INTERNATIONAL ABSTRACTS

PATTERNS OF BURN ADJUSTMENT

For a person to resume a normal life after a major burn injury, it is necessary for him or her to maintain a sense of hope for the future. This paper considers the issues involved in the process of readjustment to the outside world and acceptance of burns sequelae. It is pointed out that objective criteria, such. as return to work or pre-existing psychological problems, may not be sufficient. Other factors are involved -antisocial personality, organic brain syndromes, and lack of social support. Personality features are thus of considerable importance, and six cases are reported in this light. Individual cases of course prove nothing, but it may ultimately be possible to define fundamental types of behavioural patterns.

Bernstein N.R., O'Connel K., Chedekel D. J. Bum Care Rehabil., 13: 4-12, 1992.

PRACTICAL APPLICATIONS OF PSYCHOLOGICAL TECHNIOUES IN CONTROLLING BURN PAIN

Psychological techniques prove to be a useful complement to opioids in the control of pain in severely burned patients. Psychological techniques are indeed used all the time in the everyday management of burn pain, but this field has been little researched. The various techniques available can be distinguished as cognitive (avoidance and reappraisal), preparatory (sensory and procedural), behavioural (respondent and operant), and hypnotherapeutic. As burn pain is constantly one of the most severe of all forms of acute pain, the contribution of psychological techniques cannot be disregarded, and the various types of intervention available are discussed.

Patterson D.R. J. Burn Care Rehabil., 13: 13-18, 1992.

The role of the psychiatrist in the care of burn patients needs to be redefined as survival rates for patients with major injuries improve and significant long-term psychological disabilities are reported. The traditional function of the psychiatrist (diagnosis and treatment of discrete psychiatric disorders) must thus expand to include assisting the patient to readapt psychologically after his injury, assessing and managing burn pain, and aiding communication among the members of the burn team. The psychiatrist cannot in fact satisfactorily carry out his work unless he is a fully integrated member of the burn team.

Watkins P.N., Cook E.L., May S.R., Still J.M. J. Burn Care Rehabil., 13: 19-27, 1992.

Carbon monoxide (CO) is the leading cause of poisoning in the USA and it is often a complicating factor in the management of burn patients, with clear effects on the central nervous system. An I I -year retrospective ,,chart review was carried out to determine the incidence of myocardial injury secondary to CO poisoning. 1533 consecutive admissions were considered (July 1979-June 1990). Of these patients 18 had carboxyhaemoglobm levels of 10% or more on admission, five of whom presenting electrocardiographic changes indicative of myocardial injury. Four of these five were operated on successfully, using perioperative invasive monitoring. There were no cases (among all 18 patients) of congestive heart failure or cardiac dysrhythmias during hospitalization. It would therefore appear that the myocardial damage resulting from acute CO poisoning can be detected by appropriate screening techniques.

Williams J., Lewis 11 R.W., Kealey G.P. J. Burn Care Rehabil., 13: 210-213, 1992.

The case is described of an I I -year-old boy who sustained a 36,000 V electric shock. He suffered flame burns in over 85% BSA (75% full thickness). After treatment lasting 4 months he was discharged from hospital but began to exhibit irritability, haliucinations and, eventually, seizures and respiratory and cardiac arrest. After resuscitation, he was found to have diffuse bilateral brain damage, observed by computerized tomography (CT) and magnetic resonance imaging (MRI). He also presented hypertension (up to 290/220 min Hg). The clinical symptoms and the hypertension resolved after a week of treatment, CT scans and MRI findings were resolved within 2 months, and after 12 months the only remaining symptoms were irritability and a low tolerance for frustration. It would seem that such cases require long-term anti hypertensive treatment.

Eldad E., Neuman A., Weinberg A., Benmeir P., Rotem M., Chauoat M., Gomori J.M., Wexler M.R.

J. Burn Care Rehabil., 13: 214-217, 1992.

The purpose of this research was to compare patients who were under the influence of alcohol or drugs at the time of their burn injury with patients who were not, with specific reference to differences in mortality rate, length of hospital stay, number of complications, and number of surgical procedures. It was found that the drug or alcohol impaired patients had a lengthened hospital stay, required 50% more surgical procedures and had twice the complication rate of non-impaired patients with the same amount of third-degree burns.

Kelley D., Lynch J.

J. Burn Care Rehabil., 13: 218-220, 1992,

In this study, 32 donor areas in burned or plastic surge I ry patien I ts grafted with cultured allogeneic epidermis were clinically and histologically observed. Two methods were employed to identify the presence of the cultured epidermal allograft on the wounds:

(I)an immunocytochernistry technique; and (2)a molecular biology technique. These techniques are described. They have the advantage of high sensitivity and specificity in identifying the existence of allo geneic skin cells in grafts. It was found that the

survival time of cultured epidermal allograft lasted up to 35 days. Also, the intact coverage on some graft sites may be composed of host and donor origin cells about 3 weeks after grafting. The results refer to 32 patients in all.

Yang-bing Z, Xiong-fei Z., Ao (Ngao) L., Shu-zhen L., Xu W., Shu-Zhen R, Xia-ti Z.

Burns, 18: 4-8, 1992.

The present study was designed to examine the response of rat muscle amino acid uptake in the first 6 h after major scalding burn injury - the so-called "ebb phase" or "hypometabolic phase". The technique is described. The results were expressed as the distribution ratio of alpha-aminolsobutyric acid (AIB) and aminocyclopentane-carboxylic acid (cycloleucine) between intra- and extracellular fluid. AIB intake in vitro significantly increased (30%) in the first halfhour post-bum only and then slowly reduced to the levels in unburned animals. Muscle cycloleucine uptake in vitro was unchanged. A second study took into account the effects when extensor digitorum. longus leg muscle was incubated. There was no significant difference in muscle AIB uptake. Since muscle amino acid uptake remained fairly stable during this period, the alteration of amino acid transport across muscle cells is probably not a contributing factor to the alteration of amino acid flux during the early phase of stress.

Tang Y.W., Yu Y.M., Burke J.F. Burns, 18: 9-14, 1992.

The clinical records of 146 patients hospitalized in the Burn Centre of La Fe Hospital in Valencia (Spain) were reviewed. Mean patient age was 31.42 years; 68.5% were male; 34.1% were under the age of 15 years; and 15% were over 60 years of age. Fire was the commonest aetiology (50% of cases) and produced the most extensive lesions. Electrical current and contact with hot surfaces caused deeper burns. The home was the commonest site of thermal lesions. Half the patients were discharged wittin 15 days. The greatest number of lesions occurred in winter.

Tejerina C., Reig A., Colina J., Safont J., Baena P., Mirabet V. Burrís, 18: 15-18, 1992.

A retrospective study was carried out of patients presenting to a Burns Centre for cement burns between 1981 and 1989. This involved 20 individuals (1.8% of the total number of adult patients treated in the period). These burns, though comparatively rare, occur most commonly in manual labourers. They are alkali burns which develop insidiously, unlike thermal burns. Early recognition and treatment are therefore very important. If the burns prove to be full skin thickness, early wound excision and skin grafting are indicated.

Feldberg L., Regan P.J., Roberets A.H.N.R.

Burns, 18: 51-53, 1992.

Proper treatment of first web space contractures resulting from burns is very important as limitations of thumb movement reduce the essential functions of grasp and pinch and reduce working capacity. Adequate release of these contractures followed by a

local skin flap cover and dynamic abduction splintage for 6 weeks was found to give good results. Recurrences should be watched for and these can be prevented to some extent by secondary surgery in the from of flexor pollicis longus tendon lengthening or opponens-plasty.

Bhattacharya S., Bhatnagar S.K., Pandey S.D., Chandra R.

Burns, 18: 54-57, 1992.

This study was designed to analyse the influence of elasticized nylon anti-burnscar supports on joint range of motion (ROM) in burn patients. Data were compiled from 80 burn-affected joints in 17 patients. Joint ROM was measured using standard goniometric techniques before and immediately after use of the pressure support. ROM increased in 26 joints (32.5%), decreased in 26 (32.5%) and remained the same in 28 (35%). The findings would appear to show that although there may be some initial measurable effects on ROM produced by the pressure support in question there seems to be no long-term detrimental influence.

Ward R.S., Hayes-Lundy C., Reddy R., Brockway C., Mills P.

Burn, 18: 60-62, 1992.

Children are at high risk, as regards burn injury, because of their natural curiosity, mode of reaction, impulsiveness and lack of experience in risk evaluation. For these reasons they constitute a substantial proportion of burn patients. This retrospective study addresses the problem, with a view to optimizing the introduction of the most effective preventive measures, which are necessary if the devastating effects of burns in children are to be minimized. In the study, relative to the year 1990, 127 paediatric burn patients are considered. Epidemiological data include age, sex, seasonal variation, place of bum, family size, economic status, and the period of time between the burn and hospital admission.

Gupta M., Gupta O.K., Goil P.

Burns, 18: 63-67, 1992. 1

BURN OF THE ELBOW: THE ROLE OF THE RADIAL FOREARM ISLAND FLAP. ,

An account is gi " ve - n of the successful treatment of an elbow burn covered by a radial forearm island flap. This kind of flap is supplied by multiple segmental perforators from the radial artery which can be sacrificed without jeopardizing hand ability. It can

be based proximally' or -distally. In this case, the patient had fallen in. a state of intoxication on to hot ashes. The burn was extensively debrided, and the elbow joint, the olecranon and the triceps tendon were exposed. A radial island flap based proximally on the radial artery, comcomitant veins and the cephalic vein was designed to cover the defect, including the lateral

cutaneous nerve of the forearm. Full details of the technique are given. Movement of the elbow was initiated two weeks after the operation, and was completed several days later. The antebrachial island flap must be considered to be an important method

for the coverage of exposed structures in the posterior elbow region. It is however contraindicated in certain cases.

Velasco V.M.S~, Garcia-Nto.rato V., Garcia F.J.F. Burns, 18: ~71-73, 1992.