences in observed scar outcomes at donor sites, leaving the polyurethane foam–treated and the porcine xenograft–treated patients with the least satisfying scars. Multivariable regression analysis showed that the group treated with the xenografts had worse scores for overall opinion of the scar than did the other groups (P = .03), the most important factor being pigmentation. There was no correlation between duration of healing time and quality of the scar.

CONCLUSIONS: There were significant differences among the groups, with the hydrofiber group being the most satisfied with the appearance of their scar.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
National Category
Surgery Otorhinolaryngology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-146085 (URN)10.1097/01.ASW.0000530684.31491.5f (DOI)000435188200008 ()29561343 (PubMedID)
Available from: 2018-03-27 Created: 2018-03-27 Last updated: 2019-04-11Bibliographically approved
Elmasry, M., Steinvall, I., Thorfinn, J., Abdelrahman, I., Olofsson, P. & Sjöberg, F. (2017). Staged excisions of moderate-sized burns compared with total excision with immediate autograft: an evaluation of two strategies.. International journal of burns and trauma, 7(1), 6-11
Open this publication in new window or tab >>Staged excisions of moderate-sized burns compared with total excision with immediate autograft: an evaluation of two strategies.
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2017 (English)In: International journal of burns and trauma, ISSN 2160-2026, Vol. 7, no 1, p. 6-11Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Different surgical techniques have evolved since excision and autografting became the treatment of choice for deep burns in the 1970s. The treatment plan at the Burn Center, Linköping University Hospital, Sweden, has shifted from single-stage excision and immediate autografting to staged excisions and temporary cover with xenografts before autografting. The aim of this study was to find out if the change in policy resulted in extended duration of hospital stay/total body surface area burned (LOS/TBSA%).

METHODS: Retrospective clinical cohort including surgically-managed patients with burns of 15%-60% TBSA% within each treatment group. The first had early full excisions of deep dermal and full thickness burns and immediate autografts (1997-98), excision and immediate autograft group) and the second had staged excisions before final autografts using xenografts for temporary cover (2010-11, staged excision group).

RESULTS: The study included 57 patients with deep dermal and full-thickness burns, 28 of whom had excision and immediate autografting, and 29 of whom had staged excisions with xenografting before final autografting. Adjusted (LOS/TBSA%) was close to 1, and did not differ between groups. Mean operating time for the staged excision group was shorter and the excised area/operation was smaller. The total operating time/TBSA% did not differ between groups.

CONCLUSION: Staged excisions with temporary cover did not affect adjusted LOS/TBSA% or total operating time. Staged excisions may be thought to be more expensive because of the cost of covering the wound between stages, but this needs to be further investigated as do the factors that predict long term outcome.

Place, publisher, year, edition, pages
E-Century Publishing Corporation, 2017
Keywords
Burn surgery, moderate sized burns, xenografts
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-135745 (URN)28123862 (PubMedID)
Available from: 2017-03-20 Created: 2017-03-20 Last updated: 2018-05-03Bibliographically approved
Elmasry, M., Steinvall, I., Thorfinn, J., Abbas, A., Adly, O., Abdelrahman, I., . . . Sjöberg, F. (2016). Scald management protocols - outcome differences in two different time periods using different treatment strategies.. Annals of burns and fire disasters, 29(2), 139-143
Open this publication in new window or tab >>Scald management protocols - outcome differences in two different time periods using different treatment strategies.
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2016 (English)In: Annals of burns and fire disasters, ISSN 1592-9558, Vol. 29, no 2, p. 139-143Article in journal (Refereed) Published
Abstract [en]

Over the years the treatment of scalds in our centre has changed, moving more towards the use of biological dressings (xenografts). Management of scalds with mid dermal or deep dermal injuries differs among centers using different types of dressings, and recently biological membrane dressings were recommended for this type of injury. Here we describe differences in treatment outcome in different periods of time. All patients with scalds who presented to the Linkoping Burn Centre during two periods, early (1997-98) and later (2010-12) were included. Data were collected in the unit database and analyzed retrospectively. A lower proportion of autograft operations was found in the later period, falling from 32% to 19%. Hospital stay was shorter in the later period (3.5 days shorter, p=0.01) and adjusted duration of hospital stay/TBSA% was shorter (1.2 to 0.7, p=0.07). The two study groups were similar in most of the studied variables: we could not report any significant differences regarding outcome except for unadjusted duration of hospital stay. Further studies are required to investigate functional and aesthetic outcome differences between the treatment modalities.

Place, publisher, year, edition, pages
Mediterranean Council for Burns and Fire Disasters, 2016
Keywords
burns, duration of stay, outcome, scalds
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-135746 (URN)28149237 (PubMedID)
Available from: 2017-03-20 Created: 2017-03-20 Last updated: 2017-09-27Bibliographically approved
Elmasry, M., Steinvall, I., Thorfinn, J., Olofsson, P., Abbas, A., Abdelrahman, I., . . . Sjöberg, F. (2016). Temporary coverage of burns with a xenograft and sequential excision, compared with total early excision and autograft. Annals of burns and fire disasters, 29(3), 196-201
Open this publication in new window or tab >>Temporary coverage of burns with a xenograft and sequential excision, compared with total early excision and autograft
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2016 (English)In: Annals of burns and fire disasters, ISSN 1592-9558, Vol. 29, no 3, p. 196-201Article in journal (Refereed) Published
Abstract [en]

During the 80s and 90s, early and total excision of full thickness burns followed by immediate autograft was the most common treatment, with repeated excision and grafting, mostly for failed grafts. It was hypothesized, therefore, that delayed coverage with an autograft preceded by a temporary xenograft after early and sequential smaller excisions would lead to a better wound bed with fewer failed grafts, a smaller donor site, and possibly also a shorter duration of stay in hospital. We carried out a case control study with retrospective analysis from our National Burn Centre registry for the period 1997-2011. Patients who had been managed with early total excision and autograft were compared with those who had had sequential smaller excisions covered with temporary xenografts until the burn was ready for the final autograft. The sequential excision and xenograft group (n=42) required one-third fewer autografts than patients in the total excision and autograft group (n=45), who needed more than one operation (p<0.001). We could not detect any differences in duration of stay in hospital / total body surface area burned% (duration of stay/TBSA%) (2.0 and 1.8) (p=0.83). The two groups showed no major differences in terms of adjusted duration of stay, but our findings suggest that doing early, smaller, sequential excisions using a xenograft for temporary cover can result in shorter operating times, saving us the trouble of making big excisions. However, costs tended to be higher when the burns were > 25% TBSA.

Place, publisher, year, edition, pages
Mediterranean Council for Burns and Fire Disasters, 2016
Keywords
autograft, burn surgery, sequential excision, total early excision, xenograft
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-137912 (URN)28149249 (PubMedID)
Available from: 2017-06-01 Created: 2017-06-01 Last updated: 2018-07-03
Nilsson, H., Jonson, C.-O., Vikström, T., Bengtsson, E., Thorfinn, J., Huss, F., . . . Sjöberg, F. (2013). Simulation-assisted burn disaster planning. Burns, 39(6), 1122-1130
Open this publication in new window or tab >>Simulation-assisted burn disaster planning
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2013 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 39, no 6, p. 1122-1130Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to evaluate the Swedish medical systems response to a mass casualty burn incident in a rural area with a focus on national coordination of burn care. Data were collected from two simulations of a mass casualty incident with burns in a rural area in the mid portion of Sweden close to the Norwegian border, based on a large inventory of emergency resources available in this area as well as regional hospitals, university hospitals and burn centres in Sweden and abroad. The simulation system Emergo Train System (R) (ETS) was used and risk for preventable death and complications were used as outcome measures: simulation I, 18.5% (n = 13) preventable deaths and 15.5% (n = 11) preventable complications; simulation II, 11.4% (n = 8) preventable deaths and 11.4% (n = 8) preventable complications. The last T1 patient was evacuated after 7 h in simulation I, compared with 5 h in simulation II. Better national coordination of burn care and more timely distribution based on the experience from the first simulation, and possibly a learning effect, led to a better patient outcome in simulation II. The experience using a system that combines both process and outcome indicators can create important results that may support disaster planning.

Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Burns; Rural areas; Surge capacity; Mass casualty incidents; Preparedness
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-86596 (URN)10.1016/j.burns.2013.01.018 (DOI)000324349700014 ()
Available from: 2012-12-19 Created: 2012-12-19 Last updated: 2017-12-06Bibliographically approved
Thorfinn, J., Angelidis, I. K., Gigliello, L., Pham, H. M., Lindsey, D. & Chang, J. (2012). Bioreactor optimization of tissue engineered rabbit flexor tendons in vivo. JOURNAL OF HAND SURGERY-EUROPEAN VOLUME, 37E(2), 109-114
Open this publication in new window or tab >>Bioreactor optimization of tissue engineered rabbit flexor tendons in vivo
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2012 (English)In: JOURNAL OF HAND SURGERY-EUROPEAN VOLUME, ISSN 1753-1934, Vol. 37E, no 2, p. 109-114Article in journal (Refereed) Published
Abstract [en]

Tissue-engineered rabbit flexor tendons reseeded with cells are stronger in vitro after culture in a bioreactor. It is not known whether this effect persists in vivo. Tenocytes from New Zealand white rabbits were seeded onto rabbit rear paw flexor tendons that were deprived of cells and exposed to cyclic strain in a bioreactor. Reseeded constructs that were kept unloaded in a medium for 5 days were used as controls. The tendons were implanted to bridge a zone II defect in the rabbit. After explantation 4 weeks later, the ultimate tensile strength (UTS) and elastic modulus (EM) were determined. Tendon constructs that were exposed to cyclic strain had significantly improved UTS and EM. Histology showed that cellularity was increased in the bioreactor tendons.

Place, publisher, year, edition, pages
SAGE Publications (UK and US), 2012
Keywords
Hand flexor tendon, tissue engineering, tenocytes, bioreactor optimization, cell culture
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-75278 (URN)10.1177/1753193411419439 (DOI)000299481700003 ()
Note
Funding Agencies|Veterans Affairs Medical Merit Review Grant||Veterans Affairs Rehabilitation Research & Development Merit Review Grant||Swedish Fulbright Commission||County Council of Ostergotland (Sweden)||Borje Gabrielssons Memorial Fund||Swedish Society of Medicine||Johan & Jakob Soderberg Foundation||Linkoping Society of Medicine||Available from: 2012-02-27 Created: 2012-02-24 Last updated: 2012-02-27
Sjöberg, F., Iredahl, F., Larsen, R., Samuelsson, A., Thorfinn, J., Bak, Z., . . . Rousseau, A. (2011). Data visar att hyperbar syrgasbehandling kan vara skadlig. Läkartidningen, 108(32-33), 1506-1506
Open this publication in new window or tab >>Data visar att hyperbar syrgasbehandling kan vara skadlig
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2011 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 32-33, p. 1506-1506Article, review/survey (Other (popular science, discussion, etc.)) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-75951 (URN)
Available from: 2012-03-19 Created: 2012-03-19 Last updated: 2017-12-07
Sjöberg, F., Larsen, R., Bak, Z., Samuelsson, A., Iredahl, F., Thorfinn, J., . . . Rousseau, A. (2011). Hyperbar syrgasbehandling kan vara skadlig vid kolmonoxidförgiftning. Läkartidningen, 108(32-33), 1506
Open this publication in new window or tab >>Hyperbar syrgasbehandling kan vara skadlig vid kolmonoxidförgiftning
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2011 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 32-33, p. 1506-Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-75561 (URN)21922948 (PubMedID)
Available from: 2012-03-07 Created: 2012-03-07 Last updated: 2017-12-07
Farnebo, S., Thorfinn, J., Henricson, J. & Tesselaar, E. (2010). Hyperaemic changes in forearm skin perfusion and RBC concentration after increasing occlusion times. MICROVASCULAR RESEARCH, 80(3), 412-416
Open this publication in new window or tab >>Hyperaemic changes in forearm skin perfusion and RBC concentration after increasing occlusion times
2010 (English)In: MICROVASCULAR RESEARCH, ISSN 0026-2862, Vol. 80, no 3, p. 412-416Article in journal (Refereed) Published
Abstract [en]

Tissue occlusion and the hyperaemic response upon reperfusion can be used as a tool to assess microvascular function in various vascular diseases. Currently, laser Doppler flowmetry (LDF) is applied most often to measure hyperaemic responses. In this study, we have applied tissue viability imaging (TiVi) and LDF to measure the change in red blood cell concentration and perfusion in the skin after occlusions of the forearm with increasing duration. We have found that there is a strong correlation between the changes in perfusion and red blood cell (RBC) concentration during post-occlusive hyperaemia (perfusion: r = 0.80; RBC concentration: r = 0.94). This correlation increases with longer occlusion durations (1, 5 and 10 min). Furthermore, for both perfusion and RBC concentration, the maximum responses (perfusion: r(2) = 0.59; RBC concentration: r(2) = 0.78) and the recovery times (perfusion: r(2) = 0.62; RBC concentration: r(2) = 0.91) increase linearly with the duration of the occlusion. Maximum responses and recovery times were more reproducible for RBC concentration (as measured with TiVi) than for perfusion (as measured with LDF). These results show that perfusion and RBC concentration are related during post-occlusive hyperaemia and that TiVi can be used as a tool in the assessment of hyperaemic responses that has advantages in terms of reproducibility, sensitivity and ease of use.

Place, publisher, year, edition, pages
Elsevier Science B.V., Amsterdam, 2010
Keywords
Occlusion, Hyperaemia, Laser Doppler, Tissue viability imaging, Perfusion, Red blood cell concentration, Polarisation light spectroscopy, Ischemia, Reperfusion
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-63383 (URN)10.1016/j.mvr.2010.07.008 (DOI)000284678300016 ()
Note
Original Publication: Simon Farnebo, Johan Thorfinn, Joakim Henricson and Erik Tesselaar, Hyperaemic changes in forearm skin perfusion and RBC concentration after increasing occlusion times, 2010, MICROVASCULAR RESEARCH, (80), 3, 412-416. http://dx.doi.org/10.1016/j.mvr.2010.07.008 Copyright: Elsevier Science B.V., Amsterdam http://www.elsevier.com/ Available from: 2010-12-17 Created: 2010-12-17 Last updated: 2010-12-22
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