The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Jul 1994
Comparative StudyA biochemical and histologic rationale for the treatment of hydrofluoric acid burns with calcium gluconate.
Hydrofluoric acid has unique properties that make it attractive for a variety of industrial and household uses. Exposure to dilute and concentrated solutions of hydrofluoric acid can lead to severe pain and tissue necrosis. Local treatment with topical calcium gluconate and subdermal injections of 0.5 ml 10% solution of calcium gluconate per cm2 of affected tissue has been advocated but frequently fails to relieve the patient of pain. ⋯ The purpose of this study was to show what, if any, were the microscopic effects on the distal arterial tree of intraarterial infusion of calcium gluconate. By studying 1 micron-thick cuts of distal rat aortas after proximal infusion of concentrated (10%) and dilute (2%) calcium gluconate, we were able to show that the incidence of microperforations in the intima and media of the rat aorta increased with the concentration of calcium gluconate. We conclude that intraarterial infusions should be reserved for only the most severe cases of hydrofluoric acid burns unresponsive to local therapy.
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J Burn Care Rehabil · May 1994
The costs of burn care: an analysis with an emphasis on the use of parenteral antimicrobials.
Because infection is a common cause of morbidity and mortality in patients with burns and intensive antibiotic therapy is often required, the focus of this study was to describe the patterns of use and costs of parenteral antibiotics in a burn unit. The study also evaluated the overall economics of burn care in our population. Forty-one percent of the study group received parenteral antimicrobial agents; the specific agents, indications, and costs are described. ⋯ If all patients studied (n = 61) were reimbursed under diagnosis-related groups the unit would have experienced an annual loss of approximately 1.2 million dollars. If specialized burn care facilities are to remain, it may be necessary to reevaluate the appropriateness of the diagnosis-related group reimbursement system for burn-related injury. This is especially important if all third-party reimbursement sources consider conversion to this system of compensation.
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A retrospective review of patients undergoing reconstruction for perineal scar contracture between 1980 and 1991 was performed to determine the surgical principles involved in perineal contracture release. Of the 5280 reconstructive admissions, 18 (0.34%) were for perineal contracture release. Fifty-six percent of patients received a local flap as an initial release, 28% underwent incisional release with split-thickness skin grafting (STSG), 5% had primary release and closure, and 11% had a combination of these techniques. ⋯ Although there was a higher rate of recurrence in the flap group, the procedure was much simpler to perform and recovery time was shorter. The use of STSG should be reserved for large bilateral contractures and recurrences, especially if normal skin for a flap is not available. Growth is an important variable in the development of perineal contractures in children with burns; thus these patients should be followed up closely during rapid-growth periods.
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A search of the burn literature to find standard dimensions for fabrication of a typical splint to use with patients with a dorsal hand and finger burn is an elusive endeavor. The original impetus for such a search stemmed from a discussion with a student therapist on how to properly splint a burned hand. An ongoing interest was sustained when no one set of universal dimensions for a hand splint design was found to exist. ⋯ In general, dorsal hand burn splints can be classified either as position of function or antideformity splints. However, there is little agreement among authors about how to make these splints. The purpose of this investigation was to document the wide range and variable designs among splints for dorsal hand burns and present the findings for use as a resource guide when making decisions about their fabrication.
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J Burn Care Rehabil · Mar 1994
Randomized Controlled Trial Comparative Study Clinical TrialEnteral feeding during operative procedures in thermal injuries.
Multiple surgical procedures necessitated by thermal trauma traditionally require withholding nutritional support during the perioperative period. Significant caloric deficits develop with subsequent catabolism of body tissues to provide energy and amino acids for the synthesis of protein. Eighty patients, matched for age and total body surface area burn, were enrolled in a study to evaluate the safety and efficacy of providing enteral support throughout operative procedures. ⋯ No patient in either group experienced aspiration. The unfed group demonstrated a significant caloric deficit (p < 0.006) and increased incidence of wound infection (p < 0.02) and required more albumin supplementation to maintain serum levels at a minimum of 2.5 gm/dl (p < 0.04). Enteral nutrition can be provided safely during the perioperative period and provides the additional benefits of reducing caloric deficits, wound infections, and exogenous albumin supplementation.