The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Nov 1988
The epidemiology of methicillin-resistant Staphylococcus aureus in a burn center.
The emergence of methicillin-resistant Staphylococcus aureus (MRSA) in a critical care facility creates a multifaceted epidemiological problem in uncovering the source of infection. This study was undertaken to determine the true etiology of MRSA burn wound infections. Patients with a 30% or greater TBSA burn had both burned and unburned skin surface cultured upon admission, using RODAC plates. ⋯ However, the remaining 42.9% of the patients had methicillin-sensitive, B-lactamase positive staphylococci present on admission. Isolates of group D streptococci resistant to methicillin were isolated in 35.7% of the patients. This data suggests that burn wound infections caused by MRSA very likely arise from the endogenous flora present at the time of injury through conferring the resistant plasmid by conjugational transfer.
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Candidal (yeast) and noncandidal (filamentous fungal) wound infections have become an increasingly important cause of burn-associated morbidity and mortality. However, these two diseases differ markedly in their epidemiology, onset, appearance, diagnosis, and treatment. ⋯ Early recognition and diagnosis are essential. Radical excision when the infection is confined to superficial invasion of only one anatomic area is key to decreasing mortality from this lethal disease.
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J Burn Care Rehabil · Nov 1988
The role of oxygen-derived free radicals in burn-induced myocardial contractile depression.
The release of oxygen free radicals from ischemic myocardium has been implicated as a causative factor of cardiac dysfunction after thermal injury. In this study, isolated coronary perfused guinea pig hearts were used to determine if free radical scavengers improve left ventricular (LV) intrinsic contractile response to burn shock. Parameters measured included peak isovolumic LV pressure (LVP) and maximal rate of LVP rise (+dP/dtmax) and fall (-dP/dtmax) at a constant preload. ⋯ There was no significant difference in heart rate or time to peak pressure or time to maximal contraction or relaxation among the groups. Left ventricular function curves for burned hearts were shifted downward and to the right of curves obtained from control hearts (P less than 0.01), regardless of scavenger treatment. PEG-SOD, 6,000 U, improved left ventricular contractility (+dP/dt) at maximal levels of end-diastolic pressure but deficits in left ventricular pressure and relaxation persisted.(ABSTRACT TRUNCATED AT 400 WORDS)
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J Burn Care Rehabil · Nov 1988
A preliminary report on transplantation of microskin autografts overlaid with sheet allograft in the treatment of large burns.
The technique of transplantation of autologous microskin grafts (MG) with overlays of split-thickness skin allografts was used in the treatment of nine extensively burned patients. Preparation of MG includes: 1) mincing small pieces of split-thickness skin autografts into skin particles (SPs); 2) dispersing the SPs evenly on a piece of silk cloth; 3) transferring SPs to the dermal surface of an allograft sheet (20/1000 in.); 4) transplanting the allograft with SPs to the excised wound. The mean burn area (total/3 degrees, mean +/- SEM) of this group was 74.9 +/- 16.6/62.1 +/- 18.1% TBSA (range 40 to 94/28 to 90%). ⋯ The average time for complete healing was about six to seven weeks postgrafting. Eight patients survived; one died of overwhelming pulmonary infection 22 days postburn. Advantages of this technique are: 1) the great potential of MG to provide a large expansion ratio of 8:1 to 15:1, average greater than 10:1 in this series; 2) good maintenance of the healed graft to withstand trauma except in areas of repeated flexion; 3) ease of preparation and application with less cost compared to cultured epidermal sheet grafts; 4) prevention of infection in extremely large burns by providing continuous epidermal coverage following sheet allograft application.
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J Burn Care Rehabil · Nov 1988
The suppressive effect of subeschar tissue fluid upon in vitro cell-mediated immunologic function.
Fluid administered during resuscitation translocates beneath the burn wound and is considered inert "third space" loss. This study was done to determine whether subeschar tissue fluid (STF) functions as an immunobiologic reservoir. Seven patients with a mean BSA burn of 55% underwent isotonic volume resuscitation and burn treatment with low penetration topical agents. STF was collected at the time of fascial excision. Chemical analysis of STF was similar to serum; bacterial cultures grew no organisms. Ten percent dilutions of STF and burn serum significantly blunted mitogen-induced blastogenic response compared to control serum. STF was significantly more suppressive than burn serum (P less than .03). ⋯ 1. STF may act as both an immunologic barrier to microbial clearance in otherwise viable subcutaneous tissue and a reservoir for systemically reabsorbed immunosuppressive factors. 2. In addition to removing dead tissue, fascial excision may prove beneficial because it removes large amounts of immunosuppressive STF.