The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Nov 1989
Comparative StudyHealing characteristics of expanded autografts on wounds covered with homograft and Biobrane temporary wound dressing.
This study compared the healing characteristics of expanded autografts on wounds with interstices that were closed with cryopreserved cadaver homograft split-thickness skin and wounds with interstices that were closed with the synthetic skin substitute, Biobrane temporary wound dressing. Nine paired wounds in four patients with large burns were used in this study. ⋯ Although wounds covered with homograft immediately had the appearance of healed wounds, biopsy specimens showed evidence of a delay in epithelial migration. Although these results indicate impaired epithelial migration with the use of both materials, we concluded that homograft offered an advantage because the wounds that were covered with it remained closed during the entire reepithelialization process.
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The supplement on burns by the National Disaster Medical System (NDMS) requires an evaluation of burn centers' and burn hospitals' capabilities for treating seriously burned victims. The American Burn Association (ABA) and its members, as experts in burn care, should take the lead in working with local, state, and federal disaster planners. ⋯ Periodically, the ABA should verify that the burn care facilities identified in the disaster plan meet its standards. Once the burn disaster system is developed, drills should be held locally on a regular basis and nationally on an annual basis.
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J Burn Care Rehabil · Nov 1989
Burns and associated nonthermal trauma: an analysis of management, outcome, and relation to the Injury Severity Score.
Nonthermal trauma in patients with burns necessitates additional considerations in management. The charts of all patients with nonthermal trauma admitted to a regional burn center from 1977 to 1987 were reviewed. The causative events and types of injury were determined. ⋯ Fracture management varied, and the only complications that occurred among the 15 of 61 patients with fractures were associated with overlying burns. The mortality rate was 20%, which is comparable to that predicted from the patients' ages and the percent of total body surface area burned. The mortality rate predicted from the Injury Severity Score is much lower, which brings into question its use for analysis of this patient population.
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J Burn Care Rehabil · Nov 1989
Changes in coagulation factors in patients with burns during acute blood loss.
A prospective study was undertaken to determine the change in coagulation factors in patients undergoing tangential excisions of burn wounds when red blood cells preserved with ADSOL (adenine, dextrose, saline, and mannitol) and crystalloid solution were used for volume replacement. Nine patients with burns were studied, three on two separate occasions. No patient had a history of a bleeding disorder or had taken aspirin within 10 days of surgery. ⋯ No patient in the study group developed a coagulopathy or received fresh frozen plasma or platelet supplementation. These findings suggest that the intraoperative blood losses that occurred during tangential excisions of burn wounds were made safe by the higher than normal preoperative levels of platelets, fibrinogen, and factor VIII and by the slow wash-out curve for platelets and factor IX. Prophylactic use of either fresh frozen plasma or platelet concentrates is not indicated unless a specific deficit or coagulopathy has been identified.
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We studied loss of cutaneous sensibility after grafting in 60 patients with burns who had applied for impairment assessment. Fifty-eight patients (97%) demonstrated markedly diminished or absent responses to sharp/dull, hot/cold, and light touch stimuli over grafted areas. However, all but one patient had intact perception over donor areas and over areas of healed (ungrafted) partial-thickness burns. ⋯ Depth of burn injury appears to be the best predictor of altered sensation, and some abnormalities in patients appear inevitable after skin grafting. Patients should be counseled about possible outcomes. However, the decrease in sensation that was observed rarely contributed significantly to the long-term impairment rating of these burn victims.