The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Jan 1992
ReviewThe role of the psychiatrist in the team treatment of the adult patient with burns.
Improved survival rates for patients with major burn injuries and the consistent finding of significant long-term psychologic disability among survivors of burn trauma call for a redefinition of the role of the psychiatric consultant in the care of patients with burns. In addition to the traditional functions of diagnosis and treatment of discrete psychiatric disorders in patients with burns, this expanded role includes assisting the patient's normal process of psychologic adaptation after injury, assessing and managing burn pain, and facilitating communication among all members of the burn team. The functions of the psychiatrist are most effectively carried out when the psychiatrist is able to participate on a regular basis in the care of every patient as a member of the burn team.
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J Burn Care Rehabil · Jan 1992
Case ReportsWound bed preparation: approaches to replacement of dermis.
Cultured epidermal autograft (CEA) can provide a valuable source of protection in patients with large amounts of skin loss as a result of thermal injury. An unanswered question is: will the long-term outcome be better if a dermis is present? We have approached the problem by attempting to retain the cryopreserved allograft dermis that is originally placed as temporary wound coverage. The retained dermis provides a substantial, uniform, well-vascularized bed that accepts the CEA. ⋯ CEA was placed on allodermis on days 24, 28, and 35, respectively. Patients 1 and 2, who survived and returned to work, had a "take" of at least a 90% of allograft and a permanent coverage CEA take of 88% and 81%, respectively. Patient 3, who died, had an allograft take of only 20% to 30% and a CEA take of less than 10%.
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The research literature suggests but does not test the hypothesis that differential factors determine when a patient will return to work after serious burn injury. In this study, factors influencing time before return to work after serious burn injury were investigated prospectively as part of a large burn research project. Sixty-five patients with burns who had returned to work were followed. ⋯ Sufficient data were available to develop a regression equation to specifically predict time before return to work. The data presented here are useful in informing patients, families, employers, and health-funding agencies as to the probable delay before return to work that can be expected after serious burn injury. In particular, predictability refinements are possible with the regression equation developed in this study.
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J Burn Care Rehabil · Jan 1992
Case ReportsPreliminary experience with cultured epidermal autograft in a community hospital burn unit.
Initial experience with cultured epidermal autograft (CEA) in a community hospital burn unit is described. Five applications of CEA to three patients (mean burn size, 59% total body surface area) were made. Final graft "take" of CEA ranged from 10% to 80%. ⋯ CEA is more sensitive to infection than meshed autograft. A review of the literature concerning topical antibiotic use with CEA is included. This experience with CEA demonstrates that large burns can be successfully managed with this modality in a community hospital burn unit setting.
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For many years, burn professionals have attempted to assess the outcomes of different types of burn injury and the factors that are related to good patterns of coping with the aftermath of thermal injury. Most writers have attempted to use objective criteria such as return to work or preexisting psychologic problems (e.g., alcoholism) in determining the success of rehabilitation, but much controversy over the forms of assessment persists. ⋯ The use of denial, the ways in which hostility is managed by the patient, and how he or she uses key persons in the environment are examined. The cognitive, emotional (affective), and behavioral styles of patients are examined as part of this pilot study of cluster patterns or types of adjustment.