The Journal of burn care & rehabilitation
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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 · 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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To investigate the role of hydrotherapy in the treatment of patients with burns, a survey was conducted of the use of hydrotherapy in Canada and the United States as part of an intensive investigation into the causes of Pseudomonas aeruginosa infections in burn injury. Results of the survey conducted indicate that hydrotherapy continues to be an important part of burn wound care in most (94.8%) burn centers in North America. Of the burn centers that use hydrotherapy, 81.4% continue to immerse patients, 82.8% perform hydrotherapy on all patients with burns regardless of total body surface area, and 86.9% continue with hydrotherapy throughout the entire phase of the patient's hospitalization. ⋯ Pseudomonas aeruginosa was identified as the most common, major cause of sepsis in 52.9% of the burn units surveyed, Staphylococcus aureus in 25.5%, and Candida albicans in 5.2%. This survey demonstrates the extensive use of hydrotherapy in North American burn units and the concern for serious infections in patients with burns from gram-negative organisms such as Pseudomonas species. With the increasing number of reports of Pseudomonas infections related to the use of hydrotherapy equipment, the importance for further investigation into burn wound care with and without hydrotherapy, infection rates, and cost analysis appears to be indicated.