Burns : journal of the International Society for Burn Injuries
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Case Reports
Versatility of the free or pedicled superficial cervical artery skin flaps in head and neck burns.
The usefulness of the free or pedicled superficial cervical artery skin flap in reconstructive surgery of head and neck burns is reported. This flap can be made with the pivot point near the cervical region. Moreover, it can be elevated as a free or long vascular pedicled flap. Therefore, it is widely applicable in reconstructing the scar contractures of the head and neck, particularly in extensively and deeply burned patients.
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A method for obtaining widely expanded postage stamp autografts, first described in 1963 by C. P. Meek, has been evaluated in our burns unit. ⋯ In a series of 16 consecutive skin graft procedures performed on 10 patients with extensive burns, the mean epithelialization rate was 90 per cent (range 70-100 per cent) within 5 weeks. Cosmetic results were comparable to those achieved with widely expanded mesh grafts. The Meek technique utilizes small pieces of autograft, and has proved to be a practical alternative to mesh grafts when donor sites are limited.
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The estimations of blood loss and transfusion requirements during burns surgery are notoriously difficult. This clinical study investigated the effectiveness of estimates made by junior and senior burns surgeons and senior anaesthetists by comparing them with calculated blood losses. Regression analysis shows good correlation between these methods (r-value range 0.75-0.97), although 'eye-balling' the losses tends to underestimate the transfusion requirements (regression slope coefficients ranged between 0.56 and 0.87). ⋯ The mean blood loss for 1 per cent of burn excised or split skin donor site harvested was 117 ml in adult cases. Blood loss can also be expressed as a mean percentage of the patient's calculated total blood volume for each 1 per cent burn excised or autograft harvested, giving figures of 2.6 per cent for adults and 3.4 per cent for children. Gravimetric analysis of soiled swabs underestimates the blood loss by approximately 50 per cent.
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We have treated 25 pregnant patients with burns over a period of 6 years (1986-91). During this period total admissions to the burn unit were 1260. There were 187 women of child-bearing age, with burns ranging between 15 and 100 per cent TBSA. ⋯ Abortion was common in the first trimester of pregnancy. Septicaemia was the commonest cause of abortion. Fetal death is not always preceded by maternal death.