摘要:

Alterations in the cutaneous vasomotion function caused by scald burns to a large area on the flank were observed and quantified in a dorsal skin flap window with a hamster model. Subsequent to chronic implantation of the window chamber to provide direct microscopic observation of blood flow for an entire thickness of skin, control measurements of vasoactivity in a defined network of arterioles were taken by means of a digital video image splitter over a period of several days. A 100° C, 5-second water scald was then effected over 17% to 55% of the total body surface area, and the vasoactivity was remeasured in the targeted set of sites at serial time intervals for 2 to 4 days. Data were acquired directly into a computer and analyzed for both the magnitude and time pattern of diameter fluctuations during 3-minute observation periods. Average and standard deviations of diameters were computed, and the Prony power spectral analysis method was applied to identify the presence and strength of fluctuation frequencies. In general, vasomotion was suppressed for several hours subsequent to the burn, and the activity was dominated by much slower contractions than control. No direction of vessel diameter changes prevailed uniformly throughout the peripheral microcirculation. Large alternate constrictions and dilations were also observed for some arteriolar and venular components, but others exhibited no significant change at all. The incidence and magnitude of peripheral microvascular response was proportional to the size of the injured area.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A multifaceted approach that involves early debridement and control of infection is critical to successful and rapid burn wound healing. This pilot study was conducted in 15 adult patients with burns to assess the usefulness of early enzymatic debridement with a combination of collagenase ointment and polymyxin B sulfate/bacitracin spray versus silver sulfaldiazine cream in partial-thickness burns. Combination treatment with collagenase and polymyxin B sulfate/bacitracin resulted in significantly shorter time to achieve a clean wound bed than silver sulfadiazine (median 6 vs 12 days;p= 0.0012) and significantly more rapid wound healing than silver sulfadiazine (median 10 vs 15 days;p= 0.0007). These results are encouraging and justify implementation of a larger, multicenter, comparative study.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Elderly patients with burns who were age 70 years or older and who were admitted to Tokyo Medical College Hospital from 1981 to 1992 were evaluated. Among 63 patients with burns, operations were performed in 35. Of the 63, 18 patients died (six after operation). Aggressive surgical wound closure with dermolipectomy, which we have been performing since 1986, obtained statistically significantly earlier wound closure compared with conventional methods. In cases with a burn index of 10 to 30, the number of fatalities was significantly lower. In addition, the lowering of the ability of daily life and mental status after the wound closure was statistically and significantly smaller. From these facts, aggressive wound closure with dermolipectomy appears appropriate for elderly patients with burns.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

One of the main uses of topical fibrin glue is hemostasis. Fibrin glue from pooled human plasma has been used in Europe for many years. It was used for fixation of skin grafts as early as 1944. Because of the risk of hepatitis and now of acquired immunodeficiency syndrome, this compound has not been approved by the U.S. Food and Drug Administration for use in the United States. It is now possible to make fibrin glue from a single unit of blood. Many blood banks have this capability, and burn centers in the United States are beginning to report its use in skin grafting procedures performed on patients with burns. In an effort to document a hemostatic effect, a prospective double-blind study was designed. Donor sites of patients with burns undergoing skin grafting were studied to provide a uniform wound; anatomic location varied, particularly with respect to gravity. Half of each donor site was sprayed with thrombin and fibrin glue, and the other half was sprayed with thrombin and placebo. A large absorbent pad was placed over the gauze dressing, and all dressings were collected and weighed by the investigators at 6 and 18 hours after the operation. Ten patients have been studied to date. In five patients slightly more bleeding occurred in the site treated with fibrin. One patient had no difference, and four had slightly less bleeding on the donor site treated with fibrin. No significant difference could be found in this initial study group. In this prospective double-blind study of skin graft donor sites, no significant difference in blood loss between areas treated with thrombin and fibrin glue and areas treated with thrombin and placebo could be found. It is recommended that additional work be done to determine the role of topical fibrin in burn care.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Chronic hand edema after wound healing is a troublesome condition to treat in patients with burns. Stagnant edema can cause fibrosis, which impedes rehabilitation and may lead to deformity. Although favorable results have been reported with mechanical compression used in acute injuries, no literature was found on the effects of compression for the treatment of chronic hand-burn edema. Five male patients with nine chronically edematous burned hands were subject to mechanical compression at 55 mm Hg pressure. A single-cell unit was used for a 30-minute treatment at 4:1 treatment ratio. Goniometric and volumetric hand measurements were recorded both before and after treatment. Although patients expressed a subjective feeling of improvement, no statistical difference was found in finger joint range of motion nor in hand volume when comparing pretreatment and posttreatment measurements. Many different treatment protocols exist in the literature and are discussed.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The combination of a glove made of an expanded polytetrafluoroethylene membrane—based laminate and silver sulfadiazine cream was evaluated as a treatment for burned hands. Eight patients who had burns averaging 25% total body surface area and who had 11 extensive partial thickness hand burns (2% total body surface area) were treated with an average of 17 gloves over 9 days. The burn wounds healed with no unusual or unexpected outcomes. Nurses and therapists agreed that dressing changes were quick and easy and that the gloves provided greater range of motion and function in the hands. Patients also expressed a preference for this method of treatment.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Recently, several of our patients have raised questions concerning the safety of blood transfusions and especially the transmission of human immunodeficiency virus infection. We have noticed a growing reluctance of patients to receive blood transfusions. This prompted us to review the use of blood in our burn unit for 530 patients who were admitted from 1987 to 1989. Our traditional reasons for transfusion have been either an ongoing hemorrhage that leads to hypotension or a hematocrit of less than 30%. For these reasons 131 (24.7%) of the 530 patients reviewed required transfusions. The average number of units transfused in patients who received blood was 10 (range 1 to 69). Three hundred ninety-nine patients (75.3%) did not require transfusions. We undertook a prospective preliminary trial of recombinant erythropoietin in five patients who were admitted to our burn unit over a 2-month period to evaluate whether this agent could lessen the transfusion requirements. Because no definite value is given in the literature as to what level of hematocrit is most appropriate for transfusion, we chose a hematocrit of 20% as our new indication for transfusion. Inclusion into the trial required a total body surface area burn of over 10% that required at least one operation. Five patients met the inclusion criteria. Administration of erythropoietin was started on admission. According to our new criteria for transfusion none of the five patients receiving erythropoietin required the transfusion of blood or blood products. This study would suggest the need for both a prospective clinical trial of erythropoietin and further studies to better define the indications for transfusions in patients with burns.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Options for treating the Jehovah's Witness with burns who repeatedly refuses blood are very limited. This article describes the use of human recombinant erythropoietin as an alternative to blood transfusion in a Jehovah's Witness with a 35% total body surface area burn. The combination of erythropoietin treatment, limited blood drawing, and excision and grafting under tourniquet control allowed this patient to undergo successful burn care, including four operative procedures to excise and graft 19.5% of the body surface area.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

3 mg/L) in 31 cases. For victims with cyanide levels above 3 mg/L the mean carboxyhemoglobin level was 62.5%. Cyanide poisoning is infrequent in fire fatalities, and when present it is associated with significant carboxyhemoglobinemia. Cyanide can be both produced and degraded in blood and tissue, making interpretation of blood levels difficult. In survivors of fire, detoxification of cyanide can occur without specific antidotes with the use of aggressive supportive care. Specific assay and treatment for cyanide poisoning is rarely necessary in the treatment of victims of smoke and fire.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID