摘要:

Blood loss has been reduced using both tourniquets and epinephrine-injected subeschar during burn wound excision. This study quantified and compared blood loss in extremities distal to an inflated tourniquet with that after subeschar infusion of 1:1,000,000 epinephrine in saline into the trunk or proximal extremities. Tangential excision of eschar to viable dermis or fat was followed by immediate application of meshed autograft. Blood loss was calculated by determining the difference of preoperative and postoperative hemoglobin values and the volume of whole blood administered between these. With tourniquets for limbs, 2.07 ± 0.34% of circulating blood volume per 1% body surface excised was lost; whereas after epinephrine injection 3.42 ± 0.39% of blood volume per 1% body surface excised was lost (P< 0.05). Both methods effectively reduced blood loss when compared with excision followed by delayed autograft application. Where there was a choice the tourniquet was more effective.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Pain control is a major issue concerning children admitted for burns. Pain and anxiety associated with twice daily wound cleansing and dressing changes are difficult to control, especially if there is no intravenous access. We explored the effectiveness of intranasal midazolam (INM) combined with intravenous and/or oral pain medications prior to painful treatments. Charts of all patients admitted from October 1995 to November 1996 under the age of 9 were reviewed for use of INM. Twelve patients had INM used at some point during their hospitalization. Our study covers this group, with each child acting as his/her own control. Pain and response to medication during wound cleansing was assessed by the nursing staff as documented in the patient’s nursing assessment. Nursing documentation indicated that patient response was positive regarding the use of INM with intravenous and/or oral pain medication.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The interaction between melanocytes and keratinocytes in epidermal tissue suggest a bidirectional interchange between these two cell types. Although keratinocytes appear to affect melanocyte function, there are no reported effects of melanocytes on keratinocytes. Using cell strains, we examined the effect of melanocytes on keratinocyte proliferation. Two conditioned medium techniques were used: one was a co-culture system, where both cell types, grown on separate surfaces shared a common volume of medium. The second was simply feeding keratinocytes melanocyte-conditioned medium. Mixed cultures (both cell types together in a monolayer) where also studied. Our results showed that melanocyte-conditioned medium and melanocytes in co-culture significantly stimulated keratinocyte proliferation as measured by bromodeoxyuridine incorporation assay. However, growth of both cell types together in culture did not affect the growth rate of either cell type. Our results showed that cultured human melanocytes produce one or more soluble factors that stimulate the growth of cultured keratinocytes.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The steam burn caused by an electric rice-cooker is a unique mode of burn injury in Asian countries, especially Korea and Japan. This type of burn injury is characterized by 1) occurring most frequently on the volar aspect of the hand in toddlers younger than 2 years of age (92.8%); 2) the depth of burns are normally deep second-degree to third-degree (98%) and usually need surgery at the time of injury; 3) flexion contractures of multiple finger joints and web space contracture are common sequelae. We hypothesized that primary full-thickness skin graft (FTSG) would give more reliable results and eliminate the late reconstructive procedures. Between January 1997 and September 1999, 36 patients underwent primary FTSG, and the results of this primary FTSG group were compared with 124 patients who were treated with split-thickness skin graft (STSG; 79/124; 63.7%) or by conservative management (45/124; 36.3%), and readmitted for the correction of hand deformities between September 1995 and September 1999. In the primary FTSG group, 11.1% (4/36) of mild web contractures and 5.5% (2/36) of finger joint contractures were documented, and these did not require the reconstructive procedure during a follow-up period of 8.8 ± 4.8 months. In 124 patients of the primary STSG or conservative group, the mean time interval to reoperation was 8.9 ± 4.0 months and all patients received FTSG for correction of late hand deformities. In a retrospective study of the primary STSG group, 42 of 53 patients (79.2%) received reconstructive procedure during a 5-year follow-up period. In this report, we introduce the nature of steam burn caused by electric rice-cooker and propose that primary FTSG may be a reliable method for the treatment of this more severe type of acute burn in pediatric patients.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Lower extremity amputations are occasionally required after high-voltage electric and deep thermal burns. The extensive loss of skin and soft tissue after these injuries may make it difficult to fashion below-knee amputation that will readily tolerate a prosthesis. We have found an osteocutaneous pedicle fillet flap of the foot useful in the salvage of below-knee amputation after severe burn injury. Three patients have undergone this procedure after burn injury, 1 with burn secondary to high-voltage electric injury and 2 after deep thermal burns. All became ambulatory with artificial prostheses. There were no postoperative infections and no need for further revisions. The osteocutaneous pedicle fillet flap of the foot has proven to be a reliable form of below-knee stump coverage in patients with extensive soft tissue necrosis after burn injury.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The purpose of this study was to examine the prevalence of preexisting and burn-related impairments and to describe their association with preburn employment status. Data gathered during the acute hospitalization were analyzed on a consecutive series of burn patients aged 16 to 64 years (N = 770) enrolled in a prospective, longitudinal, multicenter study. Patients who were unemployed before the injury were more likely than those who were employed to report being alcohol-dependent (36 vs 18%), abusing other drugs (22 vs 10%), having received psychiatric treatment in the past year (21 vs 6%), and having preexisting physical disability (23 vs 3%); all were significant atP< .001). Of the unemployed patients who received toxicologic screening at admission, 49% tested positive for alcohol and 39% positive for other drugs, percentages that were significantly higher than 26 and 31%, respectively, for the employed. With adjustment for age, sex, race, and education, variables that were most predictive of preinjury unemployment status were preexisting physical disability (odds ratio, 51.0; 95% confidence interval, 7.7–336.9) and being alcohol-positive at admission (odds ratio, 2.8; 95% confidence interval, 1.2–6.8). Unemployed and employed patients also differed significantly in injury patterns and clinical outcomes, with inhalation injury and psychiatric distress being more prevalent among the unemployed and both hand burns and hand surgery among the employed. The greater prevalence of preexisting impairments among survivors who were unemployed before the injury helps explain why preburn employment status is such a powerful determinant of postburn work outcomes, and suggests the need to include psychosocial services in a program of comprehensive rehabilitation.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Twenty-nine patients with necrotizing fasciitis who were treated with 5% mafenide acetate solution (MAS) as an adjunct after grafting were compared with 45 patients treated without MAS. Statistical analysis of differences was obtained throughPvalues by &khgr;2testing. The MAS+ (M) and MAS− (C) groups were similar in percent skin deficit (M = 7.5%; C = 9.8%), with the extremity being the most common area of infection.Streptococcuswas the most common single organism but polymicrobial infections were the most prevalent (M = 48%; C = 58%). Patients with necrotizing fasciitis treated with MAS had fewer debridements per patient (M = 3.7; C = 5.4), fewer closure procedures (average per patient: M = 1.2; C = 1.73) and a higher percent of first-time closures (83 vs 59%; &khgr;2= 4.26;P= 0.039). There is a trend toward a lower mortality rate (3.4 vs 13%; &khgr;2= 2.00;P= 0.158). We conclude that MAS is a useful adjunct in necrotizing fasciitis wound care protocols.

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:

Melanocyte restoration is critical in reconstituting skin color. We developed a spotted (piebald) pig wound model to study methods of restoring melanocytes to the epidermis. Paired, full-thickness, porcine wounds were covered with nonpigmented, fully expanded, 3:1 meshed, split-thickness skin grafts and were sprayed with an epidermal cell suspension. The suspensions were highly pigmented skin (HPS) cell isolates for half of the wounds (n = 16) and nonpigmented skin (NPS) cell isolates for the remaining wounds (n = 16). Histologic sections showed 6.0 ± 3.0 and 15 ± 4.0 pigmented melanocytes per high-power field on days 8 and 20 in HPS-treated wounds and no pigmented melanocytes in NPS-treated wounds. Melanin pigment was dispersed in all layers of the epithelium for the HPS group on day 20 compared with a lack of melanin pigment observed in the NPS group. Cell spraying may provide a clinical method to restore color to skin; further work is needed to control the expression of melanin.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Management of pain is a primary concern in the treatment of burn patients. The intent of this study was to test the efficacy of music-based imagery and musical alternate engagement in assisting burn patients in managing their pain and anxiety during debridement. Twenty-five patients, 7 years of age and older, who were admitted to the Comprehensive Burn Care Center were enrolled in the study, which used a repeated-measures design with subjects serving as their own control. Subjects were randomly assigned to 1 of 2 groups. Those placed in Group A received music therapy intervention during their first dressing change, and no music therapy on the following day. Group B received no music therapy intervention during their first dressing change and music therapy during their next dressing, on the following day. Data were collected at 4 intervals in the medical procedure; in the patient’s room before transfer to the treatment room, in the treatment room during debridement, in the treatment room after debridement, and upon returning to the patient’s room. The measurements taken were pulse, patients’ self-report of pain, patients’ self-report of anxiety, and the nurse’s observation of patients’ tension. There was a significant reduction in the self-reporting of pain in those who received music therapy in contrast to those who did not receive music therapy (P< .03). Music therapy is a valuable noninvasive intervention for the treatment of pain after burn injury.

ISSN:0273-8481    

出版商:OVID    

年代:2001

数据来源: OVID