Burns : journal of the International Society for Burn Injuries
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Three hundred and forty-two patients with 10-50 per cent body surface area burns were studied prospectively over the 5-year period from 1982 to 1986 for the effectiveness of topical 1 per cent silver sulphadiazine. Various parameters were studied including: (i) healing time of deep partial skin thickness burns, (ii) eschar separation time, (iii) conversion rate of deep dermal burns to full skin thickness burns, (iv) burn wound surface bacterial flora and their changing pattern over the years, (v) incidence of invasive sepsis and (vi) overall mortality. There was a remarkable decrease in the time taken for the healing of deep dermal burns, and the conversion rate of deep dermal burns to full skin thickness was significantly reduced. ⋯ There was a total change in the predominent surface micro-organisms from Staph. aureus, which was predominant in 1982, to pseudomonas species and klebsiella in 1986. Moreover, there was the emergence of a new variety of micro-organism within the last 2 years. The incidence of invasive infection and overall mortality was significantly reduced.
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There were 96 deaths among 1433 burns patients admitted to the Plastic Surgery and Burns Unit at Ibn Sina Hospital and Plastic Surgery Unit at Mubarak Al-Kabeer Hospital from January 1982 to December 1987. This represents an overall mortality of 6.7 per cent; 74 per cent of the patients who died had sustained more than 50 per cent body surface area (BSA) burns. A large number of deaths occurred in two age groups, 0-5 years (21 deaths) and 21-30 years (24 deaths). ⋯ Flame burns due to domestic accidents were the aetiological factors in the majority of patients; 84 (87.5 per cent) of those who died sustained flame burns, although flame burns were only responsible for 46.6 per cent of all burns cases admitted. The mean survival period was 16.8 days postburn, the longest period being 79 days for a patient with 60 per cent BSA burns. Forty-seven patients (49.9 per cent) died of septicaemia which, with its related complications, remains the most important cause of death in our burns patients.
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Three hundred and nineteen patients with different types of burns were studied at King Fahd Hospital, Jeddah, Saudi Arabia over a 2-year period (December, 1985 to December, 1987). Scalding was the most common cause (56.4 per cent) of burn injuries compared with 41.4 per cent of patients who sustained flame injury; 84.6 per cent of the thermal injuries occurred at home, with children (less than or equal to 18 years of age) being affected most frequently (61.8 per cent). The overall mortality was 9.4 per cent.
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One hundred and seventy-two burn wound swabs obtained from 90 patients admitted to the Aljila Hospital Burn Unit, Benghazi over a 3-month period were processed to determine the microbial flora colonizing burns and their resistance patterns to selected locally available topical and systemic agents. Approximately 84.9 per cent of the swab specimens yielded growth of 11 bacterial species and Candida spp.; of these, Ps. aeruginosa, Staph. aureus and Klebsiella spp. predominated in order of prevalence, followed by Enterobacteria. ⋯ In studies in vitro using six topical agents, Ps. aeruginosa strains were most sensitive, in decreasing order, to mafenide acetate, silver sulphadiazine, acetic acid, silver nitrate and Eusol. Seventy-eight per cent of Staph. aureus isolates were resistant to methicillin and erythromycin and 93 per cent to tetracycline.
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Case Reports
Experience of reverse medial arm flaps in the reconstruction of burned elbow scar contractures.
There are many methods to correct scar contractures in the elbow region after burn injury, including Z-plasty, Y-V or rectangular flaps, local or distant fasciocutaneous flaps, muscle or myocutaneous flaps, free flaps, tissue expanders and non-surgical orthotics. Among these, the reverse medial arm island flap, based on the recurrent ulnar artery, has proved to be a convenient local fasciocutaneous flap for elbow scar reconstruction. In the past 2 years, 12 reverse medial arm flaps were used in 11 patients. ⋯ Two complications, one partial flap necrosis, another ulnar nerve compression, were noted. Our clinical experience with this flap encourages us to use it for burn elbow reconstruction in the future. The advantages and disadvantages are discussed.