Journal of burn care & research : official publication of the American Burn Association
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Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and Stevens-Johnson/TEN overlap syndrome (SJS/TEN) are severe exfoliative skin disorders resulting primarily from allergic drug reactions and sometimes from viral causes. Because of the significant epidermal loss in many of these patients, many of them end up receiving treatment at a burn center for expertise in the care of large wounds. Previous work on the treatment of this disease focused only on the differences in care of the same patients treated at nonburn centers and then transferred to burn centers. ⋯ Patients with SJS/TEN and TEN were more likely to be treated at a burn center. Patients treated at burn centers appear to have more severe disease but similar mortality to those treated at nonburn centers. Further study is needed to determine whether patients with these disorders do indeed benefit from transfer to a burn center.
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Firefighters are at significant risk for burn injuries. Most are minor and do not significantly affect ability to work in full capacity, but there exists risk for both short- and long-term incapacitation. Many push for earlier return to work than is medically advisable. ⋯ While many cite love of the job and a culture of pride and camaraderie that is "in our DNA," firefighters' decisions to return to work after burn injury are equally driven external pressures and obligations. Additional education is needed, which may best be facilitated by treatment at a Burn Center. Improved understanding of factors driving firefighters' views on returning to duty after injury may help establish support systems and improve education regarding risks of premature return to work, particularly with regard to reinjury.
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A Rule of Thumb for Hand Burns: Categorization and Mapping of Proportional Surface Area Involvement.
Hand burns are common and often complex injuries, requiring referral to specialist centers. The patient's thumbprint is a rapid means of accurately assessing hand burn surface area. This study aimed to establish categories and evaluate sites of hand burn surface area in order to facilitate comparison of hand burns. ⋯ The median thumbprint burn surface area was 1.5T (range 0.20-80T), which corresponds to 0.05% TBSA. The hand areas with the highest burn frequency per unit area were the dorsum of the hand and dorsum of the index finger, with relative sparing of the palm and palmar surface of the digits. Hand burns surface area varies widely, and thumbprint evaluation with categories and mapping allows finer distinction between the surface area proportions and specific sites involved, even in a small series of hand burns.
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We aimed to evaluate the results of dermal substitute implantation after early excision in the acute phase of major burn cases within the scope of efforts to reduce contractions and scar formation in functional anatomic areas (face, neck, axilla, elbow, popliteal). Twelve patients with major burn who were treated in the burn center between September 2017 and September 2018 were included in the study. In these patients, Nevelia® dermal substitute was implanted into 24 functional areas with deep partial or full-thickness burns after surgical debridement of the wound. ⋯ In the implantation sites, the Vancouver Scar Scale ranged from 1 to 7. The aesthetic and functional evaluation showed excellent/good results in 21 of 24 anatomic regions, moderate results in 2 regions, and poor results in 1 region. The use of dermal substitute in deep burns of functional/mobile anatomic areas at the acute phase after early excision and subsequent skin autografting has opened a new alternative area in the burn surgery arena to prevent contractures and functional limitations.