Journal of burn care & research : official publication of the American Burn Association
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Hypertrophic scarring is a fibroproliferative process that occurs following a third-degree dermal burn injury, producing significant morbidity due to persistent pain, itching, cosmetic disfigurement, and loss of function due to contractures. Ablative fractional lasers have emerged clinically as a fundamental or standard therapeutic modality for hypertrophic burn scars. Yet the examination of their histopathological and biochemical mechanisms of tissue remodeling and comparison among different laser types has been lacking. ⋯ Molecular changes noted in the areas of dermal remodeling indicated that matrix metalloproteinase 2, matrix metalloproteinase 9, and Decorin may play a role in this dermal remodeling and account for the enhanced effect of the Er:YAG laser. We have demonstrated that ablative fractional laser treatment of burn scars can lead to favorable clinical, histological, and molecular changes. This study provides support that hypertrophic third-degree burn scars can be modified by fractional laser treatment.
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American Burn Association Past President Palmer Q. Bessey, MD, orchestrated a Burn Workforce Conference in Washington, DC in February, 2014, with the goal of evaluating the workforce needs for doctors, nurses, and occupational/physical therapists. This report summarizes the issues related to the need for training future surgeons to manage burn patients. ⋯ The number of surgeons entering burn fellowships is limited to approximately 10 per year and there are only a handful of burn fellowship programs to train future burn surgeons. A survey sent to burn surgeons revealed that the current workforce is aging and needs to a constant supply of new physicians. It is clear that there is a need to formalize burn fellowships and it was felt that the American Burn Association should be responsible for accreditation of those fellowships.
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There is a paucity of information in the peer-reviewed literature characterizing the current burn surgeon workforce and compensation potential, and, in a parallel topic, training opportunities and recruitment methods. What does exist documents minimal exposure to the field and surgeon shortages. A comprehensive survey was created to address 1) the demographics of current burn surgeons in practice, and 2) the structure of burn centers training models. ⋯ A representative sample of burn surgeons from across North America sustains practices in similar ways. Access to the next generation of surgeons is at an early period in training (PGY1-3) which may prove valuable as surgical education evolves. Overall, burn surgeons express good job satisfaction, a significant point of interest as attention turns towards succession planning.
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After a serious burn, re-entry into family life, society, and work can be incredibly difficult. Support services such as professional counseling and peer support play a key role for recovering survivors. Herein, we sought to identify support service participation rates, barriers to participation, and quality of life (QOL) among burn survivors treated at a regional burn center. ⋯ A sizable number of burn survivors want SPs. However, access to these services and advertising their existence are hurdles to overcome. Future burn survivor SPs should focus on psychosocial stresses identified in the QOL assessments.
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Multicenter Study Clinical Trial
Efficacy of a Gel Containing Polihexanide and Betaine in Deep Partial and Full Thickness Burns Requiring Split-thickness Skin Grafts: A Noncomparative Clinical Study.
Despite overall advances in burn therapy, wound infection remains one of the leading causes of morbidity and mortality in patients with severe burn injuries. This prospective, multicenter, noncomparative clinical trial was conducted to assess the efficacy and safety of Prontosan® Wound Gel X (PWX), a gel containing polihexanide and betaine, for moistening and cleansing in deep tissue burn wounds requiring split-thickness skin grafting. Patients with deep partial or full thickness burn wounds requiring split-thickness skin grafting were treated with the gel to evaluate its tolerability and safety as well as graft take and the healing of the skin graft. ⋯ No wound infection or erythema occurred. This is the first study to document the outcomes of deep partial and full thickness burns treated with PWX for moistening and cleansing. The gel was shown to be efficacious, safe, and well tolerated for use in burn wounds requiring split-thickness skin grafts.