The Surgical clinics of North America
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The early management of burn patients requires a set of supportive procedures in addition to excision and closure operations. Most supportive procedures related to vascular access, tracheostomy, and enteral feeding access are identical to those required by trauma patients and are not covered here. ⋯ Subsequently, acute excision and closure operations dominate patients' needs. These operations have evolved in recent years to be less ablative, less bloody, and less physiologically stressful.
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Surg. Clin. North Am. · Aug 2014
ReviewBiology and principles of scar management and burn reconstruction.
Hypertrophic scarring is extremely common and is the source of most morbidity related to burns. The biology of hypertrophic healing is complex and poorly understood. Multiple host and injury factors contribute, but protracted healing of partial thickness injury is a common theme. ⋯ All have limited efficacy. Laser interventions for scar modification show promise, but as yet do not provide a definitive solution. Their efficacy is only seen when used as part of a multimodality scar management program.
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Burn injury affects all facets of life. Burn care has improved over time. ⋯ Integration of professionals from different disciplines has enabled burn centers to develop collaborative methods of assessing the quality of care delivered to patients with burns based on their ability to reintegrate into their normal physical, social, psychological, and functional activities. Burn outcomes will continue to develop on the foundation that has been built and will generate evidence-based best practices in the future.
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Surg. Clin. North Am. · Aug 2014
ReviewInitial assessment and fluid resuscitation of burn patients.
For the physician or surgeon practicing outside the confines of a burn center, initial assessment and fluid resuscitation will encompass most of his or her exposure to patients with severe burns. The importance of this phase of care should not be underestimated. This article provides a review of how to perform initial resuscitation of patients with significant burns and/or inhalation injury, while arranging for transfer to a regional burn center.
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As a result of continuous development in the treatment of burns, the LD50 (the burn size lethal to 50% of the population) for thermal injuries has risen from 42% total body surface area (TBSA) during the 1940s and 1950s to more than 90% TBSA for young thermally injured patients. This vast improvement in survival is due to simultaneous developments in critical care, advancements in resuscitation, control of infection through early excision, and pharmacologic support of the hypermetabolic response to burns. This article reviews these recent advances and how they influence modern intensive care of burns.