The Journal of burn care & rehabilitation
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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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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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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.
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J Burn Care Rehabil · Sep 1995
The Vancouver Scar Scale: an administration tool and its interrater reliability.
The Burn Scar Index, often called the Vancouver Scar Scale, is widely used in clinical practice and research to document change in scar appearance. Several sections of the Index require equipment to accurately score the items. ⋯ We recently devised a pocket-sized tool to aid in scoring the scar and to increase staff compliance in use of the Index. With this tool interrater reliability is good, which makes the Burn Scar Index a viable measure for research.
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As funding for health care becomes a national concern, and workman's compensation and private health insurance companies attempt to limit their expenditures in the treatment of the client with burns, it may become the responsibility of the burn specialists to create a cost-effective approach to quality burn rehabilitation. Our outpatient rehabilitation program has taken a cost-effective approach that limits the use of inpatient rehabilitation, emphasizes the burn team guiding the client to a quick functional return to home and work, and concentrates costs for therapy rather than room and board. This cost-effective rehabilitation approach emphasizes an intensive 6-hours-per day, 5-days-per-week outpatient program that begins immediately after discharge. ⋯ In the cost-effective rehabilitation approach, 82% of the health care costs are concentrated for therapy. In the traditional inpatient rehabilitation program, room and board costs comprise 57% of the charges. Because it is the responsibility of the burn specialists to educate the health care payers, a program description to implement the cost-effective approach to burn rehabilitation is provided.