Burns : journal of the International Society for Burn Injuries
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Despite refinements in burn shock resuscitation, improvements in surgical techniques, advances in intensive care medicine and the presence of very expert surgeons, the treatement of patients with severe burns exceeding 60% TBSA remains a big challenge. A major problem in the treatment of severe burn injuries is the lack of autologous skin. In selected cases cultured epidermal autograft (CEA) may be used. ⋯ He was treated with artificial skin, split-thickness autograft and CEA in combination. The clinical history and the follow-up of approx. 1 year are presented and the results discussed. We consider the survival of this patient being a result of the therapeutic progress of the recent decades.
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The following report describes an unusual iatrogenic contact burn from a heated dental instrument. The potential hazard of inflicting a contact burn using a glass bead sterilizer must be kept in mind.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
The effect of a tissue engineered bilayered living skin analog, over meshed split-thickness autografts on the healing of excised burn wounds. The Apligraf Burn Study Group.
The potential of Apligraf(R) (Graftskin) (Organogenesis Inc., Canton, MA), to improve cosmetic and functional outcomes when applied over meshed split thickness autografts was evaluated in a multicenter, randomized within patient controlled clinical trial. Experimental treatment sites had Apligraf(R) placed over meshed autograft while control sites were treated with meshed autograft covered with meshed allograft, or meshed autograft not covered by a biologic dressing. Forty patients were entered into this study of which 38 were evaluable. ⋯ Vancouver burn scar scores were shown to be statistically better at Apligraf(R) sites compared to control at all time points from week 1 to month 24. These results indicate that Apligraf(R) is a suitable and clinically effective treatment for burn wounds when applied over meshed autografts. Furthermore, cosmetic and functional advantages with Apligraf(R) were demonstrated when applied over meshed autograft compared to the current standard treatments of meshed autografts.
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Case Reports
Heparin-free hemodialysis in the treatment of hypernatremia in severely burned patients.
Hypernatremia in severely burned patients is associated with high morbidity and mortality rates. As the causes of hypernatremia in major burn patients are still not clear, hemodialysis is the method of choice for the treatment. While hemodialysis is effective for the control of hypernatremia, it can cause bleeding complications that may be fatal for burn patients with extensive wounds and potential gastro-intestinal mucosal damage. ⋯ Heparin-free hemodialysis is an effective and safe method in the treatment of hypernatremia in extensively burned patients.
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From 1995 to 1998, 12 burned patients with acute renal failure (ARF) were treated by veno-venous continuous renal replacement therapy (CRRT) at the Burn Unit of Hôtel-Dieu de Montréal. Their mean (+/-SD) age was 51+/-12 years, and the mean burned surface covered 48.6+/-15.8% of total body surface area. All patients were mechanically ventilated and presented evidence of sepsis. ⋯ The mortality rate was 50%. The six survivors all recovered normal renal function with four of them requiring intermittent hemodialysis for short periods. In conclusion, veno-venous CRRT is particularly well suited for this selected population allowing smooth fluid removal and aggressive nutritional support.