The Journal of burn care & rehabilitation
-
J Burn Care Rehabil · Sep 1998
Case ReportsTitanium tetrachloride: an unusual agent with the potential to create severe burns.
Titanium tetrachloride (TiCl4), an intermediate compound in the production of white pigment, can cause severe burns. Two cases are reported in which TiCl4 created 18% to 20% total body surface area burns. These full-thickness injuries were the combined consequence of hydrochloric acid and the heat that was generated in areas where this otherwise stable compound was mixed with perspiration. ⋯ Wound biopsy specimens taken on postburn days 3 and 6 were subjected to immunostaining that showed that TiCl4 did not retard wound healing. Exposure time to TiCl4 vapor will determine the pulmonary and ophthalmologic involvement in each case. Clinical awareness of the propensity of TiCl4 to react with water--even when that water is in the form of perspiration--is vital because prompt management can limit the extent of injury.
-
J Burn Care Rehabil · Sep 1998
Complete integration of inpatient and outpatient burn care: evolution of an outpatient burn clinic.
Burn centers are under continuing pressures to lower costs and maintain quality of care. One method of achieving this goal is to integrate inpatient and outpatient care in the burn unit. In 1991, our unit instituted an on-site outpatient clinic that was expanded significantly in 1996. ⋯ From 1990 to 1996, the average length of inpatient stay for burns of 0% to 5% total burn surface area (TBSA), 6% to 10% TBSA, and 11% to 15% TBSA has decreased from 7.5 to 3.7 days, 10.3 to 7.7 days, and 16.6 to 11.8 days, respectively. Complete integration of inpatient and outpatient burn care can be achieved. An expanded on-site outpatient facility leads to optimal continuity of care, outpatient management of a larger percentage of burn injuries, and a shift in census from the inpatient to outpatient settings.
-
J Burn Care Rehabil · Sep 1998
Development of a burn rehabilitation unit: impact on burn center length of stay and functional outcome.
In 1995 we initiated the development of a specialized burn rehabilitation unit within an acute rehabilitation hospital, geographically separated from our burn center. The purpose was to allow an earlier initiation of an intensive rehabilitation program while still maintaining optimal burn wound care and nutritional support. The unit was directed by a burn center nurse coordinator who spent 50% of the time in the burn center and 50% in the rehabilitation unit training and supervising care. ⋯ This length of stay was also significantly shorter (24%) than that predicted by the American Burn Association Registry formula. In addition, the rehabilitation unit length of stay required to restore the same degree of function according to a standardized measurement was significantly shorter (by 9 +/- 3 days) than for patients referred to other rehabilitation facilities in 1996. We conclude that the benefits of a burn rehabilitation unit include not only a decreased burn center length of stay but also a more rapid restoration of function.
-
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.
-
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.