The Surgical clinics of North America
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Surg. Clin. North Am. · Apr 1976
Primary excision and prompt grafting as routine therapy for the treatment of thermal burns in children.
There is much evidence that the most important factor in the successful treatment of skin destruction after thermal injury is to remove dead tissue and promptly close the wound. While the exact methods employed to achieve this goal may vary, in the cases reported here three basic methods were used: (1) simple excision of burn eschar with immediate closure with autograft for small and medium-sized burns; (2) excision and immediate wound closure with autograft supplemented by allograft, with replacement of allograft by autograft before extensive allograft rejection, for large burns; and (3) immunosuppression and temporary skin transplantation for massive third degree burns. All have markedly decreased hospital stay and complications, and in large and massive burns mortality was substantially reduced.
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Respiratory care of patients undergoing open heart surgery should begin in the preoperative period. Patients must stop smoking, and if obese they are encouraged to lose weight. Pulmonary infection is treated and secretions must be eliminated. ⋯ Oxygen therapy is given with either a nasal catheter or a mask, according to the patient's need. IPPB and physiotherapy are continued until the patient shows no signs of pulmonary infection and is capable of effectively eliminating secretions. This routine management and extended postoperative respiratory care definitely contribute to the successful outcome of open heart surgery.
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Anesthesia and operation may impair the immune system so that bacterial growth and tumor spread may occur more readily, and host response to transplanted tissue and allergenic substances may be altered. Suggestions are presented regarding the anesthetic management of patients at risk from infection or tumor spread.