The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Jan 1992
Case ReportsBurns are different: the child psychiatrist on the pediatric burns ward.
This article is written from the dual perspective of a child psychiatrist, consultant to a burn unit, who also happens to have suffered burns to his hands and face as the result of a car accident in 1976. One of its central themes is that burns are different from other surgical conditions. The role of the child psychiatrist as a consultant to a pediatric burn unit is explored and illustrated with clinical vignettes.
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J Burn Care Rehabil · Jan 1992
Cultured epidermal autograft and the treatment of the massive burn injury.
As a rule, adult and pediatric patients with thermal injuries that involve more than 90% total body surface area (TBSA) burn have poor prognoses. Even for patients who are 5 to 34 years old with a 70% TBSA burn, the mortality rate is 80%. Lack of autologous donor skin, which is essential for permanent wound closure, is the major problem. ⋯ CEA take is best on early granulation tissue or freshly excised wounds. Early excision of burn eschar, temporary wound closure with cadaveric allograft and Biobrane (Winthrop Pharmaceuticals, Wound Care Div., Fountain Valley, Calif.), and permanent closure with CEA may improve survival rates among patients with massive burn wounds. CEA is a tremendous asset to the management of massive burn injuries.
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Burn injuries can have a profound effect on the personality development and emotional stability of children, particularly those children who had preexisting pathologic conditions at the time of injury. Integration of an altered sense of self and reentry into the social arena are two challenges that children with burn injuries must face. Creative psychosocial services are of critical importance in providing support to children as they meet these challenges. School reentry programs and burn camps are presented as two services that are currently provided to facilitate the adaptation and reentry process for these children.
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Clinical experience assumes major importance as the source of data on cultured epidermal autograft (CEA), since a large controlled study is probably not forthcoming. Among the general questions to be answered are: Which patients are candidates for grafting with CEA? Do selection criteria specify size of total body surface area burn or age? Is CEA more suitable for certain body areas than others? Does CEA close the wound as quickly, as well, and as safely as other available methods of coverage? Fresh or frozen allograft, the gold standard, is presumed to be safe, but the current concern about transmission of viral diseases raises doubts. Presumably, CEA would be safe. ⋯ Whether CEA saves lives is probably unanswerable, but as a skin cover it may reduce incidence of burn wound sepsis. Perhaps in the future, a combination of cultured epidermal cells and a type of permanent dermis will produce a cover that is genuine skin. Today we have only materials that are parts of skin.
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J Burn Care Rehabil · Nov 1991
Randomized Controlled Trial Comparative Study Clinical TrialBurn size estimate reliability: a study.
A study was undertaken to assess any differences between physicians' and nurses' estimates of burn size from drawings of 10 hypothetical patients with burns. Patient drawings were sent to the 199 burn facilities that are listed in the American Burn Association's Burn Care Resources in North America 1989-1990. The mailings were randomized between physicians and nurses. ⋯ Estimates of burn sizes with the use of standardized burn forms were consistently the same whether estimates were made by physicians or nurses. Sixty-eight percent of the respondents used the Rule of Nines or the Lund & Browder chart to estimate burn size, but 21% of the respondents failed to answer the question about which method is used in their units. In conclusion, there appears to be little variance in estimation of burn size as made by experienced burn nurses and physicians, and use of these estimates in a centralized data bank should be reliable.