Annals of the MBC - vol. 2 - n' 4 - December 1989
INTERNATIONAL ABSTRACTSAN EVALUATION OF A011APHOR* GAUZE DRESSING IN BURNED CHILDREN
Aquaphor Gauze (AG) consists of a gauze dressing made from fibres of cellulose acetate, impregnated with a cream composed of petrolatum, mineral oil, mineral wax and wool-wax alcohol. An investigation was made of the ability of this new type of gauze to act as a dressing for skin graft donor sites, partial-thickness burn injuries, and split-thickness skin grafts. The control dressings used for comparative purposes were as follows: fine mesh gauze for the skin graft donor sites, silver sulphadiazine (Silvadene) on coarse mesh gauze for the partial-thickness burns, and nitrofurazone (Furacin) on fine mesh gauze for the skin grafts. AG proved to be inferior to the fine mesh gauze as a donor site dressing. There was no significant difference between AG and the control dressing in the treatment of partial thickness bums. The best use of AG was seen as a dressing for skin grafts, when it was found to be significantly superior to Furacin, with improved graft take and reduced pain. AG is recommended as a dressing for skin grafts, provided that there is no excessive risk of infection.
Waymack J.P., Nathan P., Robb E.C.,
Plessinger R., Rapien J., Krummel R., Jenkins M., Macmillan B.G.
DYNAMIC CHANGES OF LUNG LYMPH FLOW AND THE RELEASE OF LYSOSOMAL ENZYME FROM THE LUNGS AFTER SEVERE STREAM INHALATION INJURY IN GOATS
Six adult goats were prepared for collection of lung lymph, using the authors' modification of Witin's and Stothert's methods, in order to define the pathophysiology of pulmonary oedema after severe steam inhalation injury. In the 24 h post-injury, arterial blood gas, lung lymph flow (QLym), lymph/plasma total protein concentration ratio (L/P) and B-glucoronidase (B-G) in plasma and lung lymph were monitored. Pathological changes in lung tissue were investigated on conclusion of the study. Directly after injury, QLym began to increase steadily, peaking at 6 h, declining at 18 and 24 h. L/P immediately decreased in the first hour after injury and then increased to a peak value at 4 h (p<0.05). A significant increase in B-G was observed only 4 h post-burn. Lung lymph B-G activities and lymph B-G transport did however increase immediately after steam inhalation, reaching a peak at 4 h. Hypoxaemia and hypocapnia occurred at 2 h post-bum and deteriorated progressively. Pulmonary interstitial and alveolar oedema were clearly visible on microscopic investigation. The increase in transvascular fluid and protein flux after steam inhalation injury is shown by this study to be mainly due to increased pulmonary microvascular permeability, although a hydrostatic pressure effect cannot be completely ruled out, especially in the first hour post-bum. Lysosomal enzyme release would seem to be one of the important factors which damage lung microvascular elements and induce an increase in their permeability.
Cheng-zhong W, Ao L. (Ngao), Pei-fang L, Zhong-cheng Y., Jing-yan G., Si-qun L, Dun W., Na A.
Bums, 12: 415-421, 1986.
RELEASE OF BURN SCAR CONTRACTURES OF THE NECK IN PAEDIATRIC PATIENTS
A review of 143 neck-release procedures carried out at the Cincinnati Shriners Burns Institute indicated a high rate of recurrence of contractures, particularly in patients who had previously suffered bums to the entire anterior neck. Recurrence rates were 81 per cent after treatment with Z-plasties and 62 per cent after releasing incisions with split thickness skin grafts. The recurrence rate was reduced, following skin grafting, to 17 per cent by the use for one year of a neck hyperextension brace. Some patients were not cooperative in wearing the brace, in which case best results were obtained by using a fullthickness skin graft in the release site. A variety of techniques proved successful in the treatment of contractures resulting from minor burns.
Waymack LR Bums, 12: 422-426, 1986.
ACUTE ELECTRICAL BURNS: A 10-YEAR CLINICAL
Over a 10-year period (1975-1984) 113 cases of electrical burns were treated at the Cook County Bum Center, representing 3.5 per cent of a total number of 3265 acute bum admissions.
Low-voltage electricity was responsible for 73 per cent of the 113 cases, mainly involving household electricity supplies and occurring prevalently in children. Most of the bums were preventable. Arc burns of the perioral region were allowed to heal spontaneously. Other arc burns and flash burns were treated surgically as for most deep bum wounds.
High-voltage electricity was responsible for the remaining 27 per cent of the cases. More than half of these were not work-related, tending to occur mainly outside the home in young males; these accidents too were frequently preventable. No case of acute renal failure occurred in any of these patients. Septic complications were avoided by early surgical debridement of devitalized tissue with allografting, prior to delayed definitive wound closure or amputation. Loss of a limb is the major factor contributing to the high morbidity rate in these injuries. None of the 113 patients died. We believe this lack of mortality to be due to the early transfer of the patients to our Burn Unit, aggressive fluid resuscitation, continuous haemodynamic and metabolic support, and early surgical intervention.
Hanumadass M.L., Voora S.B., Kagan R.J., Matsuda T. Burns, 12: 427-431, 1986.
13-MODE ULTRASONIC ECHO DETERMINATION OF DEPTH OF THERMAL INJURY
It was found that current ultrasonic techniques are of no practical value to the bum surgeon in the precise differentiation between the depth of a deep dermal burn and a full thickness thermal injury. This finding was reached after a pilot study of five burned patients. A high-resolution high-frequency prototype B-mode ultrasonic scanning device was used to determine the depth of the bum injury. Ultrasonic scanning was not superior to traditional clinical evaluations and histopathological studies of the same burned areas in the prediction of bum depth.
Wachtel T.L., Leopold G.R., Frank H.A., Frank D.H. Bums, 12: 432-437, 1986.
CEMENT BURNS OF THE HEEL
Serious burns from wet cement have been reported in the literature, but here two unusual cases are described of thermal bums caused by hot cement powder. Two artisans sustained burns of both heels and lower legs. The pathology of their bums was similar to that of burns with wet cement, i.e. formation of erythema, within hours of contact, leading to skin necrosis. blackening and ulceration which takes 4-6 weeks to heal. This is an occupational hazard among building workers; governments, especially in developing countries, should enforce strict safety precautions.
Onuba 0., Essiet A. Burns, 12: 438-439, 1986.
THE USE OF THE MINI-TRACHEOTOMY TECHNIOUE IN BURNED PATIENTS
Mini-tracheotomy is a very useful technique. It is safe, easily performed and leads to improved survival in cases of sputum retention (with or without inhalation injury). Two cases are reported.
Frame J.D., Eve M.D., Walker C.C. Burns, 1986: 440-442, 1986.
COMFORT CARE: AN ALTERNATIVE TREATMENT PROGRAMME FOR SERIOUSLY BURNED PATIENTS
Very severely burned patients with little or no prospects of survival present a difficult ethical and practical problem for medical decision-makers. The choice is between the use of aggressive curative therapy and purely comfort care. The patient and/or close relatives should be presented with this option. A 12-point protocol is given for comfort care when it is decided to abandon curative therapy.
Wachtel T.L., Frank H.A., Nielsen J.A. Burns, 13: 1-6, 1987.
METHOD TO DETERMINE ANTIBACTERIAL ACTIVITY OF SILVER SULPHADIAZINE CREAMS
There is a need for an in vitro microbial assay to determine if and to what degree an organism is resistant to a topical cream, and in particular to silver sulphadiazine (AgSu), which has long been successfully used in the prevention and treatment of infection following wounds, in view of the finding that some AgSu-resistant organisms have been observed. An assay method is described to determine the minimal bacterial concentration of AgSu-resistant in a topical cream (Silvadene). The method was optimized using two different sonicators and isolates of Pseudomonas aeruginosa, Staphylococcus epidermidis, and Staphylococcus aureus. Sonication induces homogeneity of AgSu cream samples in a liquid broth and equivalent diffusion of AgSu from sample to sample.
Klein S., Lentsch R.H., Christoffersen G. Burn Care, 7: 382-384, 1986.
FREE FLAPS IN SELECTED BURN PATIENTS
Three selected cases of severe thermal or electric injuries are described. The lesions were extensive and the patients required resuscitation. Free flaps were used to cover the burned areas; pedicle flaps were not considered appropriate or technically possible because of severe full-thickness burns of adjacent skin and muscle. The surgical procedures were well tolerated and function was regained that otherwise would have been lost.
Slater H., Newton E.D., Goldfarb W.I., Hernandez P. Burn Care, 7: 385-387, 1986.
PROGRESS IN THE CHARACTERIZATION OF IMMUNOSUPPRESSIVE GLYCOPEPTIDE (SAP) FROM PATIENTS WITH MAJOR THERMAL INJURIES
An investigation was made of the immunosuppressive activity of glycopeptide (SAP) in burn patients. Its effects include inhibition of neutrophil chemotaxis, suppression of T lymphocyte blastogenesis, and erythrocyte haemolysis. The activity of SAP appears to be calcium dependent and it is greatly reduced by the addition of anti-collagen, anti-Clq, or anti-burn toxin globulin and by treatment with cerium nitrate. The whole plasma used for the studies was obtained from severe patients, all with 40% BSA burns. It is concluded that SAP plays a major role in the immune consequences of thermal injuries. However a definite understanding of its pathophysiological role will be achieved only when the mediator has been completely characterized and eventually synthesized.
Ozkan AX, Ninnemann J.L., Sullivan J.J. Burn Care, 7: 388-397, 1986.
INFLUENCE OF MEMBRANE DRESSINGS ON WOUND CONTRACTION
This work was prompted by the desire to substantiate the recent finding that coverage of full-thickness wounds on rats with the membrane dressing Biobrane caused significant inhibition of wound contraction. Other membrane dressings (inverted Biobrane, porous Biobrane, Op-site and fine-mesh gauze) were also studied. The results suggest that maintenance of an adherent dressing on a full-thickness wound in the rat can prevent or significantly reduce the degree of wound retraction. It is not yet known how relevant these findings are to the management of large full-thickness burns in man.
Foresman P.A., Tedeschi K.R., Rodeheaver G.T. Burn Care, 7: 398-403, 1986.
A number of common chemical bums are described. It is stressed that it is essential in the presence of these burns to initiate immediate hydrotherapy in order to prevent continuation of the destructive activity of the chemical, which on no account must be allowed to spread over healthy skin areas. Two case histories are described, one involving bums caused by petrol and the other by phenol.
Saydjari R., Abston S., Desai M.H., Herndon D.N. Bum Care, 7: 404-408, 1986.
PSEUDOMONAS MALTOPHILIA: AN UNUSUAL WOUND PATHOGEN
Pseudomonas maltophilia is a rare burn wound pathogen. The isolate described was unusually antibiotic-resistant. Two case histories are described. The possible presence of P. maltophilia in burn patients draws attention to the need for constant vigilance in the investigation of any unusual isolates.
Kealey G.P., Cram A.E. Burn Care, 7: 409-410, 1986.
COMPARISON OF BURN SIZE ESTIMATES BETWEEN PREHOSPITAL REPORTS AND BURN CENTRE EVALUATIONS
A comparison is made between estimates of burn size made by prehospital personnel and subsequent burn centre evaluations. Out of a series of 193 patients, total body surface burn was overestimated in 113 cases and underestimated in 59 cases. The prevalence of overestimation of burn size by prehospital personnel may overload maximum-care facilities and cause inefficiency in staff use and increased costs. Improvement in evaluation methods by prehospital personnel is therefore desirable.
Berkebile B.L., Goldfarb W., Slater H. Bum Care, 7: 411-412, 1986.
A. BENIGNO M.D. E. PIRILLO M.D.