A comparison was made between a new poly(ether urethane) (PEU) wound covering with a high water permeance and tulle gras treatment on adjacent areas in 20 split-thickness skin graft donor sites in burn wound patients. The PEU-covered sites caused little or no pain, while 70% of the patients treated with tulle gras notified pain. It was also found that the PEU wound covering prevented fluid retention and jellified the wound exudate. The tulle gras dressing ensured similar healing rates, but was more painful, especially when it had to be removed.

Jonkman M.F., Bruin P., Pennings A.J., Coenen J.M.F.H., Klasen H.J.
Burns, 15: 211-216, 1989.

THE AETIOLOGY OF BURNS IN DEVELOPED COUNTRIES: REVIEW OF THE LITERATURE

A review is made of the causes of burns, with particular reference to Europe, America and Australia - scant literature is available from non-Western countries. The commonest causes of thermal injury are generally considered to be scalds caused by hot liquids, burns due to flame, flash and contact, electrical and chemical burns, and burns due to other causes. Men appear to be at greater risk than women. A common home hazard is hot tea and coffee. One fact that must be pointed out is that surveys are invariably carried out among burn victims but not, for example, among parents whose children have not had burn accidents. These factors must be taken into consideration when a prevention campaign is undertaken.

Van Rijn O.J.L., Bouter L.M., Meertens R.M. Burns, 15: 217-221, 1989.

Severe burns are generally considered to affect the biophysical behaviour of the white blood cells, a phenomenon which might alter their immunological functions and thus influence the microcirculatory perfusion of the affected tissues. In view of the possibility that these changes could be of clinical and/or prognostic significance, 15 randomly selected severely burned patients were investigated immediately after admission to hospital. Comparison with normal controls showed that the burn injuries were associated with higher white cell counts and enhanced leucocyte aggregation. This alteration could be of prognostic significance and further research is recommended.

Ernst E., Schenkel R., Weiland H., Matrai A., Heiss J. Burns, 15: 222-224, 1989.

A study was undertaken in order to evaluate with some degree of accuracy the topical effects of human uterine angiogenic factor (HUAF) on the neovascularization process in experimental wounds and burns. A bioassay of HUAF was carried out on an i . n vivo model of subdermally implanted collagen sponges and on sponges implanted into full thickness burn wounds in Hartley-derived albino female guinea-pigs. It was found that HUAF extract was active on the in vivo model of experimental burns.

Lindenbaum E.S., Kaufman T., Beach D., Maroudas N.G. Burns, 15: 225-229, 1989.

BURN RESUSCITATION WITH A LOW-VOLUME PLASMA REGIMEN - ANALYSIS OF MORTALITY

A mortality analysis was carried out in order to assess the validity of the burn resuscitation regimen used in 482 consecutive patients in the five-year period 1978-1982, at the Rambam Medical Center, Haifa, Israel. The management of severe burns during the shock period was by a low-volume regimen based on the use of plasma and a small volume of crystalloids in the form of lactated Ringer's solution. A probit analysis of mortality was performed, according to Bull and Squire, in order to evaluate the efficacy of the method. It was found that adequate resuscitation with low volume of Mostly colloid solution in the form of plasma contributed to a higher rate of survival.

Aharoni A., Abramovici D., Weinberger M., Moscona R., Hirshowitz B.
Burns, 15: 230-232, 1989.

INTERMINGLED SKIN GRAFTS WITH IN VITRO CULTURED KERATINOCYTES - EXPERIMENTS WITH RATS

Experiments carried out in rats showed that in the treatment of deep thermal burn injuries it was possible to use a "brel" of autogenic in vitro cultured keratinocytes instead of autogenic split-thickness skin islets in intermingled skin grafts, with good results. The take was more homogeneous and therefore cosmetically more appealing. Possible future clinical applications are considered.

Hafema~n B., Frese C., Kistler D., Hettich R. Burns, 15: 233-238, 1989.

A retrospective study was made of 37 burn patients aged over 70 years, with the intention of examining the effect of age on prognosis and to determine the real causes of the generally worsened prognosis of elderly patients. The mean percentage BSA of the 37 patients was 18% (range 0.5-65%). Baux's index (age plus surface area index) averaged 98. Mortality was 59%, compared to a 27% mortality rate during the same period among 291 burn patients under the age of 70 years admitted to the same Unit during the same period, although the mean BSA was very similar. The risk of death, for a given BSA, appeared to be twice as high in patients over 70 years of age than in younger subjects. Pre-existing pathological conditions had a very important influence on the outcome, in particular cardiorespiratory and circulatory conditions. The form of treatment is also important, as it is significant that, of the elderly patients treated conservatively or by early excision graft, two-thirds died.

Baux S., Mimoun M., Saade H., Lioret N., Esteve M., Nolland X.B., Bertière M.N. -
Burns, 15: 239-240, 1989.

A review was made of the records of 162 consecutive paediatric (up to age 17 years) admissions to the Western Pennsylvania Hospital Burn/Trauma Center over the past three years. The mean age was 5 yrs 5 mths and the ratio of males to females was 2 to 1. The mean body surface burn area was 20% second and third degree burns. A low mortality rate was achieved in the treatment of seriously burned children through the application of current standard principles in the management of adult patients and these are described.

Feldman M., Slater H., Goldfarb W. J. Burn Care & Rehabil., 7: 244-246, 1986.

This study concentrates its attention on burned children who show competence and resilience in the face of burn injuries. The factors that appeared to improve a burned child's social competence were a family with greater interest in political, intellectual and cultural matters, a family with greater participation in social/recreational activities, a family of higher socioeconomic status, a family with many members in the household, a mother who viewed her child's adjustment more positively, a longer period since the burn, and a more severe burn. It is not true that the less severe the burn the fewer the adjustment problems.

Byrne C., Love B., Browne G., Brown B., Roberts J., Streiner D. J. Burn Care & Rehabil., 7: 247-252, 1986.

In the USA about a half of all cases of arson are caused by juveniles under the age of 18. This article describes a programme of re-education for such offenders, which has been successful because out of 220 juvenile fire offenders participating, only one has since been in trouble again, but not for fire-related offences. These young people often have emotional problems and trained personnel is required capable of psychological counselling. The parents and guardians of the children also need to participate if any such programme is to be a success.

J. Burn Care & Rehabil,, 7: 253-256, 1986.

The head splint described is a thermoplastic and foam device worn by the patient post-grafting to minimize movement of the neck. In this way it is possible to achieve the relative immobilization necessary to prevent shearing between graft and recipient bed. This splint has the advantages of comfort, adjustability and easy removal to cheek for pressure areas.

Carlow D.L., Gelfant B. J. Burn Care & Rehabil., 7: 257-260, 1986.

This article discusses the various pulmonary disease states in the order in which they develop in the burn patient. Most of these dysfunction syndromes are treatable if recognized early and managed aggressively. A review is therefore made of basic pulmonary physiology, pulmonary abnormalities, the effect of chemical burns on the lung, impairment of chest wall compliance, post-burn lung dysfunction, pulmonary circulation, and inflammation-induced respiratory failure.

Dernling R.H. J. Burn Care & Rehabil., 7: 277-284, 1986.

Successful management of thq ventilatordependent burn patient requires reliable protocols for monitoring and protecting the patient, aggressive pulmonary toilet and positioning, a logical approach to weaning and extubation, and - above all -informed, experienced and dedicated bedside personnel. A review is made of the complications of airway maintenance and conventional positive-pressure ventilation, routine care of the ventilated patient and ventilation monitoring, management of the patient who seems to be "fighting" the ventilator, weaning considerations, and extubation procedures.

Wallfisch H.K. J. Burn Care & Rehabil., 7: 285-293, 1986.