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Biomedical subjects

A J Platt

Publications and source records attributed to A J Platt.

13 recordsLinked to original sources
PubMed1998

Is there still a place for comfort care in severe burns.

Successive improvements in burn care have steadily increased the survivability of many major burn injuries, however for some patients with the most severe injuries comfort care rather than active resuscitation has been seen as the correct course of action. A survey of UK burn unit directors by postal questionnaire sought details of current practice regarding comfort care, the factors involved in the decision making process and their response to eight hypothetical case histories. An 84% response to the survey showed that units would, on average, actively resuscitate thirty-seven patients a year and administer comfort care three times per year. Opinion was often divided regarding the decision to resuscitate in the cases presented.

Adult↗
PubMed1997

Temperature profiles during resuscitation predict survival following burns complicated by smoke inhalation injury.

Temperature and resuscitation profiles of 15 non-survivors were compared with matched survivors of major burns. All patients were intubated and ventilated for smoke inhalation injury, survived more than 3 days postburn and had a cutaneous burn greater than 15 per cent of the body surface area (mean 32.3 +/- 11.0 per cent SD). Cases were matched for similar ages (within 10 years) and total body surface area burn (within 10 per cent). The rate of core temperature rise following admission to the burn unit was significantly greater in survivors (mean 0.46 +/0 0.18 degree C/h) compared with matched non-survivors (mean 0.30 +/- 0.15 degrees C/h; p < 0.01). Core temperature increased at a rate of 0.27 degrees C/h or greater in all survivors, whereas 7 non-survivors raised their core temperature at a rate less than this. The rate of skin temperature rise was also significantly greater in the survivors (mean 1.35 +/- 0.91 degrees C/h) compared with matched non-survivors (mean 0.63 +/- 0.43 degrees C/h, p < 0.01). In 13/15 survivors, the skin temperature increased at a rate of 0.6 degree C/h or greater, whereas in 8/15 non-survivors skin temperature increased at a rate less than this. There was a negative relationship between initial core temperature and delay from time of burn to admission to the burns unit in non-survivors (correlation coefficient = -0.92; p < 0.01), whereas there was no effect of delay in the survivors. These findings suggest that patients with a high mortality probability can be detected early in their clinical course by means of temperature profiles.

Adult↗
PubMed1997

A new method for the assessment of suturing ability.

A new method for the formal assessment of surgical ability in simple wound closure is presented. Suture tension and accuracy of placement are measured indirectly in a standardized rig using Lyofoam as a skin substitute. This method has been used to assess a group of seven junior hospital doctors before and after instruction in a workshop setting. Formal instruction reduced suture tension by an average of 30.3% for the group as a whole (P < 0.01). Standard deviation in inter-suture distance was reduced by an average of 39.4% (P < 0.05), suggesting increased accuracy of suture placement following teaching. On the basis of this study, it appears that those involved in suturing wounds would benefit from postgraduate instruction in workshop setting early in their career.

Clinical Competence↗
PubMed1996

Free tissue transfer in the management of burns.

Although the majority of burn wounds undergoing surgical treatment require only excision with split-skin grafting, the introduction of free microvascular tissue transfer has allowed for the preservation of otherwise unsalvageable deep burn injuries and the resurfacing of burn scars in areas with no available local tissue. A total of 1699 patients with burn injuries were admitted to the Burns Unit in Newcastle upon Tyne in the 5 years 1989-1993. During this period 604 patients (35.5 per cent) required surgical treatment of their burns. Of these patients 582 (96.4 per cent) underwent excision of their burns with split-skin grafting, 13 (2.1 per cent) of the patients required local flap cover and nine patients (1.5 per cent) had free tissue transfer. Free flap loss in this study was 22 per cent in burns patients as compared to only 3 per cent in patients undergoing microsurgical reconstruction for other reasons.

Adolescent↗
PubMed1996

A comparative study of silicone net dressing and paraffin gauze dressing in skin-grafted sites.

This prospective randomized study has compared paraffin gauze dressing (n = 19) with silicone net dressing (Mepitel, n = 19) applied as the first layer to newly grafted burn wounds. At the first postoperative dressing visual analogue pain scores were greater in the paraffin gauze group (mean 4.4) than in the silicone net group (mean 1.4, P < 0.01). All patients in the paraffin gauze group experienced some degree of pain on dressing removal, whereas 53 per cent of patients in the silicone net group experienced no pain. Overall graft take was similar in both groups, (silicone net mean 95.7 per cent; paraffin gauze mean 94.3 per cent). Dressings were harder to remove in the paraffin gauze group as assessed by a simple scoring system (P < 0.001). In conclusion silicone net dressing confers advantages over conventional paraffin gauze, especially in reducing patient discomfort during dressing changes.

Adolescent↗
PubMed1995

Aneurysmal bone cyst of the capitate.

Aneurysmal bone cysts are uncommon in the hand. An aneurysmal bone cyst in the capitate of a 16-year-old girl is presented, and 32 previously recorded cases are discussed.

Adolescent↗
PubMed1995

Post-operative infection following hand surgery. Guidelines for antibiotic use.

An audit was designed to analyse the risk factors for developing post-operative wound infection following hand surgery. 249 consecutive patients were prospectively entered into the study. 236 (95%) patients were available for follow-up. Infection was diagnosed by clinical criteria. There was an infection rate of 10.7% in elective operations and 9.7% in emergency operations. There was no significant reduction in infection rate in the elective group with the use of antibiotics (P = 0.5). In the emergency group of patients peri-operative antibiotic administration was associated with an 8.5-fold reduction in infection rate (P = 0.014). The presence of a dirty wound was associated with a 13.4-fold increase in post-operative wound infection rate (P = 0.002). A postal questionnaire of members of the British Society for Surgery of the Hand revealed a wide variation in antibiotic usage. Guidelines for antibiotic use in patients undergoing hand surgery are presented.

Adult↗