Journal of burn care & research : official publication of the American Burn Association
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Severe burn injury results in a multifaceted physiological response that significantly alters drug pharmacokinetics and pharmacodynamics (PK/PD). This response includes hypovolemia, increased vascular permeability, increased interstitial hydrostatic pressure, vasodilation, and hypermetabolism. These physiologic alterations impact drug distribution and excretion-thus varying the drug therapeutic effect on the body or microorganism. ⋯ Dosing techniques must be adapted based on burn injury-related changes in PK/PD parameters in order to ensure drug efficacy. Although several PK/PD studies have been undertaken in the burn population, there is wide variation in the analytical techniques, software, and study sample sizes used. In order to refine dosing techniques in burns and consequently improve patient outcomes, there must be harmonization among PK/PD analyses.
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The term "functional" in burn rehabilitation has gained widespread use to describe a patient's recovery after burn injury. But what truly is "functional" when applied to a patient recovering from burn injury? A literature search was performed for information defining "functional" range of motion (ROM). Maximum upper and lower ROM values to perform a variety of daily activities were abstracted and compared with published outcomes of patient groups recovered from burn injury. ⋯ In comparing the results, many burn survivors with severe burn scar contractures could be considered "functional." Refinement of the term "functional" is needed related to burn outcomes. Functional ROM of a particular joint to perform one specific task may be insufficient to perform a variety of other tasks when all planes of motion are considered. Use of the term "functional" to describe a patient's outcome should be used in a guarded manner.
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After a burn injury, superficial partial-thickness burn wounds may progress to deep partial-thickness or full-thickness burn wounds, if kept untreated. This phenomenon is called secondary burn wound progression or conversion. Burn wound depth is an important determinant of patient morbidity and mortality. ⋯ Warm water, simvastatin, EPO, or cerium nitrate may represent particularly promising approaches for the translation into clinical use in the near future. This review demonstrates promising experimental approaches that might reduce secondary burn wound progression. Nevertheless, a translation into clinical application needs to confirm the results compiled in experimental animal studies.
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The main objective of the present study was to examine whether self-inflicted burn patients would differ from nonintentional, nonwork related burn patients on psychiatric and personality characteristics. Sociodemographic and injury related factors were also compared. Self-inflicted (N = 15) and nonintentional (N = 178) burn patient samples were drawn from a larger study examining physical and psychosocial outcomes following major burn. ⋯ There were no differences on TBSA (P = .52) or sociodemographic characteristics (P values > .08). Relative to survivors of nonintentional burns, self-inflicted burn patients in the United States demonstrate high psychiatric comorbidity. Standards of care must be developed to optimize treatment procedures and recovery outcomes in this subgroup.
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One of the dramatic consequences of burns is scar contracture and deformities of the neck. Cervical contracture in children is especially dangerous, leading to face disfigurement and kyphosis; therefore, early reconstruction is indicated. Despite the existence of many various surgical techniques, the successful neck contracture treatment in pediatric patients remains a challenge for surgeons. ⋯ The flaps continued to grow and the skin grafts shrinkage was moderate. Local trapeze-flap plasty allows neck contracture elimination in children in the cases when a more complex technique is impossible or undesirable to use. Early surgical intervention prevents secondary complications, allotting enough time for patients to mature and be ready for more complex procedures.