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Volume III |
Number 1 |
March 1990 |
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SUMMARIES
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LA PLACE DE L'EXPANSION CUTANÉE DANS LES SEOUELLES DE BRÛLURES
(S. Baux - France)
Il existe une grande variété d'expandeurs cutanés, dont deux grands types s'opposent: les modèles à valve incorporée et les modèles avec valves à distance. L'auteur décrit son expérience avec les expandeurs mis en place chez 137 patients. Il analyse en outre les types divers d'expandeurs et leurs avantages et leurs désavantages. La connaissance de cette technique de l'expansion cutanée n*est pas encore complète, mais elle permet déjà à l'heure actuelle de résoudre chez le brûlé un certain nombre de problèmes encore insolubles il y a peu et notamment l'exérèse des vastes placards cicatriciels.
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THE USE OF GAMMAGLOBULINS AND IMMUNOMODULATORS IN THE THERAPY OF INFECTIONS IN SERIOUS BURN PATIENTS
(Magliacani G., Stella M. - Italy)
The causes of infection in burn patients are examined in relation to origin and type. The importance of the condition of anergy in these patients is underlined. For correct immunological therapy it is indispensable to have an accurate diagnosis with haemocultures, biopsies, lymphograms, etc. On the basis of five years' experience the use is recommended of gammaglobulins in patients with a low scrum IgG titre in the shock phase and/or sepsis. Despite the absence of precise evidence regarding the utility of immunomodulators, their use is ic.cornmended whenever the bacterial flora present is not sensitive to antibiotics and in the pre-operative phase.
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SURGICAL TREATMENT OF POST-BURN CONTRACTURES OF THE HAND
(Caleffi E., Bocchi A., Toschi S., Ghillani M. - Italy)
When static and dynamic splints fail to improve the functional and aesthetic outcome of post-burn contractures of the hand, surgery is often found to be necessary. The only surgical procedure that offers satisfactory results is the flap technique. Three case histories are described.
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METACARPO-PHALANGEAL JOINT RELEASE IN THE MANAGEMENT OF POST-BURN STIFF HAND
(Tarek Atta A., Rizk A., Ismail M. - Egypt)
The present work presents the use of metacarpophalangeal (M.P.) joint release in the management of 20 cases with post-bum stiff hand. The paper presents a new modification of the technique of M.P. capsulectomy. The principle of our method of treatment is that we release the origin of the collateral ligaments, dorsal capsule and the deep transverse metacarpal ligament from the metacarpal head from within the joint through a dorsal incision in the capsule. After closure of that incision, the joint is left with an intact soft tissue sleeve around it, formed by the periosteum of the metacarpal, the joint capsule and periosteum of the proximal phalanx. This soft tissue sleeve will stretch enough to allow the joint to be flexed and the metacarpal arch to be regained. This position is maintained by Kirschner wires transfixing the joint, so that the ligaments and the dorsal capsule will get a more distal attachment to the metacarpal heads. Thus, the stability of the joint is not jeopardised. In the meantime, the dorsal contracted skin is replaced with healthy suitable skin cover. In conclusion, M.P. joint release in the management of post-bum stiff hand is recommended, as evidenced by the good post-operative hand function in the cases described.
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POST-BURN CONTRACTURE OF THE AXILLA EVALUATION OF THREE METHODS OF MANAGEMENT
(Higazi M., Mandour S., Shalaby H.A. - Egypt)
The surgical correction of 32 post-burn contractures of the axilla was evaluated using skin graft, Z-plasties and scapular flaps.
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CRYOPRESERVED ALLOGRAFT SKIN TO COVER 50% DEEP BURNS
(Pousa Real F. - Spain)
Cryopreserved allograft skin from cadaveric sources has proved to be an excellent material for burn wound covering, allowing temporary closure of the wound 10 days post-bum. Its use has many advantages in the case of second- or third-degree burns. The methods of obtaining, preserving and applying the skin are described. Two case histories are also given.
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SKIN BANK ORGANIZATION
(Pousa Real F. - Spain)
A survey is made of the organizational considerations that have to be faced in the setting-up of a skin bank, 1 hesc concern equipment, personnel, records and quality control. The methods of acquiring, processing, preserving and storing the skin are Careful records must be kept of its origin and destination. Strict application of a predetermined protocol will ensure a regular supph oi'~ iable allograft for the plastic surgeon.
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NURSING CARE IN BURNS
(Dayoub A. - Syria)
Nursing care in bum patients must take into account sources of infection, disinfection, isolation, nutrition and intravenous fluid administration. Some practical advice is given about basic nursing care.
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IS SEPSIS STILL A PROBLEM IN BURNS?
(Haberal M., Bayraktar U., OztOrk S., Oner I, Bilgin N. - Turkey)
From Ist January 1988 to 31st December 1988, 61 patients were admitted to our Bums Centre. The overall mortality was 19.67% 12 patients died and 49 patients were discharged. 8 (13.11%) adult patients died due to sepsis; in 7 of them, the bum cause was flame and in one electricity. 4 children died due to sepsis (bum cause hot liquid). Pseudomonas grew in 10 patients (83.33%), 7 adults and 3 children, and mixed bacteria in 2 patients (16.67%): in one adult (Pseudomonas, E. coli and Staph. coag+) and in one child (Pseudomonas, Proteus and Enterobacter).
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THE DIAGNOSIS AND TREATIVIENT'OF INFECTION IN THE BURN PATIENT
(El Morsi H.A.R. - Saudi Arabia)
The various risk factors involved in burn wound infection are reviewed, with reference to the patient's condition and to particular microbes. A number of factors, both systemic and local, can confound the diagnosis of infection and these are listed. A description is given of methods for assessing the microbial status of burn wounds. Fungal infection and immunological incompetence are also considered.
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LE PLAN D'UN SERVICE DE BRULES - SES CONTRAINTES
(Masse - France) |
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FACILITIES FOR TREATING BURNS IN MALTA
(Swain C. - Malta)
An account is given of the state of bums therapy on the island of Malta, which has a population of one third of a million, increasing in the holiday season. With such a small population, the number of burn patients is not high, and the Author expresses his pleasure at the creation of the MBC, a development that not only gives Maltese medical and paramedical stalYthe chance to work in other Mediterranean countries, thus increasing their expertise, but also provides the opportunity for the Maltese Burns Unit to accept a small number of patients from overseas, should the need arise.
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