Annals of the MBC - vol. 2 - n' 3 - September 1989
INTERNATIONAL ABSTRACTSTHE PREVENTION OF BURN INJURY
The causes of burn injuries are reviewed, with particular reference to the situation in India. It is however pointed out that the approach to the prevention of burn injuries must necessarily be different in each geographic region and for each socio-economic group. Educational campaigns among the general population must be insisted upon. But, above all, doctors should be taught how to prevent burn injury - burn prevention should be part of every medical curriculum. Many doctors may need to be re-educated in methods of immediate therapy for burns. Consumer movements must try to persuade manufacturers to improve the quality and servicing of goods that may constitute fire hazards, and the appropriate legislation should be tightened up. To avoid duplication of efTort, experiences could be shared, programmes exchanged, reciprocal visits arranged and in general an atmosphere of global cooperation to combat burn injury could be fostered.
Keswani M.H. Bums, 12: 533-539, 1986.
MICROSKIN GRAFTING. 1. ANIMAL EXPERIMENTS
A new grafting technique is described, microskin grafting. Experiments were carried out on rabbits. A piece of full thickness skin was excised from the subject rabbit to form a wound and a small portion of the removed skin was minced into tiny pieces. These were then immersed in normal saline and distributed evenly on the dermal side of a large piece of split thickness homograft taken from another rabbit. This combined autograft plus homograft was transplanted onto the wound of the subject rabbit. The microskin grafts took well and covered the wound completely in 8 rabbits out of 12. Failure was due to the homograft moving. This technique could be effective in the repair of extensive wounds when only small autografting donor sites are available.
Zhang M., Chang Z., Han X., Zhu M. Bums, 12: 540-543, 1986.
MICROSKIN GRAFTING. 11. CLINICAL REPORT
The microskin grafting technique was used successfully in the treatment of 7 out of 8 extensively burned patients. The recipient area covered by the microskm grafts ranged between 2.5 per cent and 44 per cent of TI1SA. Healing time ranged between 22 to 45 days after the transplant. The one failure was due to the homograft not taking, so that the microskin grafts beneath it could not survive. Microskin grafting can economize on autografts, the procedure is simple, and there is less scar formation on the healed wound. It is therefore a new approach to solving the problem of covering extensive full thickness burns with small amounts of autogenous skin.
Zhang M., Wang C., Chang Z., Cao D., Han X. Burns, 12: 544-548, 1986.
FLUID REQUIREMENTS OF SEVERELY BURNED CHILDREN UP TO 3 YEARS OLD: HYPERTONIC LACTATED SALINE VERSUS RINGER'S LACTATE-COLLOID
A prospective fluid resuscitation protocol was undertaken in which children with burns in 30 per cent or more of BSA were divided into 2 groups and treated either with hypertonic lactated saline (HLS) or with Ringer's lactate-colloid. The two groups were further divided according to age, i.e. under 3 years old, and 3 years and over. It was found that the children under 3 years of age needed significantly more fluid and sodium during the first 48 h when calculations were. made using body weight as the indexing factor. There were no significant differences in fluid and sodium requirements between the age groups when these needs were calculated on the basis of BSA. The variation in the findings appears to reflect the difference in surface area to mass ratio with regard to these age groups. The children resuscitated with HLS required 23 per cent less fluid in the first 24 h. Some retrospectively derived formulae are presented that should help the clinician in the calculation of the initial fluid requirements of the severely burned child. If body weight is used as a basis for estimating fluid needs, clinicians should be aware of the differences in fluid requirements for children under 3 years of age compared with older paediatric patients.
Bowser-Wallace B.H., Caldwell F.T. Bums, 12: 549-555, 1986.
THERMAL PROPERTIES CALCULATED FROM MEASURED WATER CONTENT AS A FUNCTION OF DEPTH IN PORCINE SKIN
Before a realistic tissue water boiling routine for a mathematical model of burn development could be developed, it was necessary to know the water content and the thermal properties of skin as a function of depth. Split thickness and full thickness skin samples were obtained from a number of domestic white pigs by means of an air-powered dermatome. The skin grafts were cut tranversely into segments, which were then processed to determine either water content or skin thickness. The tissue samples were weighed, dried and weighed again in order to determine tissue water content. In some cases tissue volume was also determined to allow the calculation of tissue density. A formula is given for the calculation of water content as a function of depth. Skin thermal properties as a function of depth were also calculated. As the data were consistent with those in the literature for human skin, the model can be used to predict human burn depths more accurately.
Knox F.S. 111, Wachtel T.L., McCahan G.R., Knapp S.C. Burns, 12: 556-562, 1986.
CHANGING PATTERNS IN THE CAUSES OF SCALDS IN YOUNG DUTCH CHILDREN
There was a reduction in the number of scalds due to hot coffee in young children admitted to a Dutch university hospital during the period 1972-85. This is probably due to the increasing use of electric coffee machines.
Klasen H.J., ten Duis H.J. Burns, 12. 563-566, 1986.
THE EFFECT OF DRUGS WHICH AFFECT THE ARACHIDONATE CASCADE IN BURNED RABBITS
A number of drugs (OP-41483, aspirin, OKY-046, CV-3988) were administered to rabbits previously subjected to full skin-thickness burns covering 35 percent of the TI1SA. All untreated animals died within 24 h after the injury. In the treated animals, renal function was distinctly improved, compared to control animals, except in the case of treatment with CV-3988, when improvement was only slight. These drugs can therefore be used to reduce the risk of organ failure after burn injury. As OP-41483 is a fast-acting agent, this drug is the most effective form of treatment, considering the speed with which these changes presumably occur immediately after the burn.
Ono L, Ohura T., Azarni K., Hoshi M,, Hasegawa T., Tsutsurni M. Burns, 12: 572-577, 1986.
ECTHYMA GANGRENOSUM IN A BURNED CHILD
The history of ecthyma gangrenosum, its pathological diagnosis, its usually grave prognosis and natural history are presented. Various forms of treatment used in the past are referred to. A case is described of a 13-month-old baby with this condition following bum injury, and a suggestion for optimal treatment is put forward based on the experience at the Cincinatti Shriners Burns Institute. This includes: early recognition, general nutritional and metabolic support, and high-dose aminoglycoside and semi-synthetic penicillin therapy (administered parenterally and by sub-eschar clysis).
Eldridge J.P., Baldridge E.D., MacMillan B.G. Burns, 12: 578-585, 1986.
THE RELATIONSHIP BETWEEN POST-BURN INCREASES IN PERIPHERAL RESISTANCE AND VASOPRESSIN
In an experiment carried out on the dog anaesthetized with sodium pentobarbital receiving a 15 per cent BSA full skin-thickness flame burn, it was found that administration of the vasopressin, V-1 receptor, blocking agent d(CH2)5Tyr(Me)AVP (SK&FI00273) before the burn significantly reduced the increase in peripheral resistance occurring in untreated animals. Treated animals had a peripheral resistance of 60.2 +/- 7.8 units at 30 min post-burn compared to 117.1 +/- 16.8 units in untreated animals. These values were, respectively, 71.3 +/- 7.2 units and 117.0 +/- 13.5 units at 60 min post-burn. The decrease in cardiac output in the animals pretreated with the vasopressin blocking agent was significantly less than that observed in the untreated animals. There were no significant differences between the mean arterial blood pressures of the treated and the untreated animals, either pre- or post-burn. It was found that immediately post-burn vasopressin plasma levels increased from 6.2 +/- 2.2 pg/ml to 27.3 +/- 9.5 pg/ml and peripheral resistance from 62.3 +/- 6.3 units to 128 +/- 20.3 units. These last values remained high during the remaining 6 h of the experimental study. On the basis of the results it can be said that following thermal injury there is a significant release of vasopressin and that the increase in peripheral resistance might be in part due to the vasoconstrictor action of the released vasopressin.
Hilton J.G., McPherson M.B., Marullo D.S. Burns, 12: 410-414, 1986.
A COORDINATED APPROACH TO THE DISCHARGE OF BURNED CHILDREN
This is a systematic approach to some psychological problems that may arise, when burned children are recovering from their injuries, prior to discharge from hospital. A 14-step programme is described, the purpose of which is to allow nursing representatives on the burn team to prepare these children for "social reimmersion".
Manger G., Speed E. J. Burn Care Rehabil., 7: 127-129.
COMPARISON OF CONTINUOUS AND INTERMITTENT TUBE FEEDINGS IN BURNED ANIMALS
On the basis of the results of a comparative study, in the guinea pig, of the nutritional effects of three delivery methods of enteral formulae (continuous, intermittent and a combination of the two), it is suggested that either intermittent or continuous enteral feedings can be used for nutritional support of burned humans, but that protein supplements should probably not be given by bolus infusion.
Trocki 0., Mochizuki H., Dominioni L., Heyd T., Alexander J.W. J. Burn Care Rehabil., 7: 130-137.
ARM HAMMOCK FOR ELEVATION OF THE THERMALLY INJURED UPPER EXTREMITY
A description is given of an arm Viammock that has been used successfully for more than two years, satisfying the therapeutic aims of elevation and circumferential wound exposure, and at the same time providing correct positioning and variable resilient support.
Kulis Hecter R, Brown R. J. Burn Care Rehabil., 7: 144-146.
A LEG SUPPORT FOR CIRCUMFERENTIAL EXPOSURE OF DONOR SITES
In view of the importance of the post-operative care of donor sites, which should be kept exposed to the air, it is essential to provide an environment conducive to expedient healing through prevention of microbial contamination, infection, and mechanical trauma. Accordingly a device was developed allowing maximum exposure of donor sites on the lower extremity, eliminating focal areas of increased surface pressure, and avoiding pressure necrosis over bony prominences.
Kulis Heeter P. J. Burn Care Rehabil., 7: 146-147.
POST-OPERATIVE SPLINTING OF THE LOWER FACE AND NECK
Post-operative splints are never easy to manufacture and among the most intricate to fabricate are splints used following reconstruction of the neck and perioral regions. A two-part splint was developed for the post-operative period of care of combined neck and under lip grafts. It satisfies three main requirements: a) total contact to graft; b) freedom of lip and mandibular movements; c) acceptable cosmesis and comfort. The basic design can be variously modified.
Parrish N.E. J. Bum Care Rehabil., 7: 148-150.
USE OF THE DYNASPLINT TO CORRECT ELBOW FLEXION BURN CONTRACTURE: A CASE REPORT
The Dynasplint* is a recently developed spring-tension, low-load, prolonged stretch device which is indicated for use in fractures, neurologic impairment, joint arthroplasties and arthrotomies, rheumatoid arthritis, haemophilia and tendon and ligament repairs. A description is given of its use also in the case of burns, in a burn patient with elbow flexion contracture. At the end of treatment the degree of elbow contracture was considerably lessened, resulting in a normal range of motion at the time of the patient's discharge.
* Dynasplint Systems, Inc, 6655 Amberton Drive, Baltimore, MD 21227, USA. Richard R.L. J. Burn Care Rehabil., 7: 151-152.
BURN CARE PROTOCOLS - DONOR SITE CARE
Three nursing protocols, as followed in three different Burn Centres, for managing donor sites are presented, satisfying the objectives of the prevention of infection and tissue maceration, the promotion of healing and comfort, and the maintenance of function. Advice is given on positioning, ways of promoting drying of the donor site and keeping it clean, methods for the support of sites in dependent locations, and on how to observe for evidence of infection.
Gordon M. (ed.) J. Burn Care Rehabil., 7: 154-159.