The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Nov 1997
Acellular allogenic dermis does not hinder initial engraftment in burn wound resurfacing and reconstruction.
Donor site morbidity, including pain and potential hypertrophic scarring, increases directly as donor site thickness increases. Autograft hypertrophy increases inversely to the thickness of autograft harvest. Both of these liabilities might be lessened by the ready availability of a functioning, "off-the-shelf" dermal substitute. ⋯ Duration of follow-up has been 11.9 +/- 3.5 weeks (range, 2 to 29), with no difference in results by Vancouver Scar Scores. We conclude that cryopreserved acellular human dermis will engraft successfully and support engraftment of overlying thin autograft. Initial results relating to the effectiveness of cryopreserved acellular human dermis in optimizing appearance and function are encouraging, but longer follow-up is required before definitive conclusions can be made.
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J Burn Care Rehabil · Nov 1997
Randomized Controlled Trial Comparative Study Clinical TrialCultured allogeneic keratinocyte sheets accelerate healing compared to Op-site treatment of donor sites in burns.
Donor site treatment is a crucial issue in the treatment of extensive burns. In this single-blind, randomized study treatment of donor sites with a polyurethane dressing, Op-Site (Smith & Nephew, York, U. ⋯ Results show a mean healing time of 6.7 days with use of cultured keratinocyte sheets compared to mean healing time of 13.6 days with Op-Site treatment. Also, improvement in the comfort of patients as the result of less exudate formation and pain attenuation was noted.
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J Burn Care Rehabil · Nov 1997
Comparative StudyLung compliance, airway resistance, and work of breathing in children after inhalation injury.
Pathophysiologic changes associated with inhalation injury make mechanical ventilation in children a challenge. Decreased lung compliance and increased airway resistance after inhalation injury may lead to elevated airway pressures and barotrauma. Previous studies have shown significant decreases in the incidence of pneumonia and death in adult patients with inhalation injury treated with high-frequency percussive ventilation (HFPV) as compared with conventional mechanical ventilation (CMV). ⋯ Five children received CMV and five children received HFPV. All patients were treated according to our standard inhalation injury protocol. Based on our data and patient population, children receiving ventilation with the HFPV have a significant decrease in the work of breathing as compared with CMV.
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J Burn Care Rehabil · Nov 1997
Pathogenesis of fever in a rat burn model: the role of cytokines and lipopolysaccharide.
We investigated the possible causal relationship between interleukin-6 (IL-6) and increased body temperature (T(B)) in a rat burn model. Transmitters for measuring core temperature and estimating activity were implanted in the abdominal cavity. Animals in the burn group were clipped and received full-thickness scald burns to 45% to 55% of the body surface area, and control animals were clipped. ⋯ The average IL-6 serum levels were 3.5-fold higher for the burned animals. In this study, burn and control serum levels of IL-6 demonstrated positive correlation with T(B). These data suggest, but do not prove, a causal relationship between IL-6 and fever in the rat burn model, and make it unlikely that circulating systemic lipopolysaccharide is the cause.
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To facilitate effective management of pain and anxiety, and to permit more objective assessment of changes in this management, a pain and anxiety guideline was developed and has been followed uniformly for 3 years. The guideline describes four patient care categories: (1) ventilated acute, (2) nonventilated acute, (3) chronic acute, and (4) reconstructive. A small and consistent formulary was emphasized. ⋯ Our objective was to develop a guideline for pain and anxiety management that: (1) was safe and effective over a broad range of ages and injury acuities seen in the unit, (2) was explicit in its recommendations, (3) had a limited formulary to optimize staff familiarity with agents used, and (4) took advantage of the presence of a bedside nurse to continuously evaluate efficacy and intervene when needed through dose-ranging. Although many drugs are appropriate, our choices were based on institutional familiarity and simplicity. This process of developing a clear and consistent guideline can be duplicated in any unit.