Burns : journal of the International Society for Burn Injuries
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Impairment rating is regularly reported for trauma and other conditions but rarely for burns. The purposes of this study were: (1) to report impairment collected prospectively at our burn center, (2) to relate this impairment to measures of psychosocial and functional outcome, and (3) to compare these data to similar data from another burn center to verify that rating impairment is standardized and that the impairments are similar. We studied 139 patients from the University of Washington (UW) Burn Center and 100 patients from the University of Texas (UT) Southwestern Burn Center. ⋯ Average whole person impairment ratings at UT Southwestern were similar at 19%. Several components of the impairment rating, however, differed at the two institutions. To minimize this variation, we recommend: (1) use the skin impairment definitions of the fifth edition of the Guides to the Evaluation of Permanent Impairment (or the most recent published versions of the Guide), and (2) include sensory impairment in healed burns and skin grafts in the skin impairment.
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Nitric oxide (NOz.rad;) is a diatomic mediator liberated on oxidation of L-arginine by the nitric oxide synthase (NOS) family of enzymes. It has complex and wide ranging functions in vivo and has been implicated in the development of the profound inflammatory response that occurs as a result of cutaneous burn injury. ⋯ This review focuses on the role of NOz.rad; in inflammation, with particular emphasis on the acute post-burn inflammatory response. Specific areas of discussion include the maintenance of microvascular haemostasis, leukocyte recruitment and remote organ dysfunction following thermal injury.
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Hypertrophic scarring occurs after deep dermal wounds. Our understanding of the etiology is poor; one reason is the lack of an animal model. In 1972, Silverstein described scarring in the Duroc pig but the model was never confirmed nor disproved. ⋯ We also found that Duroc skin contains cones. Healing in the female, red Duroc pig is sufficiently similar to human hypertrophic scarring to warrant further study so that it can be accepted or rejected as a model of human hypertrophic scarring. In addition, the relationship of the cones to hypertrophic scarring needs further detail and can be studied in this model.
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Case Reports
Double reverse V-Y-plasty in postburn scar contractures: a new modification of V-Y-plasty.
Several techniques have been defined to use in surgical treatment of postburn scar contractures. However, distal flap necrosis is frequently seen since most of these techniques require random-pattern flaps and there is often poor vascular supply to scar tissue. In the Z-plasty, V-Y-plasty and their analogues, excess tissue requires excision of the dog-ear. A new modification of V-Y-plasty, called "double reverse V-Y-plasty", is discussed. Nineteen postburn scar contractures were successfully treated with double reverse V-Y-plasty. The postoperative results represent the versatility of this technique in the surgical treatment of postburn scar contractures, especially neck and extremities. There was no distal flap necrosis. Double reverse V-Y-plasty is effective and alternative to the current techniques in surgical treatment of every kind of postburn scar contractures with one or more contracture lines. It does not need any surgical knack. ⋯ (i) double reverse V-Y-plasty is safely useful, when skin tension across the contracture line is too great to use any local flaps; (ii) when superficial scarring is localized in the contracture site, it is superior to other local flaps because of rich vascularity and mobility; (iii) double reverse V-Y-plasty is advised to the inexperienced surgeon, since it is easy to use; (iv) color and texture matches are cosmetically acceptable, and the resultant contracture is as much as with other techniques; (v) there is no necessity to use excision of the dog-ear; (vi) it can be utilized under local anesthesia almost in all cases; and (vii) it requires a shorter period of operation, and hospitalization.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomised clinical trial comparing a hydrocolloid-derived dressing and glycerol preserved allograft skin in the management of partial thickness burns.
Membranous dressings for the treatment of partial and mixed thickness burns are among the most innovative and promising new developments of the last years. In this study, we present data of a randomised prospective comparative study on a carboxymethylcellulose based dressing, Hydrofibre((R)) and glycerolized human allograft skin. In a 2 year period, 80 patients (40 for each material) were enrolled in the trial. ⋯ Incidence of hypertrophy after 6 months was higher, but not significantly, in the Hydrofibre((R)) compared to the allograft skin group (52.5% versus 30%, P=0.09, chi-square). In view of the results from our comparative study on Hydrofibre((R)) versus allograft skin, we prefer the use of allograft skin for the category of larger burns of mixed depth, usually presented to burn centres. However, for partial thickness and small burns Hydrofibre((R)) can be the first choice in treatment.