Burns : journal of the International Society for Burn Injuries
-
The use of quantitative bacteriology in the burns unit has been thought to be efficient in predicting sepsis or graft loss. To examine the relationship between clinical outcome and bacterial densities on and in the burn wound, 69 biopsy/surface swab pairs were collected from 47 patients on 64 occasions, either immediately prior to excision and grafting, or at routine change of dressings. The mean per cent TBSA burn was 16 (range 1-65). ⋯ There was no significant difference in bacterial counts between patients judged to be a clinical success or clinical failure (72 h follow-up), either after undergoing excision and grafting, or change of dressings, and no difference in counts between patients with perioperative bacteraemia and those without. With burns > 15 per cent TBSA, a relationship between bacterial counts and subsequent sepsis or graft loss still was not demonstrated. It is suggested that quantitative bacteriology by burn wound biopsy or surface swab does not aid the prediction of sepsis or graft loss.
-
Burns are the fourth leading cause of injury death in children in the USA, accounting for 1300 paediatric deaths annually. The majority of paediatric burns mortality and morbidity result from simple domestic accidents that are preventable. A prospective study of paediatric burns from 1 January 1992 to 1 January 1993 was undertaken at our burns unit to outline the profile of the Irish paediatric burns problem. ⋯ Second, 90 per cent of the accidents occurred in the home and almost all were preventable. A parent or guardian was present in 87 per cent of cases but parental knowledge of the appropriate first aid measures was poor. It is suggested that a public health education campaign on this issue would help in reducing the incidence and severity of paediatric burn injuries in Ireland.
-
A method for preparing acellular allogeneic dermal matrix (ADM) and its effectiveness as a dermal substitute are described. Treatment of rat skin with Dispase followed by Triton X-100 completely removed cellular components from the dermis. Subcutaneously implanted ADM evoked no immunological reaction and 20 weeks after implantation, the size of the implanted ADM was reduced to about 60 per cent of its original area. ⋯ A second layer of ADM placed onto the implanted ADM served as an excellent dressing, providing mechanical protection and permitting vascularization of the underlying implant. Onlay skin autografts placed onto vascularized allogeneic ADM showed good survival when the skin was grafted more than 1 week after ADM implantation. Dispase/detergent treated ADM derived from animal or human skin may be useful in full thickness skin defects providing a vascularized bed for subsequent epidermal coverage.
-
A retrospective analysis of all burns admitted to the Welsh Regional Burns and Plastic Surgery Unit, Chepstow, in the period 1 January 1990 to 1 October 1993, highlighted a group of 50 patients who had sustained contact burns from the radiators of domestic central heating systems. There was a male prevalence, with an average age of 43.4 years (range 6 months to 100 years). The mean TBSA burned was 1.58 per cent (range 0.13-6.0 per cent) and half of the injuries were full thickness depth. ⋯ The aim of the audit was to investigate the mechanism of injury and link precipitating factors. The contribution of the high surface temperature of the radiator to the burn injury is alluded to. The various methods available to reduce this risk are discussed and the use of the low surface temperature radiator, already routinely used in health care premises, is advocated.
-
Combined transplantation of skin autograft and allograft was used for the treatment of severe burns. The allografts were obtained from cadavers and were pretreated with 15 per cent glycerol for 2 h at 4 degrees C then frozen at -80 degrees C until used. Patches of autografts were placed over the burns and were covered by a stretched mesh of allografts. ⋯ At 3 weeks, the dermal components of the allograft were covered by epithelial cells from recipient tissue and were invaded by fibroblasts and capillaries. At 4 weeks, allografted skin was replaced by granulation tissue, which mediated the adhesion of the grafts to the underlying tissue. Skin allografts with a freeze-thawing pretreatment provide an appropriate matrix for the epithelial relining and for the growth of granulation tissue in burned skin.