Burns : journal of the International Society for Burn Injuries
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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.
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Local adipofascial turn-over flaps overlaid with skin grafts were used successfully to reconstruct nine deep burn wounds following electric injuries or contact burns in seven patients. Durable flap coverage of the exposed tendons, joints or bones can be achieved with a one-stage procedure. ⋯ The adipofascial turn-over flap is a reliable and simple technique for reconstruction of certain deep burn wounds if the surrounding soft tissue is available. The functional and cosmetic results in our series have been rewarding and satisfactory.
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The first 12 months of a new consultation-liaison service to a burns unit is described. Management of contact between the psychiatrist and the burns team is discussed and diagnostic categories are given for referrals seen. Diagnostic criteria are not achieved for many patients assessed, and yet the burns team still requires help managing patients who are psychologically disturbed. Education and a forum for team discussion are used as a way for the burns team to integrate psychological work in the management of their patients.
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This report describes the statistical analysis of 629 burn patients treated between January 1989 and August 1990. The analysed data include age, sex, cause of burn and mortality in relation to age, cause and extent of burn injuries. Additional information with regard to socioeconomic status, marital status, place of burn, family size, type of burn, time of accident and time between injury and hospital admission was obtained from analysis of 271 of the 629 patients admitted between January 1990 and August 1990. ⋯ Flame burns resulted in maximum deaths (62.1 per cent). In patients with over 40 per cent burns, the mortality was about 80 per cent. There were no survivors in patients with over 70 per cent TBSA burns in our series.