The Journal of burn care & rehabilitation
-
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.
-
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).
-
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.
-
J Burn Care Rehabil · Jan 1998
Comparative StudyCutaneous nerve distribution in adult rat hairy skin after thermal injury--an immunohistochemical study.
Regrowth of cutaneous nerves after thermal injury was examined in rat hairy skin with use of protein gene product 9.5, which has been shown to label nerves in skin preparations. Tissue biopsies were obtained from injured and control skin at postburn days 1, 7, 14, 28, and 120, fixed in 4% paraformaldehyde, cryoprotected, sectioned, and immunostained with rhodamine conjugated goat anti-rabbit immunoglobulin G. Immunoreactivity for protein gene product 9.5 was intense and illustrated the process of nerve regrowth in rat skin after thermal injury. ⋯ Results suggest that rat hairy skin has a capacity for nerve regrowth after thermal injury. Nerves were noted to regenerate from beneath the scar. Burn wounds in rats demonstrated vigorous cutaneous nerve regeneration.
-
J Burn Care Rehabil · Jan 1998
Case ReportsTrilaminar skin coverage combined with cultured epithelial autografts--a new technique for treating the elderly patient with burn injuries.
Additional morbidity may be associated with standard split-thickness skin graft donor sites in elderly (65 years or older) patients with burn injuries. In an attempt to minimize the area of the donor sites and maximize autografts, we describe a new technique that uses trilaminar harvesting of skin grafts with dermolipectomy closure, and permanent coverage of the autograft layers achieved with cultured epithelial autografts in an elderly burn victim. ⋯ All dermolipectomy sites healed without infection. Our procedure proved to be a useful technique in the permanent closure of full- and partial-thickness burns in an elderly patient admitted to the burn unit.