The Journal of burn care & rehabilitation
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It is well recognized that child abuse is a common mechanism of injury to burned children. A profile of an abused burn child was constructed by analyzing 321 consecutive pediatric admissions to our burn center during a 24-month period starting in April 1993. ⋯ From the 93 reported cases, 26 were taken into temporary custody, 56 were indicated for abuse, but returned to the home, and 14 were "unfounded" cases. Our analysis indicated burned children aged 3 years and under, from single-parent, impoverished homes, admitted with a scald or thermal-contact burn are at highest risk for abuse or neglect and warrant careful assessment.
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J Burn Care Rehabil · Jan 1998
Comparative Study Clinical TrialA prospective analysis of serum vitamin K in severely burned pediatric patients.
Patients with burn injuries exhibit multiple risk factors for the development of vitamin K deficiency, including malabsorption, limited enteral intake, antibiotic therapy, and multiple surgical procedures. A prospective evaluation of 48 children was conducted to evaluate serum vitamin K values during the first 4 postburn weeks. Serum levels were analyzed in relation to clinical course. ⋯ Ninety-one percent of the children demonstrated serum values below expected norms. These data suggest a relationship between coagulopathy and an intact functioning gastrointestinal tract. However, the relative importance of dietary versus endogenous vitamin K produced by intestinal bacteria remains to be elucidated.
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J Burn Care Rehabil · Jan 1998
Comparative StudyThe use of sheet autografts to cover extensive burns in patients.
We previously have reported on the enhanced cosmetic and functional outcome with the use of sheet autografts. The recent goal has been to cover larger surface areas with sheet grafts, or for patients with larger burns, covering the hands and face with sheet grafts, if possible. To evaluate the use of sheet grafts in burns of more than 30% total body surface area (TBSA), the percentage covered with sheet and meshed autograft was reviewed in 105 patients admitted between January 1, 1990, and August 30, 1994. ⋯ With even larger burns, sheet grafts were used to cover the face and hands. Because of its superior cosmetic and functional outcome, sheet autografting should be considered for covering moderately sized burns. Sheet autografting should be considered for more important cosmetic and functional areas, such as the face and hands, for massive burns.
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J Burn Care Rehabil · Jan 1998
Burn area color changes after superficial burns in childhood: can they be predicted?
Pigmentation changes after superficial burn injuries are often difficult to predict. We analyzed a sample of patients with burn injuries, looking for clinical indicators of predictable color changes in burn wounds. A sample of 50 children, predominantly those with pigmented skins, who had sustained superficial partial-thickness, (second degree) thermal, scald, or friction burns, were retrospectively grouped. ⋯ During the first 3 years after injury, burn site color changes were variable. Subsequently, there was cumulative hyperpigmentation at the burn site, provided that the melanocyte-bearing deep dermis had not been destroyed. Hyperpigmentation correlated significantly with skin color, as quantified by the Fitzpatrick scale (p < 0.01), and with time after injury (p < 0.05).
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J Burn Care Rehabil · Jan 1998
Comparative StudyLocal anesthetics improve dermal perfusion after burn injury.
Deep partial-thickness burn injury was induced in the abdominal skin of anesthetized rats. Dermal perfusion was assessed by laser Doppler flowmetry. In the first set of experiments, one group of rats (n = 15) was topically treated with a lidocaine-prilocaine cream 5% (25 mg of each in 1 g) for 6 hours, starting 5 minutes after inducing the burn injury. ⋯ Results showed a significantly improved skin perfusion in the lidocaine-treated group in a dose-response fashion as compared to control animals. A maximum improvement of dermal perfusion in the burned area was induced by intravenous lidocaine at an infusion rate of 150 micrograms.kg-1.min-1 as compared to burned controls treated with isotonic saline solution infusions (p < 0.01). Results showed that topical or systemic administration of local anesthetics can prevent progressive dermal ischemia after thermal injury.