Burns : journal of the International Society for Burn Injuries
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Comparative Study
The progress of hypertrophic scars monitored by ultrasound measurements of thickness.
Ultrasound scanning was used to measure the thickness of hypertrophic scars following burn injury. Scarred areas on patients receiving pressure therapy were monitored at regular intervals from the initial healing, through the hypertrophic stage, to maturation of the scars. The data, collected over a period of 30 months, allowed a comparison of scar development in children and adults and a comparison of the response at different anatomical sites. Measurements made on individual patients could be related to factors affecting the progress of their hypertrophic areas and provided a useful backup to visual assessment during pressure garment therapy.
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Sixteen patients at various stages of pregnancy suffered burns covering between 10 and 80 per cent of the body surface area. This review highlights the management problems of these patients during the first, second and third trimesters. Only two mothers (both with 80 per cent TBSA burns) died. There were five fetal deaths, three of them intrauterine.
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Five hundred and eighty-three children (0-18 years old), consisting of 33.4 per cent of all burn inpatients, were admitted to the University of Alberta Hospitals over an 11-year period (January 1978 to December 1988). Demographic and outcome variables, in addition to aetiological factors, were examined. 48.4 per cent of burns occurred in children less than 4 years of age, with males predominating in every age group (P less than 0.001). Children had smaller burns, a higher incidence of scalds, less inhalation injuries and a lower mortality compared to adult burn patients admitted over the same time period (P less than 0.05). ⋯ High-risk environments identified were the home (74.6 per cent of burns) and recreational settings (12.4 per cent of burns), mainly occurring around campfires. Native children were overrepresented in the burn population compared to the general population by a factor of approximately 10:1. Scald prevention, high-risk environments (home and recreational), high-risk populations (male and natives) and unsafe practices with flammable liquids (petrol in particular) should be emphasized in paediatric burn prevention programmes.
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Split-thickness pigskin graft (STPSG) was used to replace allograft skin for microskin grafting in 16 patients, nine of whom were burn patients, five suffered from traumatic defects and two from diabetic ulcers. The expansion ratios used in these patients ranged from 8:1 to 12:1. The STPSG preparation described was found to be safe for clinical application. ⋯ There were only two episodes of pseudomonas infection and no further grafting was required in any of the patients. In this study the pigskin xenograft was found to provide a suitable environment for the epithelialization of microskin autografts. When allograft is not available, this is an alternative way of ensuring successful microskin grafting.
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Sixty-four patients aged 16-74 years with total body surface area burns (TBSA) ranging from 30 to 90 per cent, were given one bathing in 0.04 M cerium nitrate within 4 h of admission to hospital. Of 21 patients aged 16-30 years, one died (aged 28 with 90 per cent TBSA), and of those aged 31-74 years, two died, one (aged 50 years with 55 per cent TBSA) had multiple internal injuries, the other (aged 51 years with 55 per cent TBSA) had a pulmonary embolism at day 19. ⋯ No FT assessment had been made on the multiple injury death whose TB risk score was 0.66. Such survival results in high-risk patients should encourage the use of cerium nitrate for treating serious burn injury.