The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Jan 1992
Multicenter Study Clinical TrialAddendum: multicenter experience with cultured epidermal autograft for treatment of burns.
Since 1989 BioSurface Technology, Inc. (Cambridge, Mass.) has provided over 37,000 cultured epidermal autografts (CEAs) for more than 240 patients in 79 different burn centers in the United States and Europe. The average burn treated with BioSurface's CEA has been 70% total body surface area, half of that being full-thickness. Data, verified for 104 patients, indicate an average final "take" of about 60%, with half of all patients achieving a final take greater than or equal to 70% and 22% with final take greater than or equal to 90%. ⋯ Early excision followed by temporary coverage with homograft, which is allowed to engraft, was found to be associated with a low infection rate and a higher rate of CEA take. When engrafted homograft was only partially excised, leaving a layer of "allodermis" as the graft bed for CEA, take averaged 90% among 14 patients. Thus, our analysis of the extensive experience of many burn centers now permits more specific and helpful recommendations on standards of care to maximize efficacy of CEA.
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J Burn Care Rehabil · Jan 1992
ReviewPsychometric assessment of psychologic factors influencing adult burn rehabilitation.
This article describes psychometric assessment instruments that are available for the screening of psychosocial problems that can interfere with patient rehabilitation. Structured assessment of patient depression, anxiety, substance abuse, social support, and willingness to take control and responsibility for health care is important throughout all stages of the patient's treatment. There are psychometrically sound, relatively brief, and nonintrusive measures with which to assess these variables. ⋯ Future clinical research will hopefully compare and contrast the efficacy and relevance of these measures. Furthermore, future clinical evaluation and research will need to relate the influence of psychosocial factors on the patient's total health functioning. Structured psychometric evaluation of the psychosocial and health characteristics will ensure that patients who have been burned will attain the most fulfilling quality of life that is available to them.
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J Burn Care Rehabil · Jan 1992
ReviewThe role of the psychiatrist in the team treatment of the adult patient with burns.
Improved survival rates for patients with major burn injuries and the consistent finding of significant long-term psychologic disability among survivors of burn trauma call for a redefinition of the role of the psychiatric consultant in the care of patients with burns. In addition to the traditional functions of diagnosis and treatment of discrete psychiatric disorders in patients with burns, this expanded role includes assisting the patient's normal process of psychologic adaptation after injury, assessing and managing burn pain, and facilitating communication among all members of the burn team. The functions of the psychiatrist are most effectively carried out when the psychiatrist is able to participate on a regular basis in the care of every patient as a member of the burn team.
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J Burn Care Rehabil · Jan 1992
Comparative StudyImmediate ambulation of patients with lower-extremity grafts.
Immediate ambulation of patients who have had lower-extremity skin grafting has been practiced in our burn center since 1987. A retrospective review of patients who had lower-extremity skin grafting only and a survey of burn centers in which 109 centers responded were conducted. ⋯ Average length of stay was 12.6 days (p less than 0.012). This review demonstrated that although immediate ambulation after lower-extremity grafting is not a widely adopted procedure, it does not impair graft take and may decrease the average length of stay.
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J Burn Care Rehabil · Jan 1992
Case ReportsWound bed preparation: approaches to replacement of dermis.
Cultured epidermal autograft (CEA) can provide a valuable source of protection in patients with large amounts of skin loss as a result of thermal injury. An unanswered question is: will the long-term outcome be better if a dermis is present? We have approached the problem by attempting to retain the cryopreserved allograft dermis that is originally placed as temporary wound coverage. The retained dermis provides a substantial, uniform, well-vascularized bed that accepts the CEA. ⋯ CEA was placed on allodermis on days 24, 28, and 35, respectively. Patients 1 and 2, who survived and returned to work, had a "take" of at least a 90% of allograft and a permanent coverage CEA take of 88% and 81%, respectively. Patient 3, who died, had an allograft take of only 20% to 30% and a CEA take of less than 10%.