Aust Fam Physician
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The introduction of contact media in burn scar management has offered a cost effective alternative to pressure garment therapy, with improvements in function and cosmesis. The range of contact media now available allows for therapy to be individualised to the patient regardless of the size and site of the scar. The application and indications for contact media are presented and the probable mode of action is briefly discussed.
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Recent understanding of the effects of topical antimicrobials on cells that heal the wound, the role of infection, and new understandings of the role of occlusive 'biological dressings' have resulted in a more rational treatment protocol for burn wounds. With improvements in the resuscitation and intensive management of severe burns, more patients survive the initial effects of the injury, resulting in developments to close a large burn wound, which include expanding the patient's own skin to cover those large areas.
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Neuroblockade techniques can serve many functions in the management of the chronic pain patient. These various functions are discussed and a brief insight given for their use in specific pain syndromes. A run-down of the type of blocks useful in the management of cancer pain is also given.
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Patient selection for repeated spinal surgery is not uniform and must be further refined. A multidisciplinary approach with careful evaluation of physical, psychological and environmental factors is ideal. Improved imaging should delineate disorders more clearly, and advances in surgical technique may improve outcome. It is likely, however, that a number of patients will continue to require long-term pain management.