The Journal of craniofacial surgery
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Sustaining a burn injury sets in motion a cycle of pain, disfigurement, and a search for survival. In pediatric burns, the injury extends to the parents where fear, ignorance, and helplessness forever change their lives. Pediatric burn injuries are caused by fire, hot liquids, clothing irons, hair curlers, caustic substances like drain cleaner, the grounding of an electrical source, and exposure to radiation. ⋯ There is a paucity of evidentiary pediatric burn economic data. More research is needed to address areas of pediatric burn care inefficiency. Improving knowledge of cost in all health care endeavors will create competition and drive down expenditures.
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Severe burn injuries frequently present a therapeutic challenge; fortunately, conservative therapies have proven highly effective in augmenting standard surgical management. Skin substitutes, such as pigskin or cadaveric tissue, aid in acute burn care by limiting fluid and heat loss. ⋯ Physical therapy promotes strengthening of local musculature and regain range of motion. We discuss the nonoperative management of severe burns, as well as provide insight into future directions in conservative burn care.
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Unique anatomic and pathophysiologic features of the thermally burned pediatric hand are reviewed, with a focus on direct management of the injured tissue in the early phases of the treatment process. A nonoperative approach to most pediatric hand burns is advocated, and principles of early wound care, including antimicrobial therapy, and escharotomy are described. ⋯ Finally, basic techniques for splinting, positioning, and exercising the burned pediatric hand are described. When properly applied, the principles discussed herein have rendered the severely scarred, functionless hand a rarity after thermal injury.
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Electrical burns of the upper extremity, particularly high-voltage injuries, are becoming more prevalent in today's society and are often times devastating to the patients' appearance and functionality. The basic tenants of flame burn reconstruction apply to electrical injuries. ⋯ Whereas the role of the surgeon continues to be the creation of ingenious techniques to deal with complications, the real treatment lies in education and prevention. This article will look to do a comprehensive review of electrical injuries to the upper extremity.
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Catastrophic burn injuries often leave patients in shock or incommunicative, creating complex ethical situations. Patient autonomy and the ability to make competent decisions become key issues. Although patient surrogates may aid in decision making, few patient advocates possess appropriate perspective of burn injury, management options, and likely outcomes. ⋯ At what point does caring for the severely burned patient become futile, and who defines it as such? Whereas formulas and algorithms guide medical management, very few well-defined principles direct ethical decision making in severe burn management. The physician must rely on his or her understanding of medical ethics to marshal a complex team of burn personnel, maintain institutional protocol, and work closely with patients and patient advocates. Only thorough, thoughtful rational application of ethics can one provide maximal respect for patient autonomy while optimally managing the severe burn injury.