The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Sep 1990
ReviewMarjolin's ulcer: a review and reevaluation of a difficult problem.
The formation of an epidermoid carcinoma in nonhealing scar tissue, a Marjolin's ulcer, is a well described neoplasm. These lesions are, however, frequently overlooked and often inadequately treated. This paper reviews six cases of scar-tissue carcinoma. ⋯ The lesions varied in anatomic location and involved the upper extremities, lower extremities, and scalp. In addition to the case studies, this paper reviews the literature and provides a logical treatment plan for a patient with a Marjolin's ulcer. Because these lesions can be very aggressive, a well thought-out treatment plan is necessary to optimize care and assure patient survival.
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J Burn Care Rehabil · Sep 1990
Carburetor burns: preventable injuries associated with high morbidity and frequent litigation.
We have identified carburetor burns as a significant cause of preventable morbidity, both from long-term functional and cosmetic standpoints. The epidemiology of carburetor burns and our experience are described. All of our patients were male, with a mean age of 35 years. ⋯ The anatomic distribution of these burns, most often on the dominant hand and on the face, contributes to the morbidity of these burns. This injury has been associated with increasingly frequent litigation. We believe that an active education campaign and the addition of warning labels to car engine compartments would make an impact in decreasing the incidence of carburetor burns.
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J Burn Care Rehabil · Sep 1990
Comparative StudyTopical Bactroban (mupirocin): efficacy in treating burn wounds infected with methicillin-resistant staphylococci.
Bacterial antimicrobial susceptibility predictors such as the minimal inhibitory concentration (MIC) assay and Nathans Agar Well Diffusion (NAWD) assay provide essential information relevant to the therapeutic approach in burn-wound sepsis. The susceptibilities of 68 gram-positive burn-wound isolates were tested against topical Bactroban (mupirocin) (Beecham Laboratories, Bristol, Tenn.) and compared with other topical antimicrobials such as mafenide acetate, silver sulfadiazine, and bacitracin/neomycin/polymyxin (BNP). Topical susceptibility data were obtained with a modification of NAWD assay. ⋯ On the basis of the in vitro data, 13 patients with MRSA burn-wound infections susceptible to Bactroban were evaluated. Quantitative wound biopsies were employed to determine the efficacy of this therapeutic approach. The outcome of these infections was correctly predicted by the NAWD assay in 92.3% of the patients treated (p less than 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)
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J Burn Care Rehabil · Sep 1990
Case ReportsCyclosporine A for prolonging allograft survival in patients with massive burns.
Cyclosporine A (CsA) immunosuppression was used in three patients with massive burns to prolong skin allograft survival. Cyclosporine A kinetic studies in patients with burns revealed markedly accelerated blood clearance and high variability in drug absorption when compared with studies in renal transplantation patients. Doses required to maintain therapeutic levels varied widely. ⋯ The disadvantage of allograft use is its early rejection and obligatory replacement until permanent coverage with autograft can be accomplished. Cyclosporine A can prolong allograft survival and allow autograft coverage from limited donor sites in a sequential fashion. This may lead to increased survival in patients with massive burns.
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J Burn Care Rehabil · Sep 1990
Familial values as factors influencing long-term psychological adjustment of children after severe burn injury.
This study replicates earlier findings that children who survive severe burn injury do make positive psychological adjustment. Family support and a family value of autonomy were predicted to be critical variables in promotion of psychological adjustment. In addition, the study presents the hypothesis that length of time after burn injury and level of intelligence are contributing factors in psychological adjustment. ⋯ Positive psychological adjustment was predicted by greater family cohesion, independence, and more open expressiveness within the family. Level of intelligence did not contribute to adjustment. Length of time after injury, if it is important to psychological healing, appears to be a factor only during the initial 2 years after burn injury.