摘要:

The timing and method of treatment of deep palm and finger burns varies widely. Our protocol involves performing full-thickness skin grafts (FTSG) in nonhealing palm burns. We reviewed the functional and cosmetic results after FTSG to the palm. From August 1997 to April 1999, 11 patients (12 palms) underwent excision and FTSG within 2 weeks of injury. A panel of medical and nonmedical professionals evaluated follow-up pictures of the grafts at 1, 2 to 4, and beyond 4 months. Parameters used for evaluation were color match with the unburned skin (1 = no difference to 4 = large difference), graft thickness (1 = flat to 4 = markedly raised), overall appearance (1 = poor to 100 = excellent), and time to maturity. Hand function, as assessed by occupational therapy notes, was also recorded. All 12 grafted palms had a 100% take and healed with minimal scarring. Mean color match scores were 2.4 at 1 month, 1.8 at 2 to 4 months, and 1.6 beyond 4 months. On the graft thickness scale, grafts were given scores of 2.6, 2.2, and 1.9 during the same intervals. The overall appearance was 71 at 1 month, 81 at 2 to 4 months, and 85 beyond 4 months. All grafts except 1 were judged to be mature at 2 to 4 months follow-up. Full passive range of motion was attained in all grafted hands within the period of 2 to 4 months after operation. Early excision and FTSG of deep pediatric palm burns can be performed in the outpatient setting. The grafts have an acceptable color match, are minimally raised, and achieve excellent cosmetic result. The grafts mature within a few months after surgery to allow for rapid return to normal range of motion. FTSG should be considered as a first choice for deep palm burns.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Recent studies have demonstrated that neutrophils have the capacity to produce a variety of cytokines after stimulation. The synthesis and release of prostaglandin E2(PGE2) via the cyclooxygenase (COX) pathway has been reported to occur in activated neutrophils. In the present study, we sought to determine the status of COX protein synthesis and PGE2production in murine neutrophils after burn injury. The effect of burn injury on neutrophil COX and PGE2response to infection or lipopolysaccharide (LPS) was also examined. Peritoneal neutrophils were obtained from BDF1 mice at 4, 18, 24, and 36 hours after a 15% TBSA full-thickness scald burn or sham burn. We found that neutrophils from healthy mice express a low level of COX-2 protein. Neutrophil COX-2 protein expression in burn animals was significantly increased at 4 hours and dramatically decreased at 36 hours after burn injury. Animals 36 hours after burn and topically infected withPseudomonas Aeruginosahad neutrophil COX-2 expression almost identical to burn injury only. Neutrophils harvested from healthy mice cocultured with LPS (1&mgr;g/ml) had a marked induction of COX-2 protein. Neutrophils 24 hours after burn were unresponsive to LPS-stimulated COX-2 enhancement. COX-1 protein was strongly expressed constitutively and not affected further by burn injury or LPS. The production of PGE2corresponded with the changes in COX-2 expression for all groups of mice. Our data suggested that neutrophils express both COX-1 and COX-2 and produce PGE2. The effects of burn injury on neutrophil COX-2 protein synthesis and PGE2production suggest that after burn there is a time-dependent response. Insights into not only the global cellular response to injury and infection but also temporal nature of the response are important in the development of the therapeutic treatment strategies for burn patients.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The formation of neoplastic changes in the scar tissue of chronically ulcerating wounds is a well-known process. This condition is most commonly seen after the postburn scars, but it may be seen after many kinds of scars. The term “Marjolin’s ulcer” is used to describe this type of carcinoma. Although many different cell types can be seen in these lesions, the most commonly seen is squamous cell carcinoma. Squamous cell carcinomas resulting from the Marjolin’s ulcer have a much greater tendency to metastasize than squamous cell carcinomas resulting from the other causes. Confusion continues about the precise pathophysiology of this lesion and the clinical behavior of this neoplasm, and the mortality and morbidity rates are also conflicting. As would be expected, there is a wide variety of suggested treatment protocols for this disease. This article, through case reports and review of the literature, offers criteria for the treatment of the Marjolin’s ulcers that arise on the scalp, which is an uncommon site.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Although it is generally safe, there are morbidities associated with home oxygen use. Experience in our burn unit led to an analysis of burn complications from this therapy.A retrospective review of records during a 12-year period identified 23 patients with burns associated with home oxygen use. Average age of the patients was 70 years, with chronic obstructive pulmonary disease the most prevalent indication for use. Concomitant cigarette smoking was the most common inciting mechanism of the burns (70%). Average burn size was 3.9% of total body surface area. Eleven patients presented in the first 10 years of the study period, whereas 12 presented in the last 2 years. We have seen a rise in injuries with the use of home oxygen. The absolute number of injuries sustained is unknown, because many are likely unreported. To decrease the morbidity and costs associated with these injuries, the need for continuing safety education is apparent.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The purpose of this study was to find a method to reduce the itch experienced by patients who have sustained burn injuries, by using and comparing the effectiveness of 2 shower and bath oils. One product contained liquid paraffin with 5% colloidal oatmeal and the other contained liquid paraffin. The study was carried out in the Adult Burns Unit, Royal Brisbane Hospital (RBH), Brisbane. It was conducted during a 10-month period from July 1998 until April 1999. Thirty-five acute burns patients participated in an assessor-blind clinical trial. Patients were asked twice daily to rate their discomfort from itch and pain. The amount of antihistamine requested by each patient was totalled daily. Analysis of data supplied by patients showed that the group using the product with colloidal oatmeal reported significantly less itch and requested significantly less antihistamine than those using the oil containing liquid paraffin.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The management of pain is one of the primary issues in burn care. Pain is not only a physiologic experience, but a psychological one as well. With this in mind, the treatment of burned patients must incorporate a holistic view of pain management and healing. Cognitive, behavioral, and pharmacologic interventions all have a role in pain management. Studies, as well as clinical experience, have shown that musical intervention has been helpful in assisting patients with pain management in a variety of medical settings. Music is an element of normal life that can be easily adapted for the needs of individual patients and their current environment while providing a means for self expression and for normalizing the environment. This article examines the rationale for using music therapy with burned patients, describes several protocols that have been adapted to meet the specific needs of burned patients, and summarizes our preliminary findings, which demonstrate significant response to music therapy protocols employed on our patients.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID