Journal of burn care & research : official publication of the American Burn Association
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Comparative Study
Burn Scar Evaluation Using the Cutometer® MPA 580 in Comparison to "Patient and Observer Scar Assessment Scale" and "Vancouver Scar Scale".
The effect of the "Patient and Observer Scar Assessment Scale" (POSAS) and "Vancouver Scar Scale" (VSS) on patients' quality of life and their correlation with objective scar assessment tools, such as the Cutometer®, is not fully elucidated. In addition, long-term results of the dermal substitute Matriderm® used in combination with split-thickness skin grafting (STSG) remain unclear. We evaluated burn scars of 45 patients at least 2 years postburn injury using the Cutometer® MPA 580, the VSS, and the POSAS with three additional questions regarding quality of life and correlated the results. ⋯ There was a significant correlation between POSAS and VSS, quality of life and the objective Cutometer® measurements. Conservatively treated superficial dermal burns do not reach the elastic qualities of healthy skin, and the use of Matriderm® significantly improves the long-term elastic qualities of STSG in deep dermal and full-thickness burns 2 years post injury. Results from the VSS and the POSAS correlate with restrictions in the quality of life of patients and also with objective Cutometer® measurements and are therefore useful tools in scar evaluation following burn injury.
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Air ambulances rapidly transport burn patients to regional centers, expediting treatment. However, limited guidelines on transport introduce the risk for inappropriate triage and overuse. Given the additional costs of air vs ground transport, evaluation of transportation use is prudent. ⋯ Independent predictors of emergent procedures included transport for airway concern (odds ratio = 45.29, confidence interval = 2.49-825.21, P = .010) and % TBSA (odds ratio = 1.13, confidence interval = 1.02-1.27, P = .019). If the 23 inappropriately triaged patients had been transported by ground, a cost savings of $106,370 could have been realized using 2016 California Medicare reimbursements (per-patient savings of $4624). While appropriate in most circumstances, the cost of air ambulances should be weighed in light of their utility, as a significant proportion of patients did not benefit from air transport.
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The military has used silver-nylon dressings as a topical antimicrobial on combat-related burns for the past 15 years. However, their clinical efficacy and associated risks have not been evaluated. Herein, the authors document our experience with the use of a specific silver-nylon dressing (Silverlon®) during global evacuation of casualties from combat zones to the United States sArmy Institute of Surgical Research Burn Center. ⋯ When compared with topical antimicrobial agents, the silver-nylon dressing was not associated with significant differences in burn-related complication. The authors demonstrate the antimicrobial efficacy of the silver-nylon dressing during global evacuation of burn casualties from combat zones to the burn center. Compared with topical antimicrobials, the silver-nylon dressing is lightweight and easy to apply and requires minimal wound management which makes it desirable as a burn dressing for combat applications as well as mass casualty situations.
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Marjolin's ulcer is an aggressive disease arising in chronic wounds and cutaneous scars. Corbo et al define Marjolin's ulcer an often overlooked or misdiagnosed tumor. We report a case of Marjolin's ulcer arose in a burn scar of a 51-year-old man who sustained a burn in childhood. ⋯ Histological examination confirmed a well-differentiated squamous cell carcinoma. Burn scars are the most commonly associated with these tumors, but other lesions may initiate this malignant transformation. The most common type of tumor reported in a Marjolin's ulcer is squamous cell carcinoma, but Pavlovic et al reported other malignancies.