Journal of burn care & research : official publication of the American Burn Association
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Many deep partial thickness burns require more than 3 weeks to heal resulting in disfiguring and dysfunctional scarring. Early excision of the eschar has been shown to improve outcomes in deep burns; however, the optimal timing of the excision remains controversial. We compared wound healing and scarring of deep partial thickness burns that were excised at different time points in a porcine model. ⋯ Scar depth and percentage wound contraction were also similar among the wounds excised at 2, 4, and 7 days (4.4 ± 1.1 mm vs 3.9 ± 1.1 mm vs 4.1 ± 1.2 mm and 52.9 ± 17.9% vs 52.6 ± 15.6% vs 52.5 ± 13.8%, respectively). Timing of eschar excision (at 2, 4, or 7 days) does not affect the rates of re-epithelialization and scarring in a deep partial thickness porcine burn model. Timing of eschar excision may not change outcomes if performed within the first 2 to 7 days after injury.
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On July 2012, a rehabilitation hospital merged with a trauma center where the regional burn center is located. That rehabilitation center provides the only burn rehabilitation program in our region. The objective of this study was to determine if earlier initiation of inpatient rehabilitation after merger had an effect on burn survivors' functional outcomes and resource utilization. ⋯ Patients transferred before the merger had significantly more chemical burns (5% vs 0%, P = .046), and more work-related burns (26.7% vs 7.7%, P = .004). Patients transferred after the merger had significantly shorter burn center LOS (28.5 ± 20.9 days vs 38.8 ± 34.2 days, P = .043), and shorter waiting time for rehab (0.7 ± 1.1 days vs 1.5 ± 2.3 days, P = .010) than patients transferred before the merger. Early initiation of inpatient rehabilitation, after the burn center and the inpatient rehabilitation service were located in the same hospital, improved burn survivors' resource utilization.
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Burn scar contractures remain a common source of severe disability in resource-limited countries. However, existing outcome measurements are unable to fully capture the impact of the scar contracture and surgical attempts at correction. To that end, we have developed a new outcome instrument, the Stanford-ReSurge Burn Scar Contracture Scale-Upper Extremity that can be used as a measurement of disability and reconstructive procedure outcomes. ⋯ Patients who underwent burn scar contracture release of the upper extremity showed an average of 14 points improvement between the preoperative and 1-month postoperative time point. The Stanford-ReSurge Burn Scar Contracture showed clinical utility for assessing outcomes in burn scar contracture release of the upper extremity. Our goal is to develop a standardized outcome instrument for burn reconstruction in the world's poorest burn patients.
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Many burn survivors experience social challenges throughout their recovery. Measuring the social impact of a burn injury is important to identify opportunities for interventions. The aim of this study is to develop a pool of items addressing the social impact of burn injuries in adults to create a self-reported computerized adaptive test based on item response theory. ⋯ This study was designed to develop a large item pool based on a strong conceptual framework using grounded theory analysis with focus groups of burn survivors and their caregivers. The 192 items represent 7 domains and reflect the unique experience of burn survivors within these important areas of social participation. This work will lead to developing the Life Impact Burn Recovery Evaluation profile, a self-reported outcome measure.
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Combat operations in Iraq and Afghanistan have resulted in up to 8.8% of combat-related casualties suffering burns. From World War I through Desert Storm, burns have been associated with approximately 4% of the combat-related deaths. Experiencing a blast injury and exposure to killing and death while deployed has been shown to increase suicide risk. ⋯ Of the 11 who died, five deaths were related to accidental poisoning by exposure to drugs; three were related to operations of war (two after returning to the war zone), and the remaining three died from other accidental causes (one explosion and two vehicle crashes). There was no indication of suicide or suspicion of suicide as a cause-of-death for the former patients included in this study, suggesting that combat burn injury did not appear to increase the risk of death by suicide in our study population. Further research is needed to understand the factors that contribute to the apparent resilience of combat burn survivors.