The Journal of burn care & rehabilitation
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The conventional approach for secondary correction of unstable axillary scars or contractures with skin grafting commonly risks failure of adherence and early recurrence of the problem, even in highly motivated patients. Potential early mobilization and the avoidance of postoperative splinting may be advantages of reconstruction with vascularized tissues instead. The local fasciocutaneous flap is advocated as a simple, rapidly elevated, single-staged option that preserves function while correcting these deformities. Although the dorsal thoracic fascial flaps are the most versatile in the axillary region, if they are unavailable or unsuitable, other unspecified but equally robust alternatives from the upper arm or anterolateral chest are similarly efficacious.
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J Burn Care Rehabil · May 1991
ReviewPressure therapy for the control of hypertrophic scar formation after burn injury. A history and review.
Devastating functional problems can result from the formation of hypertrophic scar tissue after burn injury. Although a patient with burns may have several medical problems to contend with because of the injury, most ongoing rehabilitation difficulties are a consequence of the continual wound contraction that occurs in immature burn scars. Treatment of hypertrophic burn scar consists of several surgical options and of pressure therapy, which traditionally involves wearing garments made from elasticized fabric. This article reviews the treatment of hypertrophic scar tissue, with emphasis on its history and on nonsurgical methods of managing the burn scar.
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J Burn Care Rehabil · May 1991
Comparative StudyHelicopter transport of the patient with acute burns.
Helicopter transportation of acutely injured or ill patients has become common practice at most major medical centers. However, its specific effectiveness in the transportation of acute-condition patients with burns has never been critically assessed. ⋯ Consideration such as safety, cost, and working space are discussed. It is recommended that at least one of three criteria be met before helicopter transfer is considered for patients with burns: the surface area involved should be enough to require a formal fluid resuscitation, an inhalation injury should be present or suspected, or there should be a possible need for an escharotomy.
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Exposure of skin to liquid propane causes a severe freeze injury. This cutaneous injury has the appearance of a partial-thickness thermal injury of indeterminate depth, but the deep tissue damage is greater than is at first apparent. A case history is presented that illustrates the severity of this particular mechanism of injury and the need for adequate safety precautions.
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In this 10-year retrospective survey of 2216 admissions to a regional burn center, 15 patients (0.67%) had self-inflicted burn wounds. The burns were serious, with a mean abbreviated burn severity index of 11.2, and eight patients died of their injuries. Nine patients had a documented history of psychiatric problems, seven of whom had undergone a previous psychiatric hospitalization. ⋯ Seven patients had major depression and four had chronic paranoid schizophrenia. Motives were assessed, both by chart review and by interview of five available survivors and of relatives of nonsurvivors. Fewer than half actually intended to kill themselves; equally important was the theme of attempting to control internal psychotic states.