J Trauma
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Comparative Study
Comparison of serial debridement and autografting and early massive excision with cadaver skin overlay in the treatment of large burns in children.
Thirty-two children admitted from 1977 through 1981 were treated by serial debridement of their burn wounds with 1:1.5 to 3:1 meshed autografting of granulating tissue as it became available. Thirty-two burned children treated from 1981 to 1984 were treated by early total excision to fascia with application of 4:1 expanded autograft and cadaver skin for complete closure. The ages (6.8 +/- 0.6 years), sex distribution, and mean per cent third-degree burn (64 +/- 1%) were the same in both groups. ⋯ Overall operating time (10.3 +/- 0.8 hours) and units of blood loss (28.3 +/- 3.5) were indistinguishable in the survivors of both groups. The survivors of the early excision group underwent fewer operative procedures, (5.8 +/- 0.5 vs. 7.6 +/- 0.5) and had a greatly decreased length of hospital stay (57 +/- 5 vs. 97 +/- 8). The ultimate functional and aesthetic consequences of the two techniques must be compared.
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We have reported the case of an anterolateral dislocation of the proximal tibiofibular joint in a soccer player, apparently the second case in the literature. As in that reported by O'Rourke and McManus, this patient was attempting to gain his balance and this may indeed be an important contributing factor. ⋯ Treatment usually consists of closed reduction with 3 weeks of casting. In complicated cases, however, resection of the fibular head may be required.