Annales de chirurgie plastique et esthétique
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Burns covering more than 10% of the total body surface area (TBSA) are responsible for systemic perturbations which, in very severe cases, can represent a vital risk and, in all cases, affect the wound evolution. Among these general perturbations, fluid volume and electrolyte changes, leading eventually to burn shock, have the most dramatic consequences. Burn shock is, still to day, a vital risk and can also, in case of inadequate early fluid resuscitation, results in secondary morbidity and mortality. ⋯ Finally, infection is the most frequent and the most severe complication of burn injuries. Everything have to be done to avoid bacteriological contamination including architecture, equipment's, care procedure, nutritional support, types of wound dressing and most importantly surgery. Surgical procedures have to be done as earliest as possible to excise necrosis and cover the wound.
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Mortality predictive factors of burned patients are analyzed in a population of 1929 patients by the statistical method of logistic regression. Among the variables studied (total burn skin area, deep burn area, superficial burn area, age, sex, burn location, preexisting disorders), two only, deep burn area and age, have been retained as predictive factors which, when associated, allow to classify 94.47% of the patients in either survival or death group. The prognosis weight of the deep burn area (SBP) is superior to that of the total burn skin area, yet retained in most previous studies. ⋯ A simple linear relation can be proposed as score of severity: IG = (2 x %SBP) + age. Below 80, mortality is close to zero, above mortality increases linearly up to 210, reaching 100%. This relation must be handled cautiously when comparing the severity score of two groups of patients, just as any other severity score that uses a linear relation with the burnt area associated or not to age.
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Facial burns frequently occur in child. A total of 197 burned patients with facial localisation were seen during the time period (1991-1996) covered by this retrospective study. One hundred and sixteen patients were less than three years old. ⋯ The scars had a correct cosmetic appearance, without retraction and inflammatory signs in 158 child after two years. Eleven patients needed other surgical treatment. The authors analyse the results and insist on prevention.