Burns : journal of the International Society for Burn Injuries
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One-third of all admissions to the Wessex Regional Burns Unit (WRBU) are children under 5 years of age. These patients constitute a disproportionately large part of the workload in terms of nursing and medical care. A review of children admitted to the WRBU over a 5-year period was undertaken. ⋯ There was one death. In an extension to the main database, associations between clinical and physiological observations and morbidity were sought. The data suggest that behavioural changes, 'shock', profound lymphocytopenia and pyrexia greater than 39.5 degrees C should be treated as strongly suggestive of the development of complications in the early stages after injury.
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Eleven patients with high-tension electrical-arc-induced thermal burns due to railway overhead cables were treated at the Bratislava Burn Department during a relatively short period of 18 months. All the injuries occurred by the same mechanism, that is persons climbing on top of railway carriages and approaching the 25,000 V a.c. overhead cables. All the burns were the result of an electrical arc passing externally to the body, with subsequent ignition of the victim's clothes. ⋯ In spite of high-tension aetiology, no true electrical injuries appear to have occurred and no amputations were necessary. The pathophysiology and possible preventive measures are discussed. It must be stressed that arcing can be induced by an earthed object approaching, but not touching, a cable carrying a high voltage.
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The successful use of a parascapular fasciocutaneous flap to cover an above-elbow amputation stump with exposed bone is described. Better stability of the stump to pressure (or manipulations), a relatively early one-stage surgical procedure and diminished possibility of later contracture leads to a better long-term outcome.
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Thermoplastic road markings are used at similar temperatures to tar and bitumen and spillage onto skin causes similar contact burns. Most of these occupational burn injuries can be avoided by adherence to the manufacturer's recommendations about the wearing of protective clothing. Management and foremen of contractors using these materials need to ensure that their workers comply with safe procedures and wear the specified protective clothing.
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With the introduction of silicone gel in 1981, the emphasis in the treatment of burn scar management has changed from pressure to the use of contact media. A range of 'contact media' has been introduced, allowing for therapy to be individualized to the patient and the scar. Over the last few years, the introduction of 'the adhesive technique' has allowed for earlier therapy with the aim of preventing or minimizing scar hypertrophy with better short- and long-term cosmetic results. The mode of action of 'contact media' is discussed, with a suggested hypothesis and further lines of investigation.