The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Sep 1995
Randomized Controlled Trial Clinical TrialProspective, randomized study of the efficacy of pressure garment therapy in patients with burns.
A randomized, prospective study was undertaken to determine the efficacy of pressure garment therapy in patients with burns. Patients were randomly assigned to receive either pressure garment therapy or no pressure garment therapy. ⋯ Eight of the patients receiving pressure garment therapy and nine receiving no pressure garment therapy were not involved in the follow-up. No significant differences were found between the two groups when age, body surface area burn, length of hospital stay, or time to wound maturation were compared.
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J Burn Care Rehabil · Sep 1995
Management of skin-grafted burn wounds with Xeroform and layers of dry coarse-mesh gauze dressing results in excellent graft take and minimal nursing time.
The goals of postoperative treatment for split-thickness skin grafts (STSGs) are to maintain graft integrity, prevent graft and wound desiccation, and minimize infections. As we documented in a telephone survey of 16 burn centers, dressings for skin grafts usually consist of multiple layers of coarse-mesh gauze; the dressings receive frequent applications of aqueous solutions that contain antimicrobial agents to control bacterial growth and to maintain a moist environment at the wound surface. We prospectively studied the efficacy of our standard dressing of one layer of Xeroform (Kendall Inc., Mansfield, Mass.), which consists of fine-mesh gauze impregnated with bismuth tribromophenate, applied to the STSG surface followed by layers of dry gauze dressings wrapped in Kerlix (Kendall Inc.); the entire dressings were left intact until postoperative day 5. ⋯ Patients' grafts were evaluated on postoperative day 5 for the percentage of "take" and subgraft fluid collected; this evaluation was then repeated every other day for 10 days. On postoperative day 5 evaluations, mean skin graft take in all patients was 98.54% +/- 0.72%. Xeroform and coarse-mesh gauze dressings used to cover STSGs and left intact for 5 days until the initial dressing change, resulted in highly successful graft outcomes, with minimal postoperative nursing care compared with other dressing methods for skin grafts.
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J Burn Care Rehabil · Sep 1995
Cultured epithelial autografting on meshed skin graft scars: evaluation of skin elasticity.
Many patients with meshed skin graft scars complain of the scars' unsightly appearance and hardness. Since 1989 we have shaved away meshed skin graft scars and then resurfaced the area with autologous cultured epithelium in nine patients. This method improved the disfigurement of meshed skin graft scars, with minimal sacrifice of normal donor skin. Furthermore, autologous cultured epithelium grafted areas had high skin elasticity compared with meshed skin graft scars, as measured with a noninvasive suction device.
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The share of total hospital Canadian burn care provided by 17 of Canada's 27 present burn units increased marginally to 18.3% in 1991 from 17.0% in 1981 (p = 0.0506), and the mortality rate decreased from 5.6% in 1981 to 3.5% in 1991 (p < 0.05). In 10 units providing serial data, patients with burns undergoing ventilation therapy for a concomitant smoke inhalation injury increased from 6.3% (n = 58) of 1981 admissions to 11.1% (n = 73) of 1991 admissions (p < 0.05). In 1991 Canada's 27 burn units treated 32.4% of Canada's hospitalized patients with burns and provided 50.6% of hospital burn care days. Although the total number of patients with burns hospitalized in Canada decreased by 35% from 7923 in 1981 to 5161 in 1991 (32.6 to 18.9 per 100,000 population), with a proportional decrease in patients treated in burn units, the requirement for intensive care unit capability to treat patients undergoing ventilation therapy has remained the same or is greater and must be preserved as burn units shrink.
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Life for pediatric survivors of burns appears difficult to most observers. In an assessment by use of the Child Behavior Checklist (CBCL), survivors' parents reported that approximately 30% of the children had significant problems. The Vineland Adaptive Behavior Scales were used to gather further information concerning the children's personal and social sufficiency and functioning. ⋯ The Vineland adaptive behavior domains correlated positively with the CBCL total competence scores, whereas the Vineland maladaptive behavior correlated positively with the CBCL total behavior score. Although it supports previous findings that parents of burned children see them as having problems after burn, this study elaborates on and differentiates among their difficulties in adapting to their life situations. These findings not only affirm the importance of attending to parental perceptions of burned children but also identify specific areas to be targeted for psychosocial rehabilitation of burned children.