The Journal of burn care & rehabilitation
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A review of the literature provided documentation of a vital link between sexuality and one's adjustment to an acquired disability, such as disfiguring burns. Descriptive correlational research was used to study: (1) the relationship between severity of burn injury and sexual-esteem, sexual-depression, and sexual-preoccupation in burn-injured men, ages 19 to 39 years, and (2) the relationship between selected sociodemographic variables (age, marital status, educational level, ethnicity, length of time since burn injury, and length of time since discharge from the burn unit) and sexual-esteem, sexual-depression, and sexual-preoccupation. ⋯ Statistically significant direct relationships were demonstrated between sexual-preoccupation and sexual-esteem, whereas inverse relationships were demonstrated between age and sexual-preoccupation and also between sexual-esteem and sexual-depression. No relationship was demonstrated between severity of burn and sexual-esteem, sexual-depression, and sexual-preoccupation.
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J Burn Care Rehabil · Jan 1997
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialA multicenter clinical trial of a biosynthetic skin replacement, Dermagraft-TC, compared with cryopreserved human cadaver skin for temporary coverage of excised burn wounds.
This multicenter study compared the use of a biosynthetic human skin substitute with frozen human cadaver allograft for the temporary closure of excised burn wounds. Dermagraft-TC (Advanced Tissue Sciences, Inc.) (DG-TC) consists of a synthetic material onto which human neonatal fibroblasts are cultured. Burn wounds in 66 patients with a mean age of 36 years and a mean burn size of 44% total body surface area (28% total body surface area full-thickness) were surgically excised. ⋯ DG-TC was equivalent or superior to allograft with regard to autograft take at postautograft day 14. DG-TC was also easier to remove, had no epidermal slough, and resulted in less bleeding than did allograft while maintaining an adequate wound bed. Overall satisfaction was better with DG-TC.
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J Burn Care Rehabil · Jan 1997
Comparative Study Clinical Trial Controlled Clinical TrialClinical trials of a biosynthetic temporary skin replacement, Dermagraft-Transitional Covering, compared with cryopreserved human cadaver skin for temporary coverage of excised burn wounds.
Human cadaver allograft skin (HCAS) is widely used for covering excised burn wounds when limited available skin donor sites or the overall patient condition does not permit immediate grafting with autologous skin. However, recurring problems are associated with HCAS including limited supply, variable quality, ultimate immune rejection, and the potential for bacterial and viral disease transmission. These problems speak for the need for development of a dependable substitute for HCAS. ⋯ The results showed that adherence to the wound and subsequent autograft "take" were excellent with both DG-TC variants and were at least equivalent to HCAS. No evidence of immune rejection of DG-TC was seen, whereas in four patients evidence of epidermal sloughing/rejection was noted in the HCAS control sites, which limited persistence of those grafts on the wound. Further clinical trials with this skin analogue are in progress.
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J Burn Care Rehabil · Jan 1997
Randomized Controlled Trial Clinical TrialSuperiority of oral ketamine as an analgesic and sedative for wound care procedures in the pediatric patient with burns.
The management of pain and anxiety in pediatric patients with burns includes the challenge of striking a balance between inadequate versus excessive medication. Ketamine provides effective sedative, analgesic, and amnestic properties for children and has been used intravenously with good results. With its recent availability as an elixir, we speculated that ketamine given orally may provide effective analgesia and sedation during wound care procedures with a wide safety margin. ⋯ The Ramsey scale was used to quantitate sedation and demonstrated that ketamine improved sedation by 360% (p < 0.05). These results substantiate improved analgesia and sedation with oral ketamine as compared to a commonly used narcotic and sedative in facilitating wound care procedures in pediatric patients with burns. These findings suggest that expanded use of ketamine oral suspension may be.
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J Burn Care Rehabil · Jan 1997
Hyperdynamic resuscitation improves survival in patients with life-threatening burns.
Our clinical experience has led to the conclusion, shared by others, that standard vital signs produce inadequate data for the resuscitation of severe burns. We reviewed three groups of burn patients including an index group (N = 53) whose resuscitation was guided by means of a pulmonary artery catheter, a control group (N = 33) collected from the burn registry for the period just before the index group, and a current group (N = 30) resuscitated with hyperdynamic end points defined empirically from surviving patients as guidelines. The mortality rate and organ failures decreased over time; the mortality rate of the control group was 48%, the index group 32%, and the protocol group 10% (p = 0.003). We concluded that hyperdynamic resuscitation does improve survival and reduces the incidence of organ failure.