|Annals of Burns and Fire Disasters - vol. X - n. 2
- June 1997
EFFECT OF BURN BLISTER FLUID ON THE
VIABILITY OF HUMAN CULTURE FIBROBLASTS
Caneira M., Mota-Filipe H., Castro M.,
Pinto R., Godinho-Matos M., Cordeiro-Ferreira A., Toscano Rico LM. Cir.
THE KEROSENE TRAGEDY OF
1994, AN UNUSUAL EPIDEMIC OF BURNS: EPIDEMIOLOGICAL ASPECTS AND MANAGEMENT OF PATIENTS
Gupta M., Ban sal M., Gupta A., Goil
ACCELERATION OF SKIN GRAFT HEALING BY GROWTH FACTORS
The optimum management of burn wounds continues to be problematic, especially when the lesions are deep and extensive. Attempts have been made to enhance wound healing in partial thickness wounds but agreement still has to be reached on the best method of evaluating the rate of healing in skin graft wounds. It has been shown in technically advanced studies that the use of growth factors on the wound enhances healing, even if the final outcome is inconclusive. Among the numerous studies that have been conducted, the platelet-derived growth factor is a key element that can stimulate angiogenesis, fibroblast proliferation, collagen synthesis, and reverse irradiation impaired wound healing. In this work the wound healing process was investigated by applying human platelet-derived wound healing factor (HPDWHF) and fresh porcine pituitary extract (PPE) topically to full-thickness skin graft (FTSG) wound on the back of rats. The results were encouraging, as it was found that fresh HPDWHF and PPE have powerful mitogenic activities that significantly enhance beterologous FTSG growth in rat wounds.
Wang H.J., Wan H.L.,
Yang T.S., Wang D.S., Chen T.M., Chang D.M.
TIMING AND THE THERMOGRAPHIC ASSESSMENT OF BURNS
The value of the thermographic assessment of burns using infrared imaging is well established. This technique has proved to be a useful tool in the estimation of burn depth. This study reviews thermographic images of burns obtained from 65 patients over a four-year period. In order to eliminate evaporative cooling artefacts, an infrared transparent water-impermeable membrane was used. Single images were obtained from patients suffering from burns in various sites (excluding the hands). A significant change in the temperature of deep burns was observed between days 2 and 3 post-burn. This result would suggest that the thermography of burns for the assessment of burn depth should be performed within three days of the injury.
Liddington M. L,
EPIDEMIOLOGICAL SURVEY OF CHILDHOOD BURNS IN FRANCE
Epidemiological data on childhood burn injuries are scant. This survey was intended to extend our knowledge in this field. A substantial proportion of French paediatric surgery units were invited to complete a questionnaire prepared by the Soci6te Frangaise d'Etudes et de Traitement des Brillures. The objective was to determine the characteristies of the burned children and the risk factors involved. The survey found that the typical paediatric burn injury patient was male (61.6%), with a mean age of just under four years, suffering from scald burns (64.1%) that occurred in the kitchen (56.2%). The bathroom was an especially dangerous room. Most burn lesions (59%) were superficial, covering less than 10% body surface area. Grafting was required in 35% of patients. The importance of epidemiological surveys is stressed as they provide objective information on the settings where burns are likeliest to occur. This information is essential for the development of appropriate preventive strategies.
Mercier M., Blond
PERMANENT GRAFTING OF LIVING SKIN SUBSTITUTES SURGICAL: PARAMETERS TO CONTROL FOR SUCCESSFUL RESULTS
The most conventional approach for permanent skin replacement after severe burns makes use of autologous mesh grafting, There are however several other types of skin substitute for full-thickness burn wound coverage. The clinical use of these dressings involves new surgical skills to preserve the integrity of the grafts and to promote their permanent implantation in vitro. The authors of this article consider nude mice grafted with cultured human skin equivalents. Certain parameters (quality of adhesion between implant and graft bed, size, stability and thickness of graft, chamber humidity, antibiotic administration protocol) were identified as being of crucial importance for the success of the surgical operation. This paper reports on the grafting procedures used. The results should prove useful in all transplantations of skin grafts in vitro.
Xu W., Germain L.,
Goulet E, Auger EA. J.
NEUTROPHIL RECRUITMENT AFTER REMOTE SCALD INJURY
The purpose of this series of studies was to define the relationship between a relatively small topical thermal injury and early pulmonary neutrophil recruitment as manifested by histological changes. The time course of burn-induced neutrophil recruitment was considered and observations were made with regard to the the role of infection at the burn wound and the lung that occurs simultaneously with the neutrophil recruitment pattern. The article describes the modality of the experiment, conducted on 8- to 10-week-old mice. It was found that scald injury was associated with significant pulmonary recruitment that resolved at 24 h. The presence of a wound left untreated was associated with neutrophil recruitment beyond 24 h in spite of normal outward behaviour.
Stengle J., Meyers
R., Pyle J., Dries D.J.
ASSESSMENT OF COSMETIC AND FUNCTIONAL RESULTS OF CONSERVATIVE VERSUS SURGICAL MANAGEMENT OF FACIAL BURNS
The question considered here was whether the cosmetic and functional results of tangential excision and thick split-thickness grafting (STSG) of deep facial burns were better than the results given by conservative management. The forty patients with face burns included in the study were followed up for a mean time interval of 18.3 ± 8.3 months. Of the forty patients, thirteen healed without surgery within 21 days (group A); eleven healed without surgery in 21 days or more 8 (group 13); six had early debridement and thick STSG in 18 days or less post-burn (group Q; and ten had delayed debridement and thick STSG in more than 18 days post-burn (,-roup D). Group A patients showed a significantly better overall rating on the scar assessment scale that was used. Skin-grafted areas in groups C and D had a significantly better scar rating than the spontaneously healing wounds in group B. There was no significant difference between groups B, C, and D when the total number of persistent functional problems after treatment was considered. The commonest functional problems in these 27 patients were microstomia (17) and clid ectropion (17). Patients with superficial facial burns healing in less than 21 days generally achieved very acceptable cosmetic and functional results, while those with deep facial burns requiring long periods for spontaneous wound healing, tangential excision of the wound, and resurfacing with thick STSG appeared to give better cosmetic results than conservative management, without any greater risk of functional complications.
Fraulin F.O.G., Illmayer S.J.,
EXPERIENCE WITH TOXIC EPIDERMAL NECROLYSIS TREATED IN A BURN CENTER
In recent years burn surgeons have become increasingly interested in toxic epidermal necrolysis syndrome, which is one of several clinically similar, severe acute, exfoliative skin disorders. The disease is usually an iatrogenic reaction to commonly used drugs. Recognition of the clinical course, which is similar to that of extensive second-degree burns, has led to the development of treatment protocols best carried out in a burn unit by experienced personnel acquainted with critical care techniques, the management of extensive cutaneous injuries, fluid and electrolyte derangements, and the intensive nutritional support of critically ill patients. It is now thought that toxic epidermal necrolosis syndrome is usually a CD8 lymphocyte-mediated reaction triggered by exposure to certain drugs. The target organs of the immune reaction are the skin and mucous membranes. For good results, patients must receive the best possible nutritional and critical care support that can be found in burn units.
Yarbrough R.Y., III
THE USE OF HALOPERIDOL IN THE AGITATED, CRITICALLY ILL PEDIATRIC PATIENT WITH BURNS
Haloperidol has become the drug of choice for the sedation of acutely agitated, delirious adult patients in the critical care setting. This is because of its well-documented efficacy and lack of major side effects. However, its use has not been described in critically ill paediatric burn patients. To fill this gap, this article reviews the medical records of 30 critically ill paediatric burn patients treated with haloperidol in 1986-92. It was found that haloperidol was safe and effective in the treatment of severe agitation and delirium in critically ill paediatric patients. The intravenous route appeared to be more effective than the enteral route and should be considered when rapid, acute control of agitation is necessary. Brown R.L., Henke A., Greenhalgh D.G., Warden G.D.
J. Burn Care Rehabil., 17: 34-8, 1996.