Acta chirurgiae plasticae
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Acta chirurgiae plasticae · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialFluid replacement in burned patients.
Burn injury involves a large amount of water, electrolytes and proteins loss trough the burn wound. For this reason, to avoid shock, a wide infusion of fluid is necessary in the first hours after trauma. Many reanimation formulas were proposed in the past years, with different composition: saline, colloids, plasma. ⋯ Patients were assessed for pre-existing diseases too, and data showed that complications were lower in HLS than in RLS group. HLS resuscitation formula guarantees a good electrolytes balance with lower fluid load, reducing tissue oedema and complication rate. Mortality rate was higher in HLS, may be for an higher Roy index in this group.
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In 1958 Meek described the so called Meek-Wall dermatome to cut postage stamp skin grafts. This method was eclipsed by the introduction of mesh skin grafts. In 1993 Kreis and colleagues reintroduced a modified Meek technique using a dermatome running on compressed air. ⋯ In our opinion the Meek technique is advantageous in patients with burns greater than 45% TBSAB. In smaller burns mesh grafts should be used because of lower material cost and staff requirements. Especially in extensively burned patients the Meek technique may be cost effective avoiding the need of CEA.
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Acta chirurgiae plasticae · Jan 1996
Factors influencing the early prediction of outcome from burns.
1. To reexamine the predictive value of the variables usually used in admission scores in burned patients (age, total body surface area burned (TBSAB), full thickness burn (FTB), inhalation injury (IHT) and sex). 2. To evaluate whether risk factors (alcohol abuse (AA), nicotine abuse (NA)) or preexisting diseases influence outcome significantly. ⋯ The study demonstrates that besides the "classical" variables of bum scores as age, TBSAB and IHT other variables such as sex, AA, NA and preexisting diseases have significant influence on the outcome. These variables especially gain important predictive value in patients with a medium risk of mortality.
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Before Radovan introduced skin expansion, burn sequelae were treated with skin grafts, local or distant flap, with an high morbidity on the donor site. Actually this technique is well known and standardized procedure that allows to obtain local flaps with the same characteristics in colour, texture, hair and sensitivity of the normal skin. The authors analyze their experience in the treatment of burn sequelae from 1985 to 1995. ⋯ So only in 30 expansions the final outcome was influenced by complication, with higher incidence in neck and in lower extremities. Results were generally satisfactory, with an improvement of scars and minimal donor site morbidity. With a careful selection of the patients, skin expansion offers a good solution for burn sequelae, complications can be reduced and successfull results achieved.
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Advances in medicine have brought immense possibilities in therapy but at a price including tremendous financial costs and also protracted human suffering. Cardiopulmonary resuscitation (CPR) is an emergency procedure in patients with cardiopulmonary arrest. Out-come of the CPR depends upon the character and severity of the afflicting disease, upon the patient's condition before cardiopulmonary arrest and upon the response to therapy. ⋯ The meaning of futility may be understood in a different way, but always the ethical principles must be considered: beneficence, maleficence, social justice and autonomy of the patient. In burn medicine, there are different factors encouraging the DNR orders, withheld and withdrawn treatment. This dilemma might be decided only by an interdisciplinary conference.