Clinics in plastic surgery
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This article attempts to predict the federal government's response to the cost of burn care in the 1990s by examining the explosive growth of health care costs in the 1980s and the impact that this had on hospitals with burn centers. The Prospective Payment System (PPS) was enacted in 1983, which limited the government's liability to hospitals by effectively capping the amount of federal dollars in the system. The inequities of the classification of burn patients by the PPS is discussed and a proposal for modification is outlined.
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Recent improvements in the mortality rates of burned patients are attributed to the expansion of specialized burn centers. Satellite treatment areas with trained personnel need to be developed, located away from the burn center, and efforts should be made to increase the number of patient programs at existing burn centers. In addition, studies need to be conducted on cost consequences, hypertrophic scarring, peripheral and central nervous system involvement, musculoskeletal changes, sleep deprivation, and the comparison of various treatment techniques to determine what protocols provide the best treatment outcome.
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Splints, exercise, traction, and compression garments are commonly accepted methods to minimize disabling scar formation. Although burn rehabilitation treatment has improved over the past 10 years, there is still no overnight cure for scars and contracture. The extent and depth of the burn injury, emotional strength and patience of the burn victim, and support systems available play an important role in scar treatment. ⋯ The treatments reviewed are specific for scar contracture limiting function of the upper body. Although they were presented as treatment of neck, mouth, axilla, and hand contractures, many of the principles and materials can be used after burn reconstruction of the lower extremities. Regardless of the area treated, assessment of patients is important to determine their specific needs in splint design.
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No ideal or all-purpose method of scar control exists. Successful management of hypertrophic scar depends on early and aggressive treatment. ⋯ The use of pressure is only one segment of the total rehabilitation of the thermally injured patient. Its use in conjunction with exercise, splinting, positioning, and reconstructive surgery allows an optimal level of function and cosmesis to be achieved.