Journal of burn care & research : official publication of the American Burn Association
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Observational Study
Infrared Thermal Imaging Has the Potential to Reduce Unnecessary Surgery and Delays to Necessary Surgery in Burn Patients.
Clinical distinction between superficial and deep burns is problematic. The authors determined whether an infrared thermal imaging (IRTI) camera could predict burn depth. Burn depth was assessed by an experienced surgeon, and the burns were imaged with a portable, lightweight IRTI camera that measures heat emission from the skin using long infrared wavelengths (7.5-13 μm). ⋯ Using the ultimate burn depth as the criterion standard, the overall accuracy of IRTI was considerably higher than that of clinical assessment; 87.2% (95% CI: 71.8-95.2) vs 54.1% (95% CI: 37.1-70.2). Any decrease in temperatures between days 1 and 2 was predictive of a deep wound. Our results suggest that thermography using IRTI is more accurate than clinical examination in predicting burn depth and could potentially reduce unnecessary surgery as well as reduce delays to surgery when necessary.
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The authors conducted a prospective study of fractional CO2 laser treatment of mature burn scars, comparing objective and subjective scar measurements evaluating at least one treatment and one control scar on the same patient pre- and post treatments. After institutional review board approval, burn survivors with mature blatant burn scars were invited to enter the study. A series of three fractional CO2 laser treatments was performed in an office setting, using topical anesthetic cream, at 40 to 90 mJ, 100 to 150 spots per cm(2). ⋯ Fractional CO2 laser treatment is a promising entity in the treatment of burn scars. Our study results show significant differences in objective measurements between the treated scars and the untreated control scars over the same time period. In scar treatment studies, the patient/observer and Vancouver scar scales may not be sensitive enough to detect outcome differences.
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The objective of this review was to systematically evaluate the available clinical evidence for the prescription of strength training and cardiovascular endurance exercise programs for pediatric and adult burn survivors so that practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. Summary recommendations were made after the literature was retrieved by systematic review, was critically appraised by multiple authors and the level of evidence determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Although gaps in the literature persist and should be addressed in future research projects, currently, strong research evidence supports the prescription of strength training and aerobic conditioning exercise programs for both adult and pediatric burn survivors when in the presence of strength limitations and/or decreased cardiovascular endurance after evaluation.
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Hypertrophic scar after burn injury is a significant problem. Previous studies have examined the roles for decorin, interleukin-1β, and transforming growth factor-β1 in hypertrophic scar formation locally, but few have considered their systemic influence. The authors conducted a pilot study to examine whether serum levels of these molecules could predict hypertrophic scar formation. ⋯ Decorin up-regulated the expression of toll-like receptor 4 and C-X-C receptor 4 in peripheral blood mononuclear cells, and interleukin-1β up-regulated fibroblast production of C-X-C ligand 12. Transforming growth factor-β1 up-regulated, and interleukin-1β down-regulated, the production of profibrotic cytokines, collagen, and myofibroblast differentiation. The model predicting hypertrophic scar formation is supported by clinical results and limited in vitro experiments.
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Unintentional burn injury is the third most common cause of death in the U. S. for children age 5 to 9, and accounts for major morbidity in the pediatric population. Pediatric burn admission data from U. ⋯ Among Caucasian teenagers flame burns predominate. Mean length of stay was 10 days, 23% of patients required skin grafting surgery, and mortality was 0.9%. The results of this study highlight the need for primary prevention programs focusing on avoiding home scald injuries in the very young, as well as fire safety training for teenagers.