ISSN:0273-8481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Two million people in the United States receive medical treatment each year for burn injuries. One hundred thousand of these patients are hospitalized, and 7800 die as a direct result of their injuries.1Of the patients that are hospitalized 30% to 40% are under 15 years of age. Sixty-seven percent are male. The average age of children with burns is 32 months.2Flame burns account for approximately 13% of accidents, scalds account for 85%, and electrical and chemical burns account for approximately 2%. The majority of scald injuries are small. Sixteen percent of burn injuries are not accidental, and approximately half of these are a result of documentable, inflicted abuse.3

ISSN:0273-8481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Hypermetabolism proportional to wound size is the expected response in patients who sustain large burns. This metabolic response persists until wound closure is achieved. The value of this response to the injured host remains unproven. Between 1978 and 1991, 104 patients with burns covering 30% or more of the body surface area underwent partitional calorimetry as a component of various research protocols. Thirteen of these patients failed to demonstrate an increase in metabolic rate as compared with a control group. These patients without hypermetabolism were compared with case-matched patients who demonstrated the expected increase in metabolic rate. Although they were not hypermetabolic in response to the burn injury, five of these patients were exposed to a cold stress and were able to increase their metabolic rate appropriately. The failure to mount a hypermetabolic response did not impact the clinical course as measured by survival, length of hospital stay, or maximum weight loss.

ISSN:0273-8481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The cardiopulmonary performance levels in children who are convalescing from thermal injury are unknown. This investigation was designed to evaluate cardiopulmonary function in children with and without inhalation injury. Forty children with a mean time since burn injury of 2.6 ± 1.9 years and a mean burn size of 44% ± 22% total body surface area were selected for the study and divided into two groups: inhalation injury (group 1) and non-inhalation injury (group 2). Pulmonary function studies and cardiopulmonary stress testing were completed on all patients. Both groups reached the same endurance level on the treadmill; however, patients in group 1 did so with an increased expired volume, respiratory rate, and ratio of dead space ventilation to total ventilation which indicated that there were greater demands on the respiratory system. Spirometry and lung volumes at rest showed that 64% of patients in group 1 had abnormal lung function compared with only 27% of patients in group 2.

ISSN:0273-8481    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

To substantiate an observation that donor sites that are harvested from the back scar less than those that are harvested from thighs, donor sites from both areas were evaluated for the extent of scarring. For donor sites that were harvested more that 1 year before evaluation, no significant improvements were observed. Back donor sites that were evaluated less than or equal to 1 year after harvest had significant improvements in height, color, edema, suppleness, and cosmetic appearance than those harvested from thighs. Thirty-two patients had both back and thigh donor sites harvested at the same time. Back donor sites had significant improvement in scar height, color, and edema. Cosmetic improvements were also observed. Significantly more patients preferred the back donor site over that of the thigh. The back is the preferred donor site for skin grafts in the pediatric burn population.

ISSN:0273-8481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Donor site dressings are highly diverse. The ultimate goal of any coverage is to minimize pain and healing time. Recently, synthetic laminates have become popular. Experience with Biobrane has mainly been with adult patients. This study examines the use of Biobrane in a pediatric population. One hundred eight consecutive applications of Biobrane in 95 patients (mean age 7.9 years) were reviewed. All applications were treated in identical fashion. Biobrane was left in place until healing occurred unless primary nonadherence occurred or fluid collections developed over a significant area, rendering the area nonadherent. Forty-three early removals of Biobrane were necessary at a mean of 3 1/2 days after application. The back and hip regions, with 43% and 80% early removal rates, respectively, were the areas where Biobrane was least successful in providing donor coverage until the site healed. The chest and thigh had successful full-term coverage in greater than 90% of cases. The principal basis for early removal was fluid accumulation, which reduced adherence. Early removal did not affect the healing time of the donor site. These results demonstrate a modest effectiveness of Biobrane as a donor site dressing on the back and hip regions in pediatric patients with burns. Selection of sites for which good success can be expected should be paramount in the decision to use this donor site material in this patient population.

ISSN:0273-8481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

From 1984 through 1989, 24 patients with 30 acute palmar burns (six were bilateral) that required skin grafting were evaluated to compare the efficacy of split-thickness versus full-thickness autografting. Sixteen of the palms had split-thickness skin grafts and 14 had full-thickness skin grafts. Normal range of motion was found in 8 of 14 palms that were treated with full-thickness skin grafts and in 4 of 16 for those that were treated with split-thickness skin grafts. Significantly fewer reconstructive surgical procedures were required in the palm burns that were treated with full-thickness skin grafts (full-thickness = 3 of 14 and split-thickness = 10 of 16). The results demonstrate improved function and decreased need for reconstructive procedures when full-thickness skin grafts are used for the treatment of deep palm burns in young pediatric patients.

ISSN:0273-8481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Burn scar contractures of the foot cause significant morbidity. We reviewed 68 children in regard to number and rates of burn scar contracture recurrence, surgical techniques, and functional and aesthetic results. Two surgical techniques of foot burn scar contracture release have been used. Originally, an incision over the metatarsal heads perpendicular to the line of the metatarsals, which releases the longitudinal arch of the foot was used. More recently, additional releasing incisions parallel to the plane of the metatarsals to release the transverse metatarsal arch have been used. The time between burn injury and primary burn scar contracture release was 4.18 ± 0.76 years, and the time until the first recurrence was 3.44 ± 0.46 years. With release of only the longitudinal arch, recurrence of burn scar contractures occurred in 3.5 ± 0.41 years and in 4.29 ± 1.27 years in six patients who also received release of the transverse arch. Wound closure at the time of acute burn with split-thickness skin graft expansion ratios of 1:2 and 1:4 had burn scar contractures that required release in 4.21 ± 0.70 and 2.29 ± 0.52 years, respectively.

ISSN:0273-8481    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

In spite of the common teaching that contracture releases should be avoided until scars have matured, the Cincinnati Shriners Burns Institute has been releasing contractures in immature scars to prevent prolonged loss of range of motion. To evaluate the efficacy of axillary releases and, especially, to determine whether releases performed in immature scars were detrimental, axillary releases that were performed between January 1, 1988 and December 31, 1989 were evaluated for improvements in abduction and flexion. Overall, axillary releases significantly improved abduction and flexion, and the improvement was maintained for at least 1 year. Comparison of early (less than 1 year after burn injury) with late (more than 1 year after burn injury) releases revealed that the preoperative limitation was worse in the early release group but that the ultimate outcomes were similar. Waiting for scars to mature before performance of contracture releases is not necessary.

ISSN:0273-8481    

出版商:OVID    

年代:1993

数据来源: OVID