|Annals of the MBC - vol. 5 - n' 3 - September 1992
TREATMENT OF DERMAL DEPTH BURN WOUNDS WITH AN ANTIMICROBIAL AGENT-RELEASING SILICONE GEL SHEET
This report describes the treatment of dermal depth burn wounds using silicone gel sheets containing an antimicrobial agent. The sheets, containing 0.02% Ofloxacin, were used to treat 24 patients with a total of 27 dermal depth wounds. The gel provided continuous drug delivery from the dressing to the wound. The sheets proved easy to use and no cases of infection occurred. Epithelialization was generally more rapid than with ointmentimpregnated gauze dressings.
Sawada Y., Ara M., Yotsuyanagi T., Sone K. Burns, 16: 347-352, 1990..
EXPERIENCES USTING SILICONE GEL TIE-OVER DRESSINGS FOLLOWING SKIN GRAFTING
A description is given of the use of a silicone gel tie-over technique allowing inspection of the grafted skin through it, and permitting early detection and easy removal of haematomas, if necessary. Silicone gel sheets 2 min, thick containing 0.02% Ofloxacin were used. In 12 skin grafts treated in this way without any application of pressure there were 4 cases of haematoma and congestion. When pressure was applied (c. 20-30 min, Hg) in the early post-surgery period there were no cases of haematoma or congestion of the graft. It would therefore appear that appropriate pressure applied to the graft following the surgical procedure is beneficial in preventing the formation of haematomas.
Sawada Y., Yotsuyanagi T., Ara M., Sone K. Burns, 16: 353-357, 1990.
PRECLINICAL EVALUATION OF SKIN SUBSTITUTES
Protection of an open wound by skin substitutes other than the patient's own skin has become widely practised in the last 20 years. In this investigation, important physical parameters were monitored (ability to control water loss, adherence to wound surface, gaseous permeability, mechanical properties, impermeability to micro-organisms and exudate soaking capacity). Two commercially available skin substitutes were examined, Bioclusive (an adhesivebacked polyurethane membrane) and Geliperin dry (a hydrogel-type skin substitute). The procedures established were also employed for the evaluation of a hydrogel-type skin substitute recently developed in the researchers' own laboratory. The study demonstrates the importance of preclinical assessment procedure in the evaluation of synthetic skin substitutes.
Nangia A., Hung C.T. Burns, 16: 358-367, 1990.
LABORATORY EVALUATION OF A NEW HYDROGELTYPE SKIN SUBSTITUTE
A new hydrogel-type skin substitute (HSS) was developed and investigated for its effectiveness in the management of excised wounds in rats and compared to Bioclusive' and Geliperm and air-exposed control. An evaporimeter was used to examine the effectiveness of the skin substitutes in the reestablishment of the cutaneous barrier to evaporative water loss (EWL). HSS provided a faster rate of wound healing with complete epithelialization than did Geliperm and Bioclusive. HSS-covered wounds showed a significant improvement in the rate of restoration of the barrier functions compared to uncovered controls. EWL initially rose and then decreased in uncovered controls and wounds covered with Geliperm and HSS. The EWL decline was less pronounced with Bioclusive. The study demonstrates that optimized HSS is an effective temporary skin substitute.
Nangia A., Hung C.T. Burns, 16: 368-372, 1990.
MORTALITY RATE AND PROGNOSTIC INDICES IN 2615 BURNED PATIENTS
Twenty years of admissions to a Bums Centre and Plastic Surgery Unit are considered. 2615 burned patients are analysed in relation to mortality rate. The results are compared with other prognostic indices. The statistical data are similar to those of Feller et al. (1976) but differ from those of Roi et al. (1983) and Bull (1971). The survival rate shows an improvement in the last five years and the reasons for this are discussed.
Barisoni D., Peci S., Governa M., Sanna A., Furian S. Burns, 16: 373-376, 1990.
THE ACTIVATED KERATINOCYTE: UP REGULATION OF CELL ADHESION AND MIGRATION DURING WOUND HEALING
Keratinocytes behave differently in normal and in wounded skin. In normal skin they are specialized for differentiation and in wounded skin for migration. In this paper there is a discussion of the idea that migratory-competent keratinocytes are "activated". The activation process is characterized by changes such as increased cell attachment, spreading, focal adhesion formation, and migration. These changes can partly be explained by enhanced expression of a 5 integrin subunits and reorganization of P I integrin subunits.
Grinnell F. Suppl. to J. of Trauma, 30: S144-SI49, 1990.
MODELS OF WOUND HEALING
Several methods used to study wound healing are considered, with particular reference to connective tissue metabolism. The usefulness and difficulties of cell culture are discussed. Many different animals are used as models for human healing, in particular rodents. Insertable devices have been developed that allow the ingrowth of healing tissue and these have been used in an attempt to provide better wound tissue sampling from rodents. The advantages and disadvantages of such devices are compared. Fetal wound healing is also considered.
Cohen I.K., Mast B.A. Suppl. to J. of Trauma, 30: S149-SI55, 1990.
CURRENT STATUS OF SKIN REPLACEMENTS FOR COVERAGE OF EXTENSIVE BURN WOUNDS
This article reviews the various methods currently used for covering extensive burn wounds - cutaneous cadaver allograft, Biobrane, cultured cell sheets, etc. A bilaminate membrane consisting of a collagen-based dermal analogue with a silicone epidermal component is described. Meshed autografts are also considered. In conclusion, possible future developments are indicated.
Hansbrough IF Suppl. to J. of Trauma, 30: S155-SI62, 1990.
MULTIPLE ORGAN FAILURE: CLINICAL OVERVIEW OF THE SYNDROME
The multiple organ failure syndrome has become the focus of experimental treatment techniques and the expenditure of enormous amounts of money. Most patients with prolonged stays in surgical intensive care units develop the syndrome, and mortality remains high (over 50%). The syndrome is considered in all its aspects and it is found that infection is a major cause, although other major mechanisms are also involved.
Suppl. to J. of Trauma, 30: S163-SI65, 1990,
ETIOLOGY OF MULTIPLE ORGAN FAILURE
Multiple organ failure has a complex aetiology, and three aspects are considered here: initiating (inciting) events, the gut, and mediators. The initiating events include haemorrhage and haematoma, ischaemia/reperfusion necrotic tissue, infection, and endotoxin. The mediators are the cytokines.
Meakins J.L. Suppl. to J. of Trauma, 30: S165-SI68, 1990.
INITIAL DOSAGE REGIMENS OF GENTAMICIN IN PATIENTS WITH BURNS
The standard gentamicin dosage regimen of 3 to 5 mg/kg/day, given every 8 h, was shown not to be appropriate for all bum patients. The regimen necessary to achieve optimal serum concentrations was determined in 95 burn patients. Gentamicin clearance and therefore dosage regimens can be stratified by age in burn patients with normal serum creatinine levels. Guidelines were developed to help the clinician to attain therapeutic concentrations with initial doses of gentamicin. Serum gentamicin concentrations must be monitored during therapy, and dosages adjusted to guarantee optimal concentration.
Zaske D.E., Chin T., Hoh1s P.R., Solem L.D., Strate R.G. J. Burn Care Rehabil., 12: 46-50, 1991.
LONG-TERM ASSESSMENT OF THE EFFECTS OF CIRCUMFERENTIAL TRUNCAL BURNS IN PEDIATRIC PATIENTS ON SUBSEQUENT PREGNANCIES
Long-term follow-up of young girls who sustain circumferential truncal burns is not well documented. Here seven such patients are described who on reaching adulthood conceived, resulting in a-total of 14 pregnancies. the prenatal complications consisted of one case involving the breakdown of scar tissue during the third trimester of pregnancy. It can therefore be concluded that circumferential truncal burns sustained in childhood appear to have no impact on prenatal or labour and delivery complications.
McCauley R.L., Stenberg B.A., Phillips L.G., Blackwell S.J., Robson M.C.
J. Bum Care Rehabil., 12: 51-53, 1991.
UNCOMMON NEUROLOGIC COMPLICATIONS OF BURNS IN INFANTS: A PARKINSONIAN EXTRA. PYRAMIDAL DISORDER AND MASSIVE CEREBRAL INFARCTION
Neurological complications are uncommon in both children and adults with burns. Two unusual cases are described of two infants with moderately severe burns who developed complications, an extrapyramidal Parkinsonian syndrome in one and massive cerebral infarction in the other. Both case histories are given. The first child, in whom a diagnosis of extrapyramidal Parkinsonian disorder was made, was treated with amantadine hydrochloride, and she recovered in 2 months. The other child, a more serious case, who became comatose and had intractable seizures following the trauma, was left with permanent conditions of dysphasia and right-sided hemiplegia, together with marked cognitive delay. Central nervous system involvement, though uncommon, is a possible complication in infants, who therefore constitute a high-risk group.
Shahar E, Keidan L, Brand N., Frand M., Barzilay Z. J. Burn Care Rehabil., 12: 54-57, 1991.
BIOMECHANICAL PERFORMANCE OF DEVICES THAT ENHANCE JOINT EXTENSIBILITY IN THE BEHINDTHE-BACK REACH TEST
Various devices can be used in physical therapy to improve the range of motion of the joints involved in the behind-the-back reach test, which measures the flexibility of the upper extremities, the shoulder girdles and the upper back. Three devices (flexible ladder, towel and cord) were evaluated and it was found that the results obtained were remarkably similar. All three can therefore be used during rehabilitation after injury.
Lopez AX, Chung J.K., Towler M.A., Morgan R.F., Edlich R.F. J. Burn Care Rehabil., 12: 58-62, 1991.
SERIAL CASTING AS A TECHNIQUE TO CORRECT BURN SCAR CONTRACTURES
A case study is presented of a 2-year-old male patient with severe plantar-flexion contractures of the ankles (-30' on the right and -60' on the left). The technique of serial casting proved to be a fast, relatively simple and inexpensive way of correcting the contractures. The plaster casts provide circumferential pressure and a prolonged stretch to the contracted tissue, and the patient cannot remove them. Serial casting is a reliable alternative when low-force dynamic splinting cannot be sized small enough for a child, or when patient compliance is poor.
Ridgway C.L., Daugherty M.B., Warden G.D. J. Bum Care Rehabil., 12: 67-72, 1991.