摘要:

Mechanical meshers that press blades through immobilized skin are routinely used to expand split-thickness skin grafts, and scanned incisional lasers are currendy under investigation for the same purpose. However, in contrast to the atraumatic wound edge that is created on these grafts by a sliding scalpel blade, the skin “crushing” and skin coagulation that can occur with the use of mechanical meshers and lasers are thought to reduce the outgrowth potential of the epidermis. With the use of an in vitro explant outgrowth system, epithelialization derived from wound edges that were created by a scalpel, a mechanical mesher, and a CO2laser at various settings was studied. The area of epithelialization around skin explants was not significantly different for skin bridges produced by scalpel cuts and those produced by the skin mesher, and histologic sections demonstrated similar epiboly-growth under these explants. In contrast, wounds created with the CO2laser showed unpaired epithelialization. Incisions were made at several power settings, ranging from 11 passes at 4 mW to 1 pass at 24 mW. Only minor differences were demonstrated, with the lower laser power yielding slightly better results. Recruitment of keratinocytes into the proliferative state, as assessed by bromodeoxyuridine incorporation, was equivalent for scalpel and mesh cut skin. This data does not support concerns about decreased graft viability resulting from the crushing blade action used by mechanical meshers. The possibility of cutting and meshing skin grafts with lasers of the far-infrared and mid-infrared light spectrum are discussed. (J Burn Care Rehabil 1999;20:400–5)

ISSN:0273-8481    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Toxic epidermal necrolysis (TEN) is an exfoliative skin disorder that may involve a large body surface area and mucosal surfaces. The microscopic changes that occur with this condition are similar to those that occur with superficial dermal burns, such as dermal detachment from the underlying dermis. Complications of TEN are related to the loss of the epithelial skin barrier and include pain, fluid and electrolyte loss, and an increased risk of sepsis. The treatment of a patient with TEN is best accomplished in a burn unit, where expert treatment of these complications can be provided. Medical treatment includes the administration of immunosuppressive therapy and the discontinuation of any previous corticosteroid treatment. Surgical management includes the débridement of necrotic areas. In this article, the surgical management of 8 consecutive patients with TEN who were admitted to the intensive care burn unit at the Hospital Universitario de Getafe in Madrid, Spain, from 1996 to 1998 is described. These patients were treated with extensive early debridement of necrotic skin areas followed by wound coverage with Biobrane (Dow B. Hickam, Inc, Sugarland, Tex), a temporary semisynthetic skin substitute. Skin coverage with this material decreases pain and fluid loss, and it possibly facilitates epithelization and decreases the risk of sepsis, without adverse side effects. This semisynthetic material meets some standards of an ideal skin substitute: it is easy to use, provides several beneficial physiologic effects, and improves patients' comfort. In the 8 cases of patients with TEN that were studied, the use of Biobrane skin substitute for the coverage of massive areas of detached skin was found to be an important aspect of treatment. (J Burn Care Rehabil 1999;20:406–10)

ISSN:0273-8481    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Editor's Note: Paul Silverstein, MD, FACS, is a plastic and reconstructive surgeon who has practiced medicine in Oklahoma City since 1974. Doctor Silverstein served at the US Army institute of Surgical Research from 1969 to 1972, where he was able to proceed with his research in burn care and wound healing. After completing his military service, Dr. Silverstein joined the plastic surgery department at Emory University in Atlanta, Ga, and he was trained in plastic, reconstructive, and cosmetic surgery. In 1974 he was recruited to Oklahoma City to design and direct the burn center there, and he also established a private practice. He is currently the medical director of the burn center at Integris Baptist Medical Center in Oklahoma City. Doctor Silverstein has served as vice president of the American Burn Association and president of the North American Burn Society. He lectures internationally on the subjects of burn care, wound healing, and plastic and cosmetic surgery. Because of this international recognition, it was only logical to ask him to review the following article about burn prevention in Spain. Doctor Silverstein is also known for his work in the area of burn prevention. He is a recipient of the American Burn Association Burn Prevention Award, and in international settings he has presented several papers about burn and fire prevention. Doctor Silverstein has offered encouragement and shared his knowledge with new burn team members as they have entered the burn prevention arena.

ISSN:0273-8481    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Editor's Note: Dalia Gilboa, PhD, is the Guest Editor of this issue's Psychosocial Forum. Doctor Gilboa received her PhD in clinical psychology from the Hebrew University of Jerusalem in Israel, and she performed her postdoctoral studies at McGill University in Montreal, Canada. She also holds a diploma in psychotherapy from the School of Continuing Studies in Medicine at Tel Aviv University in Israel. Doctor Gilboa is a senior clinical psychologist at the Sheba Medical Center, where she works in the psychiatric division as well as the burn unit and the plastic surgery ward. Since 1983, Dr Gilboa has served as the chief psychologist of the Israel Ministry of Health. She is a lecturer and supervisor in the psychotherapy program of the School of Continuing Studies in Medicine at Tel Aviv University, and she has developed and implemented a unique model for integrative team work for the burn unit at Sheba Medical Center. Doctor Gilboa is a regular and active participant in European conferences about burns and in international conferences about the psychiatric and psychosocial treatment of patients with burns; she has also made a significant contribution to the burn literature. Our thanks and appreciation to Dr Gilboa for a thought-provoking and insightful editorial.

ISSN:0273-8481    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This article reviews the literature about the extent of posttraumatic stress disorder (PTSD) in patients with burns. PTSD is a relatively new diagnostic label, although the emotional effects of severe trauma have long been recognized. A burn injury—one of the most traumatic of all injuries—can be accompanied by serious psychological sequelae, including PTSD. Psychiatric symptoms may not be immediately apparent in patients with burns because the patients often develop PTSD many months after the injury. The reported prevalence rate of PTSD in patients with burns varies from 8% to 45%. The factors increasing these patients' risks include preburn affective disorder, delirium or severe pain during acute treatment, and less perceived social support. Psychosocial issues must be considered in the recovery or rehabilitation phase. Pharmacotherapy, psychodynamic psychotherapy, cognitive-behavioral therapy, and eye-movement desensitization and reprocessing may be helpful to the PTSD patient. Early detection and treatment of PTSD cannot only diminish the effects of this disabling disorder but can also help the rehabilitation of patients with this condition. (J Burn Care Rehabil 1999;20:426–33)

ISSN:0273-8481    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:1999

数据来源: OVID