Burns : journal of the International Society for Burn Injuries
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Reliable, clinically acceptable pressure measuring devices are important to accurately record interface pressure. The Pliance X is a device that may overcome previous device limitations (i.e. pressure garment distortion, temperature dependent sensors). This research aimed to identify the test-retest reliability and clinical utility of the Pliance X in children receiving pressure garment therapy post-burn. ⋯ Further reliability testing is required, including inter-rater reliability testing. The device's clinical utility could be improved with alternate sensor styles and an instant mean pressure reading to enable immediately clinically useful information on the interface pressure.
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Half a million patients in the USA alone require treatment for burns annually. Following an extensive burn, it may not be possible to provide sufficient autografts in a single setting. Pig skin xenografts may provide temporary coverage. ⋯ We summarize the current status of research into skin xenotransplantation for burns, with special emphasis on developments in genetic engineering of pigs to protect the graft from immunological injury. A genetically-engineered pig skin graft now survives as long as an allograft and, importantly, rejection of a skin xenograft is not detrimental to a subsequent allograft. Nevertheless, currently, systemic immunosuppressive therapy would still be required to inhibit a cellular response, and so we discuss what further genetic manipulations could be carried out to inhibit the cellular response.
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Dermal preservation during acute burn excision is key to obtaining superior healing/scar outcomes, however, determining the most appropriate excision tool is an ongoing challenge. Novel tool development means the knife is no longer our only option, yet for the majority it remains the gold standard. This systematic review aims to evaluate evidence for burns excision approaches (knife/hydrosurgery/enzymatic). ⋯ Level 1 Evidence comparing excision modalities for acute burns is sparse. Although early excision with a knife is still often considered best practice, there is no tool choice consensus or robust comparison with alternate, possibly superior, tools. EDNX or Versajet™ should be considered alternatively. Further RCTs are indicated, with regards final scar outcomes and to allow consensus within current evidence.
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Burn scars can be associated with significant loss of cutaneous sensation, paresthesia and chronic pain. Long-term systemic changes in cutaneous innervation may contribute to these symptoms and dorsal root ganglia have been implicated in the development of chronic neuropathic pain. Therefore we hypothesized that changes in cutaneous innervation after burn injury may be mediated at the level of the dorsal root ganglia. ⋯ Type B cells constituted a greater proportion of the viable cell population in the ipsilateral DRG after a burn injury. This change may be important in the induction of signalling related to pain and itch and has important implications for the restoration of normal cutaneous innervation after burn injury. Investigating whether neuro-protective or neuro-restorative approaches can ameliorate damage to the DRG will be important to improve sensory outcomes for burn patients.
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Skin expansion in the lower limb is a difficult procedure with a significant rate of complications. We propose, in this retrospective mono centric study, a systematic review of our skin expansion procedures on the lower limb in burn sequelae with a 30-years follow-up. The objective was to evaluate the overall result of our procedure and present its technical specificities. ⋯ The success of our expansion procedures in burn sequelae of lower limb is due to technical key points such as the choice of the prosthesis size, the position of the remote internal valve, the position of the drain and a delayed inflation start. Level IV.