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Volume III |
Number 4 |
December 1990 |
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SUMMARIES
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PERSONALIZED THERAPY SCHEDULES IN THE SERIOUSLY BURNED PATIENT
(Brienza E, Di Lonardo A., Cannone M., Macripò - Italy)
A prognostic index is presented on the basis of which it is possible to programme a differential therapeutic approach for different risk classes of burned patients. The index takes into account total bum %, deep bums %, age of patient, time period between bum and hospitalization, site of bum, and associated diseases. The various aspects of therapy in the severely burned patient are considered (systemic treatment and fluid therapy, nutritional, immunological and antibiotic therapy, and topical and surgical treatment). Special reference is made to Class IV patients, i.e. those at greatest risk.
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| 233 |
POLLICISATION BILATÉRALE POUR SÉOUELLES DE BRÛLURES
(Rouge D., Grolleau J.L., Chavoin J.P., Costagliola M. - France)
Les Auteurs décrivent la pollicisation de l'index chez un jeune patient gravement brûlé (60% de la surface corporelle, index UBS de 195). Les deux mains étaient atteintes en dorsal et en palmaire et il a été nécessaire de pratiquer des amputations bilatérales portant sur les extrémités de tous les doigts longs et les bases des deux pouces. Les Auteurs se sont proposés de recréer une pince pollicidigitale aux dépens de l'index. A la suite de quatre interventions et après une phase de rééducation, il a été possible de restaurer chez ce patient très invalidé une fonction manuelle compatible avec une vie quotidienne sans I*aide permanente d'une tierce personne.
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| 237 |
THE TREATMENT OF BURN SCARS: OUR EXPERIENCE
(loannovich J., Panayotou R., Mantas N., Alexakis D. - Greece)
Scar evolution leads to three possible abnormalities: scar contractures, hypertrophic scars and keloids. As the quality of a scar is however unpredictable, preventive measures, including the use of fatty ointments and continuous pressure, should always be taken. Splints are also useful. The treatment of the three main abnormalities is described. No method is perfect and the aim in the treatment of burn scars must therefore be the prevention of abnormalities by early excision of the primary bum wound.
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| 241 |
EXPANSION DU CUIR CHEVELU DANS LES SEOUELLES DE BRÛLURES DE LA VOÛTE CRANIENNE: EXPÉRIENCE TOULOUSAINE
(Rouge D., Grolleau J.L., Bodi H., Chavoin J.P., Costagliola M. - France)
Les Auteurs décrivent leurs expériences avec l'expansion du cuir chevelu chez les patients qui présentent des séquelles de brûlure de la voûte crânienne. Le cuir chevelu, zone pileuse où la reconstitution doit être faite par la peau de voisinage elle-même pileuse, est une zone idéale pour la réalisation de la technique des expandeurs grâce à sa bonne vascularisation. Ils affrontent les problèmes techniques dans la période pré-opératoire et pendant l'intervention. Les expandeurs sont apparus comme une solution extrêmement intéressante au niveau des alopécies du cuir chevelu après brûlure.
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| 252 |
LE FLASH ELECTRIOUE, MÉCANISME ET PRÉVENTION: A PROPOS DE 21 CAS
(Rouged D., Laffitte F, Laguerre I, Conil JW, Chavoin J.B.E., Arbus L., Costagliola M. - France)
Les brûlures électriques sans passage du courant dans le corps (les flashes électriques) sont fréquentes. Il s'agit toujours d'hommes et d'accidents, et souvent d'accidents du travail. Parfois une faute humaine est à la base de l'accident, et les mécanismes de l'accident sont étudiés. Des mesures de prévention peuvent être prises. En haute tension le risque est celui de lésions profondes et étendues alors qu'en basse tension les lésions cutanées sont superficielles, touchant la face et les mains.
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| 256 |
HIGH-TENSION ELECTRICAL BURNS. PRIMARY TREATMENT OF SEVENTY PATIENTS
(Escudero-Nafs F.J., Leiva-Oiiva R.M., Collado-Aromir F, Rabanal-Suirez F, De Molina-NOfiez 1M. - Spain)
Seventy patients with high-tension bums, admitted to the <> General Hospital Burn Unit, during a period of 9 years (1980-1988), were evaluated retrospectively. Only victims with documented passage of high-tension electrical current ( > 1,000 volts) through the body were reviewed. Patients with only flash or flame bums from electrical accidents were excluded. There were 69 males and I female, with an average age of 31.3 years. Thirty-nine accidents (55.7%) occurred at work, and 31 (44.3%) occurred in leisure time. All the patients, with one exception, were admitted within 5 hours of injury. The extremities were the most frequent site of injury. In 54 cases (77%), two or more extremities were burned. Thirty patients (43%) sustained additional flash and/or flame bums. The mean total body surface area of the burns was 12%, with a mean full-thickness bum area of 7%.
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| 262 |
BACTERIOPHAGE THERAPY OF PSEUDOMONAS BURN WOUND SEPSIS
(Abul-Hassan H.S., El-Tahan k Massoud B., Gomaa R. - Egypt)
Phage therapy was used to control Pseudomonas aerugmosa infection in 30 cases of resistant infections in patients with bum areas ranging from 10-25%. Post-phage cultures showed absence of organisms in 12 patients and their presence in 18. Satisfactory graft take was present in 18 cases only and inferior take in 12 cases. It is not practical to use this technique on a wide scale and it should be restricted to cases with strains resistant to available antibiotics.
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| 265 |
SKIN SUBSTITUTES IN BURN TREATMENT - OUR EXPERIENCE
(Dioguardi D., Brienza E., De Robertis M., Di Lonardo A. - Italy)
The clinical use of skin substitutes for the temporary covering of burned body surfaces has become a more frequent requirement with the increased number of burn patients who survive the acute phase and with the ever more widespread practice of early escharectomy. The various types of substitute are reviewed: biological (homologous skin, pigskin, human amniotic membrane, collagen derivatives, cultured allografts), synthetic (e.g. Duoderm, Opsite, Omiderm) and biosynthetic (e.g. Biobrane). Actual experiences with the different substitutes are described and reference is made to the use of allogenic keratinocytes as a biological dressing.
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| 269 |
A RETROSPECTIVE STUDY OF 5505 BURNED PATIENTS ADMITTED TO ALEXANDRIA BURNS UNIT
(Mostafa M.F., Borhan A., Abdallah A.F., Beheri A.S., Abul-Hassan H.S. - Egypt)
5505 burned patients were retrospectively studied from 1969 to 1981. Most patients were young (10-30); 40.05% of the cases had less than 10% surface area burn. Scalds represented the most common cause of burns, followed by flames. The bums were mostly domestic in origin with an overall mortality rate of 21.1%, with causes such as acute renal failure, pneumonia, septic shock, acute gastric ulcerations and bleeding. The average hospital stay was 33.2 days.
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| 273 |
COORDINATION AND MANAGEMENT OF THE VOLUNTARY SERVICES IN FIRE DISASTERS
(Costanzo S. - Italy)
Voluntary Services can provide valuable assistance in the event of a disaster provided that they are well organized and that their work is properly coordinated. It is also necessary to know the exact number and size of these organizations and the particular nature of the assistance they are capable of providing in emergency situations. A number of suggestions are made as to how the contribution of Voluntary Services could be improved, and a comparison is made between the Public Services and the Voluntary Services.
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| 276 |
EVOLUTION AND RESULTS OF THE PROPHYLAXIS AND MANAGEMENT OF INFECTION IN A BURN UNIT, OVER A FOUR-YEAR PERIOD
(Herruzo-Cabrera R., Lenguas Portero F., Martinez-Ratero S., Garcia Torres V., Rey Calero J. - Spain)
The authors studied the incidence of mortality and hospital infection (together with the consumption of antibiotics and financial saving) in a Burn Unit, over a 4-year period, in relation to various modifications introduced into therapeutical management. Mortality was reduced after the second year and the incidence of infection was lower every year (in the fourth year it was 25% that of the first). The aetiology and site of infection also modified: local bum infection reduced to 25% in the period, with only P. aerugmosa and & epidermidis retaining an appreciable incidence; sepsis was similar in evolution to local bum infection; urinary tract infection had a very low incidence in all the period; other soft tissue infection became predominant in the fourth year, owing to an appreciable reduction of the more classic infections. The evolution of the consumption of antibiotics is not related to the infection rate, owing to the great use of third-generation cephalosporins in the central years of the period. A comparison, after direct standardization, between the events in the overall period and those in the fourth year shows that there has been a considerable financial saving (9-28 million pesetas), as a result of the new therapeutic measures introduced.
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| 285 |
THE PROBLEMS OF BURN PATIENT CARE. ORGANIZATIONAL CONSIDERATIONS
(Poppi V., Schiavon R, Nicoli Aldini N., Righini S. - Italy)
Using data from the Emilia-Romagna Region concerning bum patients admitted to hospital in the period 1980-86, a clinical and epidemiological analysis was carried out based on the evaluation of certain parameters, with the purpose of assessing the overall incidence of the burn pathology, the adequacy of care and the possible need for a different organizational approach. It is difficult to understand the long mean duration of hospitalization for the kind of traumatic pathology presented by the burn, a duration not related to any specific individual factor. An explanation of the phenomenon may be the effect that the treatment of bums in nonspecialized facilities has on the clinical course, the duration of hospitalization, the evolution of the disease and consequently on the economic and social cost.
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