The Journal of burn care & rehabilitation
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Progressive epithelial loss (melting) from a previously well-taken graft, healed burn wound, or healed donor site is a significant problem in the treatment of patients with burn injuries. For many years, such epithelial loss was attributed to the growth of Streptococcus spp; however, we recently have encountered progressive epithelial melting without significant colonization or infection with Streptococcus spp. We retrospectively reviewed 1035 cases admitted from January 1994 to July 1996 and then collected data prospectively from 324 patients admitted to the University of Washington Burn Center from August 1996 to May 1997. ⋯ The melting graft-wound is a significant clinical problem, and its incidence appears to be increasing. The pathophysiology, clinical course, and treatment of the melting graft-wound syndrome are not well understood, and there is no description of it in the literature. This study describes the clinical features of the syndrome.
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J Burn Care Rehabil · Jul 1998
Randomized Controlled Trial Comparative Study Clinical TrialProspective, randomized study of the efficacy of Mepitel on children with partial-thickness scalds.
We performed a randomized clinical trial in which children with partial-thickness scald burns of less than 15% total body surface area were assigned treatment with either Mepitel (Mölnlycke Health Care) or silver sulfadiazine. Data were collected on time to wound healing, pain at dressing change, infection, and resource use. Student's t and chi-square tests were used to determine differences in the two groups. ⋯ They also had significantly lower mean daily hospital charges ($1937 vs $2316; p = 0.025); as well as significantly lower charges for dressing changes and narcotics. There was no significant difference in wound infection. We believe the use of Mepitel represents a significant advance in the treatment of partial-thickness scald wounds in children.
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J Burn Care Rehabil · Jul 1998
Return to jeopardy: the fate of pediatric burn patients who are victims of abuse and neglect.
Child abuse and neglect continue to account for a significant number of pediatric burn injuries. Although the epidemiology of intentional burn injuries has been studied, this report compares victims of abuse with victims of neglect. Furthermore, we investigate the long-term fate of both victim and perpetrator. ⋯ Victims of burn abuse and neglect differ considerably in terms of history and disposition but not hospital course. Children in both groups, however, remain at risk for abuse and neglect after discharge. We recommend that more aggressive efforts be made to secure safe environments for these children and that the perpetrator, if clearly identified, be dealt with in a fashion to prevent recurrence of the offense.
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During a 2-year period, eight patients sustained burns caused by the tipping over of electric stoves. In seven of these cases, children aged 2 to 4 years stood up on the open oven door of a stove. The stove then tipped forward, and a pot of boiling liquid on the stove spilled onto the child, who fell forward across the oven door. ⋯ Hospital stay ranged from 2 to 20 days. The increase in the use of electric stove has led to a situation in which children, usually toddlers, can overbalance the stove and bring down the pots sitting on the heating elements. This represents another mechanism by which young children can be injured in the kitchen; the awareness of this should be disseminated.
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J Burn Care Rehabil · Jul 1998
Base deficit as an indicator or resuscitation needs in patients with burn injuries.
The utility of base deficit (BD) as a marker of shock and as an indicator of resuscitation requirements has been recognized in the trauma population. Base deficit in thermally injured patients has not been closely examined. ⋯ Parkland estimated fluid requirements underestimated actual volume requirements, but Parkland-calculated fluid requirements were related (p < 0.01) to actual volume requirements. BD had a better correlation to actual volume requirements, and a BD of -6 or less correlated with larger burn size (23% +/- 2% vs 47% +/- 9% total body surface area), and markedly increased mortality rate (9% vs 72%, p < 0.001).