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

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:

&NA;Prompt and permanent closure of excised full‐thickness burns remains a critical factor in a patient's recovery from massive burn injuries. Hypothetically, Integra Artificial Skin (Integra) may replace the need for allografts for immediate wound coverage, and cultured skin substitutes (CSS) that contain stratified epithelium may replace the need for autografts for definitive wound closure. To test this hypothesis, 3 patients with full‐thickness burns of greater than 60% of their total body surface areas had their eschar excised within 14 days of admission. Integra was applied, and a skin biopsy was collected from each patient for the preparation of CSS. At 3 weeks or more after the application of the Integra and the collection of skin biopsies, the outer silastic cover of the Integra was removed and CSS were grafted. The CSS were irrigated with nutrients and antimicrobials for 6 days and then dressed with antimicrobial ointment and cotton gauze. Treated wounds were traced on days 14 and 28 after the grafting of CSS for determination of engraftment and wound closure, respectively. Cost analysis was not performed. Engraftment on postoperative day (POD) 14 was 98% ± 1% (mean ± standard error of the mean), the ratio of closed:donor areas on POD 28 was 52.3 ± 5.2, and no treated sites required regrafting. The histology of the closed wounds showed stable epithelium that covered a layer of newly formed fibrovascular tissue above the reticulated structure of the degrading Integra. The clinical outcomes of the closed wounds after POD 28 demonstrated smooth, pliable, and hypopigmented skin. Two patients who had received CSS grafts over Integra on their backs were positioned supine on air beds from POD 8 or POD 9 with minimal graft loss because of mechanical loading. One patient with a full‐thickness burn of 88% of the total body surface area was covered definitively at 55 days postburn. These results demonstrate that the comb ination of CSS and Integra can accomplish functionally stable and cosmetically acceptable wound closure in patients with extensive full‐thickness burns. This combination of alternatives to the conventional grafting of split‐thickness skin permits the substitution of cadaveric allograft with Integra and the substitution of donor autograft with CSS. This approach to the closure of excised full‐thickness burns is expected to reduce greatly the time to definitive closure of burn wounds and to reduce the morbidity associated with the harvesting of donor sites for split‐thickness skin autografts. (J Burn Care Rehabil 1999;20:453‐61)

ISSN:0273-8481    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

&NA;Burn injury induces many metabolic disorders, including altered protein kinetics with muscle weakness. The skeletal muscle weakness that occurs as a result of the loss of muscle mass causes hypoventilation and dependence on respirators, a condition that increases morbidity and mortality. The presence or absence of apoptosis in muscle, which can be a cause of the loss of muscle mass, was studied in rats after they had received scald burns to 40% of their body surface areas. The potential pro‐apoptotic pathways that were activated were also examined. The burn injury produced did not directly destroy the muscle beneath; muscles just beneath the burned surface showed dramatic apoptotic changes according to assessments with the cell death enzyme‐linked immunosorbent assay and in situ TdT‐mediated dUTP‐X nick‐end labeling staining. The extent of apoptosis reached a peak on postburn days 3 and 7. Of note is that apoptosis was also confirmed in muscles at sites distant from the burn injury (eg, tibialis anterior) on both postburn days 3 and 7, a condition that is suggestive of the systemic effects of pro‐apoptotic factors. To show that heat itself causes the initiation of the pro‐apoptotic signaling, muscle‐derived C2C12 cells were subjected to heat treatment at 55°C. Ceramide, a key apoptotic second messenger, was observed to increase in the caveolae fraction but not in non‐caveolae fraction of these muscle cells. In muscle tissue from burned rats, stress‐activated protein kinase (a downstreamsignaling kinase of ceramide) was activated soon after burn injury; this finding is consistent with the hypothesis that ceramide plays a role in burn‐induced apoptosis. Caspase‐1, ‐3, and ‐9, important final apoptotic enzymes involved with the downstream signaling of stress‐activated protein kinase, were also activated after burn injury in muscle tissue from burned rats. These findings confirm the hypothesis that apoptosis occurs in skeletal muscle and that major apoptot ic pathways are activated after a burn injury. Further characterization of these apoptotic signaling cascades may provide new therapeutic targets for the prevention of burn‐induced muscle wasting. (J Burn Care Rehabil 1999;20:462‐70)

ISSN:0273-8481    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

&NA;Because of growing concern about the spread of antibiotic‐resistant gram‐positive bacteria in burn and trauma units, an inexpensive, safe, effective means of spot‐disinfecting fabrics (such as privacy curtains) that remain in clinic or patient rooms as various patients use the rooms was sought. From comparisons of cost and safety data, 3% hydrogen peroxide was chosen to be tested for its efficacy in the control of these bacteria. Systematic laboratory testing used 30 antibiotic‐resistant and sensitive staphylococci and enterococci and 4 common hospital fabrics: cotton (clothing), terry cloth (towels), cotton‐polyester blend (scrub suits), and polyester (curtains). Without disinfection, bacteria survived for many hours to several days. After a single spraying with 3% hydrogen peroxide, all bacteria on all fabrics were dead within 5 to 120 minutes. On‐site testing targeted privacy curtains in patients' rooms. Curtain edges that tended to be grabbed when moving the curtain showed a mixture of gram‐positive and gram‐negative bacteria (median, 22 bacteria/24cm2). After these areas were sprayed with 3% hydrogen peroxide, no bacteria were found. It was concluded that spraying with 3% hydrogen peroxide is a safe, inexpensive, effective means of spot‐disinfecting fabrics in patients' rooms; this simple procedure may limit the spread of potentially pathogenic antibiotic‐resistant bacteria. (J Burn Care Rehabil 1999;20:471‐7)

ISSN:0273-8481    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

&NA;Facial burns present many psychological and rehabilitation challenges. Many of our patients with facial burns who are children and adolescents have expressed that they prefer to wear the transparent face mask instead of the Jobst hood (Beiersdorf Jobst Inc, Charlotte, NC) with an underlying silicone face pad. However, questions have been raised about the consistency and amount of pressure provided by the transparent face mask. Pressure was measured under the customized transparent face mask, under the customized silicone face pad with a Jobst hood, and under the customized Jobst hood to ascertain pressure differences for a single patient. No significant difference in pressure was observed between the transparent facemask and the silicone face pad with a Jobst hood. We recommend the use of the transparent face mask on patients with severe facial burns who may require pressure to improve the appearance of their scars. (J Burn Care Rehabil 1999;20:478‐81)

ISSN:0273-8481    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

&NA;Infestations by parasites such asMycobacterium tuberculosisand other viral infections are common in third world countries. Consequently, the admission of a significant number of foreign patients to burn centers in the United States may pose new problems, not only for inpatients but also for health care workers. To document infestations in patients from third world countries and to determine the need for specific protocols, we studied 62 consecutive foreign patients admitted to our pediatric burn reconstruction service between July 1997 and December 1998. All patients were evaluated with chest X‐ray, hemogram with differential count, clinical and laboratory nutritional assessment, and skin test for tuberculosis, and stool samples were evaluated for ova and parasites. No pathologic findings were seen on chest radiographs. Only 1 patient had a positive skin test for tuberculosis, as a result of previous bacille Calmette‐Guérin vaccine. Yet, 10 patients (16%) had positive stool cultures for ova and parasites that contained 29 isolates. The most frequently identified organism wasBlastocystis hominis.All amoebas identified were nonpathogenic according to Centers for Disease Control criteria.Ascaris lumbricoidesand 1 case of cysticercosis were found. None of the patients with parasites had clinical manifestations of parasitosis or chronic infections. However, parasite infestations had a positive correlation with eosinophilia, altered nutritional status, and altered mean corpuscular hemoglobin concentration, as defined by multiple linear regression. Although foreign patients admitted to burn centers from third world countries have a low rate of infestations, patients at risk can be identified by laboratory findings and studies of nutritional status. Simple hand washing prevents the spread of disease and protects health providers. (J Burn Care Rehabil 1999;20:482‐6)

ISSN:0273-8481    

出版商:OVID    

年代:1999

数据来源: OVID